Bloodstream infections

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Bloodstream infections
Other namesBlood infection, toxemia, bacteremia, septicemia
Specialty Infectious diseases   OOjs UI icon edit-ltr-progressive.svg

Bloodstream infections (BSIs) are infections of blood caused by blood-borne pathogens. [1] Blood is normally a sterile environment, [2] so the detection of microbes in the blood (most commonly accomplished by blood cultures [3] ) is always abnormal. A bloodstream infection is different from sepsis, which is characterized by severe inflammatory or immune responses of the host organism to pathogens. [4]

Contents

Bacteria can enter the bloodstream as a severe complication of infections (like pneumonia or meningitis), during surgery (especially when involving mucous membranes such as the gastrointestinal tract), or due to catheters and other foreign bodies entering the arteries or veins (including during intravenous drug abuse). [5] Transient bacteremia can result after dental procedures or brushing of teeth. [6]

Bacteremia can have several important health consequences. Immune responses to the bacteria can cause sepsis and septic shock, which have high mortality rates. [7] Bacteria can also spread via the blood to other parts of the body (which is called hematogenous spread), causing infections away from the original site of infection, such as endocarditis or osteomyelitis.[ citation needed ] Treatment for bacteremia is with antibiotics, and prevention with antibiotic prophylaxis can be given in high risk situations. [8]

Signs and symptoms

Bacteremia is typically transient and is quickly removed from the blood by the immune system. [6]

Bacteremia frequently evokes a response from the immune system called sepsis, which consists of symptoms such as fever, chills, and hypotension. [9] Severe immune responses to bacteremia may result in septic shock and multiple organ dysfunction syndrome , [9] which are potentially fatal.

Types

Based on type of causative microbe, bloodstream infections are of many types:

Type of blood-borne infectionCausative microbeDescriptionExamples
Bacteremias Bacteria Bacteremia, in the strictest sense, refers to presence of viable bacteria in the blood. Asymptomatic bacteremia can occur in normal daily activities such as conducting oral hygiene and after minor medical procedures. In a healthy person, these clinically benign infections are transient and cause no further sequelae. However, when immune response mechanisms fail or become overwhelmed, bacteremia becomes a bloodstream infection that can evolve into many clinical spectrums and is differentiated as septicemia. [10]
Viremias Viruses Viremia is a medical condition where viruses enter the bloodstream and hence have access to the rest of the body. It is similar to bacteremia , a condition where bacteria enter the bloodstream. [11] The name comes from combining the word "virus" with the Greek word for "blood" (haima). It usually lasts for 4 to 5 days in the primary condition.
Fungemias Fungi Fungemia is the presence of fungi or yeasts in the blood. The most common type, also known as candidemia, candedemia, or systemic candidiasis , is caused by Candida species; candidemia is also among the most common bloodstream infections of any kind. [12] Infections by other fungi, including Saccharomyces , Aspergillus (as in aspergillemia, also called invasive aspergillosiis) and Cryptococcus , are also called fungemia. It is most commonly seen in immunosuppressed or immunocompromised patients with severe neutropenia, cancer patients, or in patients with intravenous catheters. Candidemia, aspergillemia (invasive aspergillosis)
Protozoemia
(blood-borne protozoal infections)		 Protozoa Protozoan infections are parasitic diseases caused by organisms formerly classified in the kingdom Protozoa. These organisms are now classified in the supergroups Excavata, Amoebozoa, Harosa (SAR supergroup), and Archaeplastida. They are usually contracted by either an insect vector or by contact with an infected substance or surface. [13]

Causes

Bacteria can enter the bloodstream in a number of different ways. However, for each major classification of bacteria (gram negative, gram positive, or anaerobic) there are characteristic sources or routes of entry into the bloodstream that lead to bacteremia. Causes of bacteremia can additionally be divided into healthcare-associated (acquired during the process of receiving care in a healthcare facility) or community-acquired (acquired outside of a health facility, often prior to hospitalization).[ citation needed ]

Gram positive bacteremia

Gram positive bacteria are an increasingly important cause of bacteremia. [14] Staphylococcus, streptococcus, and enterococcus species are the most important and most common species of gram-positive bacteria that can enter the bloodstream. These bacteria are normally found on the skin or in the gastrointestinal tract.[ citation needed ]

Staphylococcus aureus is the most common cause of healthcare-associated bacteremia in North and South America and is also an important cause of community-acquired bacteremia. [15] Skin ulceration or wounds, respiratory tract infections, and IV drug use are the most important causes of community-acquired staph aureus bacteremia. In healthcare settings, intravenous catheters, urinary tract catheters, and surgical procedures are the most common causes of staph aureus bacteremia. [16]

