Blood Stream

Infections (BSI)
A dive into
BSI's
Learning objectives 

 Definition
  Types 

  Signs & Symptoms 

 Causative agents

 Laboratory Diagnosis 

  Treatment
     
DEFINITION

 Blood stream infection (BSI) is defined as one or more positive

blood  cultures associated with systemic signs of infection such as
fevers, chills and/or hypotension.

 Bacteria can enter the bloodstream

•  As a severe complication of infections  (like pneumonia or
       meningitis)
•  During surgery (especially  when involving  mucous  membranes
       such as the gastrointestinal tract)
•  Due to catheters and other  foreign  bodies  entering  the  arteries 
       veins (including during intravenous drug abuse) 
•  After dental procedures or brushing of teeth.
       DIFFERENCE BETWEEN BACTERIMIA AND SEPTICEMIA
 TYPES OF BSI

 Based on site of origin

• Primary BSI
• Secondary BSI

 Based on place of acquisition

• Nosocomial/Health care associated BSI

• Community acquired BSI
• Maternally acquired BSI
 SYMPTOMS OF BSI

• Fast heart rate

• Low blood pressure
• Fever or hypothermia
• Shaking or chills
• Warm or sweaty skin
• Confusion or disorientation
• Shortness of breath
• Sepsis rash
• Extreme pain or discomfort
 CAUSATIVE AGENTS

Staphylococcus aureus  E.coli

Staphylococcus epidermidis   Klebsiella pneumoniae
Streptococcus pneumoniae  Pseudomonas aeruginosa
Enterococcus spp  Salmonella
Group B streptococci  Enterobacter spp
Streptococcus pyogenes  Acinetobacter
Viridans streptococci  Haemophilus influenzae
Other agents:
 Anaerobes: Bacteroides, Fusobacterium, Clostridium spp
 Fungi: Candida, Aspergillus , Pneumocystis jirovecii, 
     Cryptococcus neoformans, Zygomycetes, Fusarium, 
     Histoplasma capsulatum.
 Viruses:  HSV, CMV, dengue, influenza, enterovirus

 Parasites: Leishmania, Trypanosoma, Babesia, Malaria, Filaria,

     Schistosoma.
 LABORATORY DIAGNOSIS
 Bacteremia can be diagnosed using a blood culture.

SPECIMEN COLLECTION.
• Blood culture specimens are usually drawn using either a needle and syringe or a
vacuum-extraction collection system that draws blood into vacuum-sealed blood
culture bottles.
 LABORATORY DIAGNOSIS

Timing

• As early as possible, after the onset of clinical symptoms.

• Before starting antimicrobial therapy.

Blood volume

• Adult-10 ml per bottle.

• Pediatric – 1-5 ml per bottle.

Number of blood culture bottles.

• 2 blood culture set (1 set is equal to 1 aerobic and 

      1 anerobic bottle)
• Endocarditis –3 sets from 3 different sites within 1-2 hours
 LABORATORY DIAGNOSIS

• Incubate at 37°C .
• Incubation times :Routine aerobic/anaerobic - 5 days .
• Endocarditis :2 weeks.
• Brucellosis/fungemia :21-28 days.

Positive cultures:
• Gram stain – To determine the morphology of the organism.
• Subculture to appropriate media.
• Perform antibiotic sensitivity testing.
 TREATMENT

 The treatment for a bloodstream infection

requires prompt use antibiotics. 
 This can help to prevent complications like sepsis from occurring.

 The length of treatment can depend on the cause and severity of

the infection. You may need to be on antibiotics for 1 to 2 weeks.