SYSEMIC INFECTIONS

SYSEMIC INFECTIONS 06/22/2020

06/22/2020

1)
1) Bacteremia:
Bacteremia:

Definition // is
Definition is the
the presence of bacteria
presence of in the
bacteria in the blood.
blood.

-- Detection
Detection of
of any
any bacteria in the
bacteria in the blood
blood (blood
(blood cultures)
cultures) is
is always
always abnormal.
abnormal.
-- Bacteria
Bacteria can
can enter
enter the
the bloodstream
bloodstream as
as aa severe
severe complication
complication of
of
1- infections
1- infections (like
(like pneumonia
pneumonia or
or meningitis),
meningitis),
2- during
2- during surgery
surgery (especially
(especially when
when involving
involving mucous
mucous membranes
membranes such
such as
as the
the
gastrointestinal tract),
gastrointestinal tract),
3- or
3- or due
due to
to catheters
catheters and
and other
other foreign
foreign bodies entering the
bodies entering the arteries
arteries or
or veins
veins (including
(including
during intravenous
during intravenous drug
drug abuse)
abuse)
-- Transient bacteremia
Transient bacteremia can
can result
result after
after dental
dental procedures or brushing
procedures or brushing of
of teeth
teeth
Causative organism
Causative organism
-- Most
Most common
common organism
organism involves
involves in
in bacteremia
bacteremia is
is Staphylococcus
Staphylococcus aureus
aureus
-- but for each
but for each case
case of
of bacteremia there is
bacteremia there is characteristic
characteristic route
route of
of entry
entry into
into the
the
bloodstream and
bloodstream and characteristic
characteristic organism
organism for
for example
example
•* Group
Group AA streptococcus (GAS) typically
streptococcus (GAS) typically causes
causes bacteremia from skin
bacteremia from skin and
and soft
soft tissue
tissue
infections.
infections.
•* Group
Group BB streptococcus is an
streptococcus is an important
important cause
cause of
of bacteremia
bacteremia in
in neonates,
neonates,
•¢ Viridans
Viridans streptococci are normal
streptococci are normal bacterial flora of
bacterial flora of the
the mouth.
mouth. Viridans
Viridans strep
strep can
can
cause temporary
cause temporary bacteremia following dental
bacteremia following dental procedures or in
procedures or in patients receiving
patients receiving
chemotherapy.
chemotherapy.
•* streptococcus bovis is
streptococcus bovis is aa common
common cause
cause of
of bacteremia in patients
bacteremia in with colon
patients with colon cancer.
cancer.
Complication
Complication
-- Bacteria can
Bacteria can also
also spread
spread via
via the
the blood
blood to
to other
other parts of the
parts of the body (which is
body (which is called
called
hematogenous spread),
hematogenous spread), causing
causing infections
infections away
away from
from the
the original
original site
site of
of infection,
infection, such
such
as endocarditis
as endocarditis or
or osteomyelitis.
osteomyelitis.

1
 SYSEMIC INFECTIONS
SYSEMIC INFECTIONS 06/22/2020
06/22/2020

Treatment //
Treatment
-- Bacteremia
Bacteremia is
is typically
typically transient
transient and
and is
is quickly
quickly removed
removed from
from the
the blood
blood by
by the
the immune
immune

system
system
-- Bacteremia
Bacteremia is
is dangerous
dangerous if
if the
the patient
patient is
is at
at risk
risk or
or has
has aa prosthesis(for example
prosthesis(for example
artificial heart
artificial heart valves)
valves)
Prevention // with
Prevention with antibiotic
antibiotic prophylaxis
prophylaxis can
can be given in
be given in high
high risk
risk situations
situations

Bacteremia risk
Bacteremia risk factors
factors
There are
There are several
several risk
risk factors
factors that
that increase
increase the
the likelihood
likelihood of
of developing
developing bacteremia
bacteremia from
from any
any
type of
type of bacteria.
bacteria. These
These include:
include:
-- HIV
HIV infection
infection
-- Diabetes
Diabetes Mellitus
Mellitus
-- Chronic
Chronic hemodialysis
hemodialysis
-- Solid
Solid organ
organ transplant
transplant
-- Stem
Stem cell
cell transplant
transplant

