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by Paul M. Maggio, MD, MBA, Carla Carvalho, MD, MPH

Bacteremia is the presence of bacteria in the bloodstream (see also Occult Bacteremia).

  • Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections (such as pneumonia or a urinary tract infection).

  • Having an artificial joint or heart valve or having heart valve abnormalities increases the risk that bacteremia will persist or cause problems.

  • Bacteremia usually causes no symptoms, but sometimes bacteria accumulate in certain tissues or organs and cause serious infections.

  • People at high risk of complications from bacteremia are given antibiotics before certain dental and medical procedures.

Usually, bacteremia, particularly if it occurs during ordinary activities, does not cause infections because bacteria typically are present only in small numbers and are rapidly removed from the bloodstream by the immune system. However, if bacteria are present long enough and in large enough numbers, particularly in people who have a weakened immune system, bacteremia can lead to other infections and sometimes trigger a serious bodywide response called sepsis.

Bacteria that are not removed by the immune system may accumulate in various places throughout the body, causing infections there, as in the following:

In bacteremia, bacteria tend to lodge and collect on certain body structures, such as abnormal heart valves. Bacteria are particularly likely to collect on any artificial material present in the body, such as intravenous catheters and artificial (prosthetic) joints and heart valves. These collections (colonies) of bacteria may remain attached to the sites and continuously or periodically release bacteria into the bloodstream.

Causes of Bacteremia

Bacteremia may occur during

  • Certain ordinary activities

  • Dental or medical procedures

  • Certain bacterial infections

  • Injection of recreational drugs

Ordinary activities sometimes cause bacteremia in healthy people. For example, vigorous toothbrushing can cause bacteremia because bacteria living on the gums around the teeth are forced into the bloodstream. Bacteria may also enter the bloodstream from the intestine during digestion. Bacteremia that occurs during ordinary activities rarely leads to infections.

Dental or medical procedures can lead to bacteremia. During dental procedures (as during tooth cleaning by a dental hygienist), bacteria living on the gums may become dislodged and enter the bloodstream. Bacteremia may also occur when catheters are inserted into the bladder or tubes are inserted into the digestive tract or urinary tract. Bacteria may be present in the area where the catheter or tube has been inserted (such as the bladder or intestine). So even though sterile techniques are used, these procedures may move bacteria into the bloodstream. Surgical treatment of infected wounds, abscesses (collections of pus), and pressure sores can dislodge bacteria from the infected site, causing bacteremia.

In some bacterial infections , such as pneumonia and skin abscesses, bacteria may periodically enter the bloodstream, causing bacteremia. Many common childhood bacterial infections cause bacteremia.

Injecting recreational drugs can cause bacteremia because the needles used are usually contaminated with bacteria, and people often do not properly clean their skin.

Symptoms of Bacteremia

Usually, bacteremia that results from ordinary events, such as dental procedures, is temporary and causes no symptoms. Bacteremia that results from other conditions may cause fever. If people with bacteremia have fever, a rapid heart rate, shaking chills, low blood pressure, gastrointestinal symptoms (such as abdominal pain, nausea, vomiting, and diarrhea), rapid breathing, and/or become confused, they probably have sepsis, severe sepsis, or septic shock.

Diagnosis of Bacteremia

  • Culture of a blood sample

If bacteremia, sepsis, severe sepsis, or septic shock is suspected, doctors usually take a sample of blood so they can try to grow (culture) the bacteria in the laboratory and identify it. If needed, doctors may try to culture bacteria from other samples (such as urine or sputum).

Prevention of Bacteremia

People who are at high risk of complications due to bacteremia (such as those who have an artificial heart valve or joint or certain heart valve abnormalities) are often given antibiotics before procedures that can cause bacteremia:

  • Dental procedures

  • Surgical treatment of infected wounds

  • Insertion of bladder catheters

Antibiotics help prevent bacteremia and thus infections and sepsis from developing.

Treatment of Bacteremia

  • Antibiotics

If an infection or sepsis develops, it is treated with antibiotics.

Doctors remove sources of bacteria (such as catheters).