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medical microbiology > Bacteremia and Sepsis > Flashcards

Bacteremia and Sepsis Flashcards

1
Q
  • presence of viable bacteria in the blood
  • one of the most serious infections
A

Bacteremia

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2
Q

contamination of blood through phlebotomy

A

Pseudobacteremia

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3
Q

bacteremia present with the absence of physical signs/symptoms

A

Occult Bacteremia

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4
Q

prolonged Bacteremia plus clinical presentation of signs/symptoms of bacterial invasion and toxin production

A

Septicemia

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5
Q

how is septicemia diagnosed?

A

blood cultures

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6
Q

Systemic response to infection sometimes accompanied by organ involvement

A

Sepsis

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7
Q

Sepsis accompanied by hypotension

A

Septic shock

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8
Q

which bacteria produce endotoxins?

A

gram negative, mainly bacilli but some cocci

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9
Q

what affects can endotoxin have when released into the blood?

A

Disseminated intravascular coagulation – death is coming

Stops peripheral circulations and forces blood to major organs

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10
Q

how can antibiotics make sepsis worse?

A

if gram negative bacteria is lysed by wbc – endotoxin is released. Some Antibiotics are detrimental. Has toxic affects
Need antibiotics that prevent protein production and prevent multiplying. Not use broad spectrum

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11
Q

what are common disease causes of sepsis?

A

Meningitis. Pneumonia. Urinary tract infection.
Osteomyelitis. Gut related infection.
Cellulitis and necrotising fasciitis

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12
Q

what the common mechanical disruption of host defenses causing sepsis?

A

Intravascular catheters
Urinary catheters

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13
Q

how do these things lead to septicemia?

A

Previous infections migrate into the blood stream

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14
Q

Primary bacteremia

A
  • arises from endovascular source
  • i.e., patient with pneumonia gets into bloodstream
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15
Q

Secondary bacteremia

A
  • arises from extravascular source
  • i.e., catheters
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16
Q

Classification of Bacteremia by site of origin

A

Primary Bacteremia
Secondary Bacteremia
Bacteremia of Unknown Origin

17
Q

Classification of Bacteremia by Causative agent

A
  • Gram-positive bacteremia: S. pneumo, S. aureus, Enterococcus faecium
  • Gram-negative bacteremia: E. coli, P. aeruginosa, B. frag
  • Polymicrobial bacteremia (IV drug use, burns, GI sources)
18
Q

Classification of Bacteremia by Place of Acquisition

A
  • Community-acquired bacteremia: S. pneumo
  • Nosocomial bacteremia: P. aeruginosa, Enterococcus
19
Q

Classification of Bacteremia by Duration

A
  • Transient bacteremia: result of procedure, caused by flora
  • Intermittent bacteremia: result of abscess (meningococcemia, gonococcemia)
  • Continuous bacteremia: intravascular source, continuously present, i.e., prosthetic heart valve
20
Q

Bacteremia (risk factors)

A
  • immune competency
  • increased use of invasive procedures increases risk
  • age (very young and old at higher risk)
  • antimicrobials: broad spectrum reduce normal flora
21
Q

Bacteremia (causative agents)

A
  • in the past: E. coli, P. aeruginosa, S. aureus, CoNS, Enterococcus
  • recently: fungemias (Candida albicans, malassesia furfur)
22
Q
  • associated with community-acquired illness
  • Optochin S, Sodium desoxycholate +
  • capsule, IgA protease
A

S. pneumoniae

23
Q
  • UTI’s, bacteremia, other infections
  • catalse +, coagulase +
  • hyaluronidase, latex +
A

S. aureus

24
Q
  • blue/green on MAC
  • oxidase +, glucose oxidizer, 42C
  • capsule, motile, associated with nosocomial infection
  • CF patients pneumonia
  • Hot tub syndrome
A

P. aeruginosa

25
Q
  • # 1 colon flora, anaerobic
  • tolerates bile
  • vancomycin, kanamycin, colistin resistant
A

B. fragilis

26
Q

Antimicrobial resistant bacteremia agents

A
  • MRSA
  • VRE (Vancomycin-resistant Enterococcus)
  • ESBL (Extended spectrum beta lactamases)
27
Q

Vaccine reduction of bacteremia

A

Hib and S. pneumoniae vaccines

28
Q

Bateremia (pathogenesis)

A
  • Disruption of skin or mucosa gives bacteria access to microvasculature
  • Complications are metastatic infection (infection to multiple sites) and septic shock
29
Q

Clinical syndromes associated with bacteremia

A
  • Catheter-related bloodstream infections: S. epi, Enterococcus, S. aureus
  • UTI’s: E. coli, common in elderly
  • Pneumonias: S. pneumo, H. flu, S. aureus, P. aeruginosa
  • Intraabdominal infections: primary and secondary peritonitis (E. coli, Kleb. pneumo, Enterococcus)
  • Skin infections: bed ridden patients and diabetics
  • Infective endocarditis: CoNS, Viridans strep, S. aureus
  • Musculoskeletal infections: bone capillaries, prosthetic joints
30
Q

Bacteremia (Symptoms/Lab findings)

A
  • Shaking, chills, fever, hypotheremia
  • Thrombocytopenia, Leukocytosis or Leukopenia, Lactic acidosis, hypoglycemia or hyperglycemia
  • Abnormal liver function tests
  • coagulopathy
  • DIC, elevated C-reactive protein, haptoglobin, fibrinogen
31
Q

Blood culture contaminants

A
  • CoNS, Corynebacterium, Bacillus, alpha hemolytic strep, Propionibacterium acnes
  • skin flora contamination is expected (2-3%)
  • should be < 3%, from one site
32
Q

Blood Culture Collection (other concerns)

A
  • 3 collections are recommended
  • ideally collected before temperature rise in intermittent
  • single blood cultures are not acceptable
33
Q

Bacteremias that must be followed with Blood Cultures

A
  • infective endocarditis
  • S. aureus bacteremia
34
Q

Blood culture medium

A
  • Nutrient broth with SPS (anticoagulant)
  • incubate at 37C for 5 days
35
Q

BACTEC

A
  • automated method
  • measures CO2 production from microbe metabolism
36
Q

BacT/ALERT

A
  • automated method
  • measures CO2 derived pH changes by colorimetric sensor

medical microbiology (29 decks)

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