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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

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

A

Septicemia

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5
Q

Systemic response to infection sometimes accompanied by organ involvement

A

Sepsis

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6
Q

Sepsis accompanied by hypotension

A

Septic shock

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7
Q

Primary bacteremia

A
  • arises from endovascular source

- i.e., patient with pneumonia gets into bloodstream

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8
Q

Secondary bacteremia

A
  • arises from extravascular source

- i.e., catheters

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9
Q

Classification of Bacteremia by site of origin

A

Primary Bacteremia
Secondary Bacteremia
Bacteremia of Unknown Origin

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10
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)
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11
Q

Classification of Bacteremia by Place of Acquisition

A
  • Community-acquired bacteremia: S. pneumo

- Nosocomial bacteremia: P. aeruginosa, Enterococcus

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12
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
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13
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
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14
Q

Bacteremia (causative agents)

A
  • in the past: E. coli, P. aeruginosa, S. aureus, CoNS, Enterococcus
  • recently: fungemias (Candida albicans, malassesia furfur)
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15
Q
  • associated with community-acquired illness
  • Optochin S, Sodium desoxycholate +
  • capsule, IgA protease
A

S. pneumoniae

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16
Q
  • UTI’s, bacteremia, other infections
  • catalse +, coagulase +
  • hyaluronidase, latex +
A

S. aureus

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17
Q
  • blue/green on MAC
  • oxidase +, glucose oxidizer, 42C
  • capsule, motile, associated with nosocomial infection
  • CF patients pneumonia
  • Hot tub syndrome
A

P. aeruginosa

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18
Q
  • # 1 colon flora, anaerobic
  • tolerates bile
  • vancomycin, kanamycin, colistin resistant
A

B. fragilis

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19
Q

Antimicrobial resistant bacteremia agents

A
  • MRSA
  • VRE (Vancomycin-resistant Enterococcus)
  • ESBL (Extended spectrum beta lactamases)
20
Q

Vaccine reduction of bacteremia

A

Hib and S. pneumoniae vaccines

21
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
22
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
23
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
24
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
25
Q

Blood Culture Collection (amount collected)

A
  • neonates/children: < 1%
  • adults: up to 4%
  • dilution factor: 1:5 - 1:10
26
Q

Blood Culture Collection (other concerns)

A
  • 3 collections are recommended
  • ideally collected before temperature rise in intermittent
  • single blood cultures are not acceptable
27
Q

Bacteremias that must be followed with Blood Cultures

A
  • infective endocarditis

- S. aureus bacteremia

28
Q

Blood culture medium

A
  • Nutrient broth with SPS (anticoagulant)

- incubate at 37C for 5 days

29
Q

Sodium polyanethol sulfonate (SPS)

A
  • anticoagulant in blood culture bottles
  • neutralizes bactericidal activity (complement)
  • prevention of phagocytosis
  • inactivation of certain antimicrobial agents (streptomycin, gentamycin)
  • may inhibit Peptostreptoccus, N. gonorrhoeae, N. meningitidis, Gardnerella)
30
Q

Blood Culture Additives

A
  • Gelatin to counteract inhibitory action of SPS

- Antimicrobial removal device (ARD): absorbs antimicrobial

31
Q

BD Septi-Chek system

A
  • manual method

- rapid recovery of facultative bacteria and isolated colonies for ID and susceptibility

32
Q

Lysis-Centrifugation

A
  • manual method

- optimal recovery of unusually fastidious bacteria

33
Q

BACTEC

A
  • automated method

- measures CO2 production from microbe metabolism

34
Q

BacT/ALERT

A
  • automated method

- measures CO2 derived pH changes by colorimetric sensor

35
Q

Special Blood Culture Cases (Francisella)

A

add L-cystine and glucose to liquid broth

36
Q

Special Blood Culture Cases (Leptospira)

A

add 1-3 drops of SPS-blood to Fletcher’s medium, examine weekly with darkfield microscopy

37
Q

Special Blood Culture Cases (Brucella)

A
  • manual methods: hold up to 6 weeks

- automated methods: hold 10-14 days

38
Q

Special Blood Culture Cases (Nutritionally Deficient Strep)

A

require 0.001% pyridoxal HCl

39
Q

Special Blood Culture Cases (Campylobacter)

A

microaerophilic, 42C, curved GNR’s, fastidious

40
Q

Special Blood Culture Cases (Coxiella)

A
  • can’t be isolated by blood cultures
  • diagnosed by serology
  • causes Q fever
41
Q

Special Blood Culture Cases (Bartonella)

A
  • enriched media under increased CO2 for 3 weeks

- molecular methods are preferred

42
Q

Special Blood Culture Cases (HACEK Group)

A

fastidious, hold cultures and subculture to enriched media

43
Q

Special Blood Culture Cases (Mycobacteria)

A

Middlebrook based media, hold for 6 weeks

44
Q

Contaminated disinfectants

A
  • Benzalkonium chloride

- Povidone-iodine: Burkholderia cepacia

45
Q

Contamination or Pathogen

A
  • S. aureus, E. coli, Enterics, S. pneumo, P. aeruginosa, Candida are almost always true pathogens
  • CoNS, diptheroids, skin flora should be questioned
  • more than one bottle growing the same thing usually indicates significance
  • growth of skin biota in single bottle usually indicates contaminant

Microbiology (26 decks)

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