There are many different types of streptococcal species that can cause bacteremia. Group A streptococcus (GAS) typically causes bacteremia from skin and soft tissue infections. [17] Group B streptococcus is an important cause of bacteremia in neonates, often immediately following birth. [18] Viridans streptococci species are normal bacterial flora of the mouth. Viridans strep can cause temporary bacteremia after eating, toothbrushing, or flossing. [18] More severe bacteremia can occur following dental procedures or in patients receiving chemotherapy. [18] Finally, Streptococcus bovis is a common cause of bacteremia in patients with colon cancer. [19]

Enterococci are an important cause of healthcare-associated bacteremia. These bacteria commonly live in the gastrointestinal tract and female genital tract. Intravenous catheters, urinary tract infections and surgical wounds are all risk factors for developing bacteremia from enterococcal species. [20] Resistant enterococcal species can cause bacteremia in patients who have had long hospital stays or frequent antibiotic use in the past (see antibiotic misuse). [21]

Gram negative bacteremia

Gram negative bacterial species are responsible for approximately 24% of all cases of healthcare-associated bacteremia and 45% of all cases of community-acquired bacteremia. [22] [23] In general, gram negative bacteria enter the bloodstream from infections in the respiratory tract, genitourinary tract, gastrointestinal tract, or hepatobiliary system. Gram-negative bacteremia occurs more frequently in elderly populations (65 years or older) and is associated with higher morbidity and mortality in this population. [24] E.coli is the most common cause of community-acquired bacteremia accounting for approximately 75% of cases. [25] E.coli bacteremia is usually the result of a urinary tract infection. Other organisms that can cause community-acquired bacteremia include Pseudomonas aeruginosa , Klebsiella pneumoniae , and Proteus mirabilis . Salmonella infection, despite mainly only resulting in gastroenteritis in the developed world, is a common cause of bacteremia in Africa. [26] It principally affects children who lack antibodies to Salmonella and HIV+ patients of all ages. [27]

Among healthcare-associated cases of bacteremia, gram negative organisms are an important cause of bacteremia in the ICU. [28] Catheters in the veins, arteries, or urinary tract can all create a way for gram negative bacteria to enter the bloodstream. [17] Surgical procedures of the genitourinary tract, intestinal tract, or hepatobiliary tract can also lead to gram negative bacteremia. [17] Pseudomonas and Enterobacter species are the most important causes of gram negative bacteremia in the ICU. [28]

Bacteremia risk factors

There are several risk factors that increase the likelihood of developing bacteremia from any type of bacteria. [14] [29] These include:

Mechanism

Bacteremia can travel through the blood stream to distant sites in the body and cause infection (hematogenous spread). Hematogenous spread of bacteria is part of the pathophysiology of certain infections of the heart (endocarditis), structures around the brain (meningitis), and tuberculosis of the spine (Pott's disease). Hematogenous spread of bacteria is responsible for many bone infections (osteomyelitis). [31]

Prosthetic cardiac implants (for example artificial heart valves) are especially vulnerable to infection from bacteremia. [32] Prior to widespread use of vaccines, occult bacteremia was an important consideration in febrile children that appeared otherwise well. [33]

Diagnosis

Bacteremia is most commonly diagnosed by blood culture, in which a sample of blood drawn from the vein by needle puncture is allowed to incubate with a medium that promotes bacterial growth. [34] If bacteria are present in the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected.[ citation needed ]

Any bacteria that incidentally find their way to the culture medium will also multiply. For example, if the skin is not adequately cleaned before needle puncture, contamination of the blood sample with normal bacteria that live on the surface of the skin can occur. [35] For this reason, blood cultures must be drawn with great attention to sterile process. The presence of certain bacteria in the blood culture, such as Staphylococcus aureus, Streptococcus pneumoniae , and Escherichia coli almost never represent a contamination of the sample. On the other hand, contamination may be more highly suspected if organisms like Staphylococcus epidermidis or Cutibacterium acnes grow in the blood culture.[ citation needed ]

Two blood cultures drawn from separate sites of the body are often sufficient to diagnose bacteremia. [35] Two out of two cultures growing the same type of bacteria usually represents a real bacteremia, particularly if the organism that grows is not a common contaminant. [35] One out of two positive cultures will usually prompt a repeat set of blood cultures to be drawn to confirm whether a contaminant or a real bacteremia is present. [35] The patient's skin is typically cleaned with an alcohol-based product prior to drawing blood to prevent contamination. [35] Blood cultures may be repeated at intervals to determine if persistent—rather than transient—bacteremia is present. [35]

