Merck Manual

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Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University

Reviewed/Revised Aug 2022 | Modified Sep 2022

Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling genitourinary or IV catheters, or after dental, gastrointestinal, genitourinary, wound-care, or other procedures. Bacteremia may cause metastatic infections, including endocarditis, especially in patients with valvular heart abnormalities. Transient bacteremia is often asymptomatic but may cause fever. Development of other symptoms usually suggests more serious infection, such as sepsis or septic shock.

Bacteremia may be transient and cause no sequelae, or it may have metastatic or systemic consequences. Systemic consequences include

Etiology of Bacteremia

Bacteremia has many possible causes, including

  • Catheterization of an infected lower urinary tract

  • Surgical treatment of an abscess or infected wound

  • Colonization of indwelling devices, especially IV and intracardiac catheters, urethral catheters, and ostomy devices and tubes

Gram-negative bacteremia secondary to infection usually originates in the genitourinary or gastrointestinal tract or in the skin of patients with decubitus ulcers Pressure Injuries Pressure injuries are areas of necrosis and often ulceration (also called pressure ulcers) where soft tissues are compressed between bony prominences and external hard surfaces. They are caused... read more Pressure Injuries . Chronically ill and immunocompromised patients have an increased risk of gram-negative bacteremia. They may also develop bacteremia with gram-positive cocci and anaerobes, and are at risk of fungemia. Staphylococcal bacteremia is common among injection drug users, patients with IV catheters, and patients with complicated skin and soft tissue infections. Bacteroides bacteremia may develop in patients with infections of the abdomen and the pelvis, particularly the female genital tract. If an infection in the abdomen causes bacteremia, the organism is most likely a gram-negative bacillus Introduction to Gram-Negative Bacilli Gram-negative bacilli are responsible for numerous diseases. Some are commensal organisms present among normal intestinal flora. These commensal organisms plus others from animal or environmental... read more . If an infection above the diaphragm causes bacteremia, the organism is most likely a gram-positive coccus or bacillus.

Pathophysiology of Bacteremia

Transient or sustained bacteremia can cause metastatic infection of the meninges or serous cavities, such as the pericardium or larger joints. Metastatic abscesses may occur almost anywhere. Multiple abscess formation is especially common with staphylococcal bacteremia.

Bacteremia may cause endocarditis Infective Endocarditis Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more Infective Endocarditis , most commonly with staphylococcal, streptococcal, or enterococcal bacteremia and less commonly with gram-negative bacteremia or fungemia. Patients with structural heart disease (eg, valvular disease, certain congenital anomalies), prosthetic heart valves, or other intravascular prostheses are predisposed to endocarditis. Staphylococci can cause bacterial endocarditis, particularly in injection drug users, and usually involving the tricuspid valve. Staphylococcus is also the most common cause of hematogenously spread vertebral osteomyelitis Osteomyelitis Osteomyelitis is inflammation and destruction of bone caused by bacteria, mycobacteria, or fungi. Common symptoms are localized bone pain and tenderness with constitutional symptoms (in acute... read more Osteomyelitis and diskitis.

Symptoms and Signs of Bacteremia

Some patients are asymptomatic or have only mild fever.

Development of symptoms such as tachypnea, shaking chills, persistent fever, altered sensorium, hypotension, and gastrointestinal symptoms (abdominal pain, nausea, vomiting, diarrhea) suggests sepsis or septic shock. Septic shock develops in 25 to 40% of patients with significant bacteremia. Sustained bacteremia may cause metastatic focal infection or sepsis.

Diagnosis of Bacteremia

Treatment of Bacteremia

  • Antibiotics

In patients with suspected bacteremia, empiric intravenous antibiotics are given after appropriate cultures of potential sources and blood are obtained. Early treatment of bacteremia with an appropriate antimicrobial regimen appears to improve survival.

Continuing therapy involves adjusting antibiotics according to the results of culture and susceptibility testing, draining any abscesses Treatment Abscesses are collections of pus in confined tissue spaces, usually caused by bacterial infection. Symptoms include local pain, tenderness, warmth, and swelling (if abscesses are near the skin... read more , and usually removing any internal devices that are the suspected source of bacteria.

Once source control is achieved and clinical improvement is observed, therapy can be completed with appropriate oral antibiotics.

Key Points

  • Bacteremia may be transient and of no consequence or lead to metastatic focal infection or sepsis.

  • Bacteremia is more common after invasive procedures, particularly those involving indwelling devices or material.

  • If bacteremia is suspected, give empiric antibiotics after cultures of potential sources and blood are obtained.

NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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