2)
2) Sepsis
Sepsis
-- The
The immune
immune response
response to
to the
the bacteria can cause
bacteria can cause sepsis
sepsis ,, which
which has
has aa high
high mortality
mortality rate
rate
-- This
This response includes the
response includes the following
following symptoms
symptoms :: fever, chills, and
fever, chills, and hypotension,
hypotension,
increased heart
increased heart rate,
rate, increased
increased breathing
breathing rate,
rate, and
and confusion
confusion
-- people
people with
with aa weakened immune system
weakened immune system may
may have
have no
no symptoms
symptoms of
of aa specific
specific
infection, and
infection, and the
the body
body temperature
temperature may
may be low or
be low or normal
normal instead
instead of
of having
having aa fever
fever
-- Severe
Severe sepsis
sepsis causing
causing poor
poor organ
organ function
function or
or blood
blood flow
flow producing organ dysfunction
producing organ dysfunction
syndrome ((MODS),
syndrome which are
MODS), which are potentially
potentially fatal.
fatal.
-- poor
poor blood
blood flow
flow means
means low
low blood
blood pressure, high blood
pressure, high lactate, or
blood lactate, or low
low urine output
urine output
-- Septic
Septic shock
shock is
is poor
poor blood flow due
blood flow due to
to sepsis
sepsis that
that does
does not
not improve
improve after
after fluid
fluid
replacement

2
 SYSEMIC INFECTIONS
SYSEMIC INFECTIONS 06/22/2020
06/22/2020

Systemic inflammatory
Systemic inflammatory response
response syndrome
syndrome (SIRS)
(SIRS)
SIRS is
SIRS is the
the presence
presence of
of two
two or
or more
more of
of the
the following
following (( abnormal
abnormal vital
vital signs)
signs)
1- abnormal
1- abnormal body
body temperature-----
temperature----- Hyperthermia
Hyperthermia (>(> 38°C)
38°C) or
or hypothermia
hypothermia (<
(< 36°C)
36°C)
2- abnormal
2- abnormal heart
heart rate
rate ------
------ tachycardia
tachycardia (> 90/ min,
(> 90/ min, no
no β-blockers)
B-blockers)
3- abnormal
3- abnormal respiratory
respiratory rate, or blood
rate, or gas, --------
blood gas, -------- tachypnea
tachypnea (>
(> 20/
20/ min,
min, PCO2<
PCO2<
32mmHg)
32mmHg)
4- abnormal
4- abnormal white
white blood cell count-------------->
blood cell count-------------- >12x 10°9 or
12 × 10 or<4x 10°9
< 4 × 10

Steps_of
Steps sepsis
of sepsis
1- Sepsis
1- Sepsis
e is
is SIRS
SIRS with
with aa documented
documented infection
infection

2- Severe sepsis
2- Severe sepsis
N
1

e is defined
is defined as
as sepsis
sepsis with
with sepsis-induced
sepsis-induced
organ dysfunction
organ dysfunction or
or tissue
tissue hypoperfusion
hypoperfusion SEPTIC
(manifesting as
(manifesting as hypotension,
hypotension, elevated
elevated SHOCK
lactate, or
lactate, or decreased
decreased urine output).
urine output). SEPSIS
e Severe
Severe sepsis
sepsis is
is an
an infectious
infectious disease
disease state
state
SIRS 2SIRS
associated with
associated with multiple
multiple organ
organ dysfunction
dysfunction T: >100.4F
<%6.8F
syndrome (MODS)
syndrome (MODS) RR: >20
HR: >90 t
3- Septic shock
3- Septic shock WBC: >12,000
<4,000
Confirmed
e is
is severe
severe sepsis
sepsis plus
plus persistently low blood
persistently low blood 710% bands
PCO2< 32 mmHg or suspected
pressure, despite the
pressure, despite the administration
administration of
of infection

intravenous fluids
intravenous fluids
Slides Courtesy of Curtis Merritt, D.O.