Prior to drawing blood cultures, a thorough patient history should be taken with particular regard to presence of both fevers and chills, other focal signs of infection such as in the skin or soft tissue, a state of immunosuppression, or any recent invasive procedures. [34]

Ultrasound of the heart is recommended in all those with bacteremia due to Staphylococcus aureus to rule out infectious endocarditis. [36]

Definition

Bacteremia is the presence of bacteria in the bloodstream that are alive and capable of reproducing. It is a type of bloodstream infection. [37] Bacteremia is defined as either a primary or secondary process. In primary bacteremia, bacteria have been directly introduced into the bloodstream. [38] Injection drug use may lead to primary bacteremia. In the hospital setting, use of blood vessel catheters contaminated with bacteria may also lead to primary bacteremia. [38] Secondary bacteremia occurs when bacteria have entered the body at another site, such as the cuts in the skin, or the mucous membranes of the lungs (respiratory tract), mouth or intestines (gastrointestinal tract), bladder (urinary tract), or genitals. [39] Bacteria that have infected the body at these sites may then spread into the lymphatic system and gain access to the bloodstream, where further spread can occur. [40]

Bacteremia may also be defined by the timing of bacteria presence in the bloodstream: transient, intermittent, or persistent. In transient bacteremia, bacteria are present in the bloodstream for minutes to a few hours before being cleared from the body, and the result is typically harmless in healthy people. [41] This can occur after manipulation of parts of the body normally colonized by bacteria, such as the mucosal surfaces of the mouth during tooth brushing, flossing, or dental procedures, [42] or instrumentation of the bladder or colon. [37] Intermittent bacteremia is characterized by periodic seeding of the same bacteria into the bloodstream by an existing infection elsewhere in the body, such as an abscess, pneumonia, or bone infection, followed by clearing of that bacteria from the bloodstream. This cycle will often repeat until the existing infection is successfully treated. [37] Persistent bacteremia is characterized by the continuous presence of bacteria in the bloodstream. [37] It is usually the result of an infected heart valve, a central line-associated bloodstream infection (CLABSI), an infected blood clot (suppurative thrombophlebitis), or an infected blood vessel graft. [37] Persistent bacteremia can also occur as part of the infection process of typhoid fever, brucellosis, and bacterial meningitis. Left untreated, conditions causing persistent bacteremia can be potentially fatal. [18]

Bacteremia is clinically distinct from sepsis, which is a condition where the blood stream infection is associated with an inflammatory response from the body, often causing abnormalities in body temperature, heart rate, breathing rate, blood pressure, and white blood cell count. [43]

Treatment

The presence of bacteria in the blood almost always requires treatment with antibiotics. This is because there are high mortality rates from progression to sepsis if antibiotics are delayed. [28]

The treatment of bacteremia should begin with empiric antibiotic coverage. Any patient presenting with signs or symptoms of bacteremia or a positive blood culture should be started on intravenous antibiotics. [24] The choice of antibiotic is determined by the most likely source of infection and by the characteristic organisms that typically cause that infection. Other important considerations include the patient's history of antibiotic use, the severity of the presenting symptoms, and any allergies to antibiotics. [44] Empiric antibiotics should be narrowed, preferably to a single antibiotic, once the blood culture returns with a particular bacteria that has been isolated. [44]

Gram positive bacteremia

The Infectious Disease Society of America (IDSA) recommends treating uncomplicated methicillin resistant staph aureus (MRSA) bacteremia with a 14-day course of intravenous vancomycin. [45] Uncomplicated bacteremia is defined as having positive blood cultures for MRSA, but having no evidence of endocarditis, no implanted prostheses, negative blood cultures after 2–4 days of treatment, and signs of clinical improvement after 72 hrs. [45]

The antibiotic treatment of choice for streptococcal and enteroccal infections differs by species. However, it is important to look at the antibiotic resistance pattern for each species from the blood culture to better treat infections caused by resistant organisms. [14]

Gram negative bacteremia

The treatment of gram negative bacteremia is also highly dependent on the causative organism. Empiric antibiotic therapy should be guided by the most likely source of infection and the patient's past exposure to healthcare facilities. [46] In particular, a recent history of exposure to a healthcare setting may necessitate the need for antibiotics with pseudomonas aeruginosa coverage or broader coverage for resistant organisms. [46] Extended generation cephalosporins such as ceftriaxone or beta lactam/beta lactamase inhibitor antibiotics such as piperacillin-tazobactam are frequently used for the treatment of gram negative bacteremia. [46]

