(See Neonatal Sepsis; see Occult Bacteremia and Fever Without Apparent Source in Infants and Young Children.)
Bacteremia may be transient and cause no sequelae, or it may have metastatic or systemic consequences. Systemic consequences include
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Sepsis (previously referred to as systemic inflammatory response syndrome)
Etiology
Bacteremia has many possible causes, including
Gram-negative bacteremia secondary to infection usually originates in the genitourinary or gastrointestinal tract or in the skin of patients with decubitus ulcers. 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. If an infection above the diaphragm causes bacteremia, the organism is most likely a gram-positive bacillus.
Pathophysiology
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, 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 and diskitis.
Symptoms and Signs
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
If bacteremia, sepsis, or septic shock is suspected, cultures of blood and any other appropriate specimens are obtained.
Treatment
In patients with suspected bacteremia, empiric antibiotics are given after appropriate cultures 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, surgically draining any abscesses, and usually removing any internal devices that are the suspected source of bacteria.
Key Points
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Bacteremia may be transient and of no consequence or lead to metastatic focal infection or sepsis.
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Bacteremia is more common after invasive procedures, particularly those involving indwelling devices or material.
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If bacteremia is suspected, give empiric antibiotics after cultures of potential sources and blood are obtained.