3
 SYSEMIC INFECTIONS
SYSEMIC INFECTIONS 06/22/2020
06/22/2020

3) SEPTICEMIA
3) SEPTICEMIA
Definition
Definition
-- is
is aa potentially life-threatening infection
potentially life-threatening infection in
in which
which large
large amounts
amounts of
of bacteria
bacteria are
are present in
present in
the blood,
the It is
blood, It is commonly
commonly referred
referred to
to as
as blood
blood poisoning.
poisoning.

S.N.
S.N. Bacteremia
Bacteremia Septicemia
Septicemia
1 Bacteremia is
Bacteremia is the
the simple
simple presence
presence ofof Septicemia is
Septicemia is the
the presence
presence and and multiplication
multiplication
1.
* bacteria in the blood.
bacteria in the blood. of bacteria in the blood.
of bacteria in the blood.
2 Bacteremia is
Bacteremia is not
not as
as dangerous
dangerous asas Septicemia is
Septicemia is aa potentially life-threatening
potentially life-threatening
2. Septicemia.
* — Septicemia. infection.
infection.
3 Less amount
Less amount of of bacteria
bacteria are
are present
present inin Large amounts
Large amounts of of bacteria
bacteria are are present
present in in the
the
3. blood.
* blood. blood.
blood.
This may
This may occur
occur through
through aa wound
wound or or It can
It can arise
arise from
from infections
infections throughout
throughout the the
4.
4. infection, or through a surgical procedure
infection, or through a surgical procedure body, including infections in the lungs,
body, including infections in the lungs,
or injection.
or injection. abdomen, and
abdomen, and urinary tract.
urinary tract.
5.
5. Toxins are
Toxins are not
not produced.
produced. Toxins may
Toxins may be produced by
be produced by bacteria.
bacteria.
It shows
It shows symptoms
symptoms like like chills,
chills, fever,
fever,
Bacteremia usually
Bacteremia causes no
usually causes no symptoms
symptoms or
or
6. prostration, very
prostration, very fast
fast respiration
respiration and/orand/or heart
heart
it may
it may produce mild fever.
produce mild fever.
rate.
rate.
. Lo, ‘ck
7. Itcan resolve without treatment. Untreated septicemia can
Untreated septicemia can quickly
quickly progress
progress to to
7. It can resolve without treatment.
sepsis.
sepsis.
Rapidly removed
Rapidly removed fromfrom the
the bloodstream
bloodstream by byAntibiotics will
Antibiotics will be used to
be used to treat
treat the
the bacterial
bacterial
8.
the immune
the immune system.
system. infection that
infection that is
is causing
causing septicemia.
septicemia.
Caused by
Caused Staphylococcus, Streptococcus,
by Staphylococcus, Streptococcus,
Staphylococci, are
Staphylococci, are thought
thought toto cause
cause more
more
Pseudomonas, Haemophilus, E.
Pseudomonas, Haemophilus, coli, dental
E. coli, dental
than 50%
than 50% of
of cases
cases of
of sepsis.
sepsis. Other
Other
procedures,
procedures, herpes (including herpetic
herpes (including herpetic
commonly implicated
commonly implicated bacteria include
bacteria include
9.
9. whitlow), urinary tract infections,
whitlow), urinary tract infections,
Streptococcus pyogenes,
Streptococcus pyogenes, Escherichia coli,
Escherichia coli,
peritonitis, Clostridium difficile
peritonitis, Clostridium difficile colitis,
colitis,
Pseudomonas aeruginosa, Klebsiella
Pseudomonas aeruginosa, species
Klebsiella species
intravenous drug
intravenous drug use,
use, and
and colorectal
colorectal
and even
and even Candida
Candida spp.
cancer.
cancer.