Catheter-associated infections

For healthcare-associated bacteremia due to intravenous catheters, the IDSA has published guidelines for catheter removal. Short term catheters (in place <14 days) should be removed if bacteremia is caused by any gram negative bacteria, staph aureus, enterococci or mycobacteria. [47] Long term catheters (>14 days) should be removed if the patient is developing signs or symptoms of sepsis or endocarditis, or if blood cultures remain positive for more than 72 hours. [47]

See also

Related Research Articles

<span class="mw-page-title-main">Lemierre's syndrome</span> Medical condition

Lemierre's syndrome is infectious thrombophlebitis of the internal jugular vein. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli.

<i>Staphylococcus aureus</i> Species of Gram-positive bacterium

Staphylococcus aureus is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive for catalase and nitrate reduction and is a facultative anaerobe that can grow without the need for oxygen. Although S. aureus usually acts as a commensal of the human microbiota, it can also become an opportunistic pathogen, being a common cause of skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning. Pathogenic strains often promote infections by producing virulence factors such as potent protein toxins, and the expression of a cell-surface protein that binds and inactivates antibodies. S. aureus is one of the leading pathogens for deaths associated with antimicrobial resistance and the emergence of antibiotic-resistant strains, such as methicillin-resistant S. aureus (MRSA), is a worldwide problem in clinical medicine. Despite much research and development, no vaccine for S. aureus has been approved.

Methicillin-resistant <i>Staphylococcus aureus</i> Bacterium responsible for difficult-to-treat infections in humans

Methicillin-resistant Staphylococcus aureus (MRSA) is a group of gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths worldwide attributable to antimicrobial resistance in 2019.

<span class="mw-page-title-main">Septic arthritis</span> Medical condition

Acute septic arthritis, infectious arthritis, suppurative arthritis, pyogenic arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved, especially in neonates, younger children and immunocompromised individuals. In neonates, infants during the first year of life, and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

<span class="mw-page-title-main">Infective endocarditis</span> Medical condition

Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Signs and symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Complications may include backward blood flow in the heart, heart failure – the heart struggling to pump a sufficient amount of blood to meet the body's needs, abnormal electrical conduction in the heart, stroke, and kidney failure.

<span class="mw-page-title-main">Cefazolin</span> Antibiotic medication

Cefazolin, also known as cefazoline and cephazolin, is a first-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. Specifically it is used to treat cellulitis, urinary tract infections, pneumonia, endocarditis, joint infection, and biliary tract infections. It is also used to prevent group B streptococcal disease around the time of delivery and before surgery. It is typically given by injection into a muscle or vein.

<span class="mw-page-title-main">Hospital-acquired infection</span> Infection that is acquired in a hospital or other health care facility

A hospital-acquired infection, also known as a nosocomial infection, is an infection that is acquired in a hospital or other healthcare facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a healthcare-associated infection. Such an infection can be acquired in a hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other clinical settings. A number of dynamic processes can bring contamination into operating rooms and other areas within nosocomial settings. Infection is spread to the susceptible patient in the clinical setting by various means. Healthcare staff also spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting. Nosocomial infection tends to lack evidence that it was present when the patient entered the healthcare setting, thus meaning it was acquired post-admission.

<span class="mw-page-title-main">Bacterial pneumonia</span> Disease of the lungs

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<span class="mw-page-title-main">Boil</span> Medical condition (infection)

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Vancomycin-resistant <i>Staphylococcus aureus</i> Antibiotica resistant bacteria

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<span class="mw-page-title-main">Blood culture</span> Test to detect bloodstream infections

A blood culture is a medical laboratory test used to detect bacteria or fungi in a person's blood. Under normal conditions, the blood does not contain microorganisms: their presence can indicate a bloodstream infection such as bacteremia or fungemia, which in severe cases may result in sepsis. By culturing the blood, microbes can be identified and tested for resistance to antimicrobial drugs, which allows clinicians to provide an effective treatment.

Omphalitis of newborn is the medical term for inflammation of the umbilical cord stump in the neonatal newborn period, most commonly attributed to a bacterial infection. Typically immediately after an infant is born, the umbilical cord is cut with a small remnant left behind. Normally the stump separates from the skin within 3–45 days after birth. A small amount of pus-like material is commonly seen at the base of the stump and can be controlled by keeping the stump open to air to dry. Certain bacteria can grow and infect the stump during this process and as a result significant redness and swelling may develop, and in some cases the infection can then spread through the umbilical vessels to the rest of the body. While currently an uncommon anatomical location for infection in the newborn in the United States, it has caused significant morbidity and mortality both historically and in areas where health care is less readily available. In general, when this type of infection is suspected or diagnosed, antibiotic treatment is given, and in cases of serious complications surgical management may be appropriate.

Pseudomonas oryzihabitans is a nonfermenting yellow-pigmented, gram-negative, rod-shaped bacterium that can cause sepsis, peritonitis, endophthalmitis, and bacteremia. It is an opportunistic pathogen of humans and warm-blooded animals that is commonly found in several environmental sources, from soil to rice paddies. They can be distinguished from other nonfermenters by their negative oxidase reaction and aerobic character. This organism can infect individuals that have major illnesses, including those undergoing surgery or with catheters in their body. Based on the 16S RNA analysis, these bacteria have been placed in the Pseudomonas putida group.

<span class="mw-page-title-main">Pathogenic bacteria</span> Disease-causing bacteria

Pathogenic bacteria are bacteria that can cause disease. This article focuses on the bacteria that are pathogenic to humans. Most species of bacteria are harmless and are often beneficial but others can cause infectious diseases. The number of these pathogenic species in humans is estimated to be fewer than a hundred. By contrast, several thousand species are part of the gut flora present in the digestive tract.

<span class="mw-page-title-main">Staphylococcal infection</span> Medical condition

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<span class="mw-page-title-main">Arbekacin</span> Antibiotic

Arbekacin (INN) is a semisynthetic aminoglycoside antibiotic which was derived from kanamycin. It is primarily used for the treatment of infections caused by multi-resistant bacteria including methicillin-resistant Staphylococcus aureus (MRSA). Arbekacin was originally synthesized from dibekacin in 1973 by Hamao Umezawa and collaborators. It has been registered and marketed in Japan since 1990 under the trade name Habekacin. Arbekacin is no longer covered by patent and generic versions of the drug are also available under such trade names as Decontasin and Blubatosine.

<i>Staphylococcus capitis</i> Species of bacterium

Staphylococcus capitis is a coagulase-negative species (CoNS) of Staphylococcus. It is part of the normal flora of the skin of the human scalp, face, neck, scrotum, and ears and has been associated with prosthetic valve endocarditis, but is rarely associated with native valve infection.

<i>Staphylococcus</i> Genus of Gram-positive bacteria

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ESKAPE is an acronym comprising the scientific names of six highly virulent and antibiotic resistant bacterial pathogens including: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. The acronym is sometimes extended to ESKAPEE to include Escherichia coli. This group of Gram-positive and Gram-negative bacteria can evade or 'escape' commonly used antibiotics due to their increasing multi-drug resistance (MDR). As a result, throughout the world, they are the major cause of life-threatening nosocomial or hospital-acquired infections in immunocompromised and critically ill patients who are most at risk. P. aeruginosa and S. aureus are some of the most ubiquitous pathogens in biofilms found in healthcare. P. aeruginosa is a Gram-negative, rod-shaped bacterium, commonly found in the gut flora, soil, and water that can be spread directly or indirectly to patients in healthcare settings. The pathogen can also be spread in other locations through contamination, including surfaces, equipment, and hands. The opportunistic pathogen can cause hospitalized patients to have infections in the lungs, blood, urinary tract, and in other body regions after surgery. S. aureus is a Gram-positive, cocci-shaped bacterium, residing in the environment and on the skin and nose of many healthy individuals. The bacterium can cause skin and bone infections, pneumonia, and other types of potentially serious infections if it enters the body. S. aureus has also gained resistance to many antibiotic treatments, making healing difficult. Because of natural and unnatural selective pressures and factors, antibiotic resistance in bacteria usually emerges through genetic mutation or acquires antibiotic-resistant genes (ARGs) through horizontal gene transfer - a genetic exchange process by which antibiotic resistance can spread.

Prosthetic joint infection (PJI), also known as peri-prosthetic joint infection (PJI), is an acute, sub-acute or chronic infection of a prosthetic joint. It may occur in the period after the joint replacement or many years later. It usually presents as joint pain, erythema, joint swelling and sometimes formation of a sinus tract. PJI is estimated to occur in approximately 2% of hip and knee replacements, and up to 4% of revision hip or knee replacements. Other estimates indicate that 1.4-2.5% of all joint replacements worldwide are complicated by PJIs. The incidence is expected to rise significantly in the future as hip replacements and knee replacements become more common. It is usually caused by aerobic gram positive bacteria, such as Staph epidermidis or Staphylococcus aureus but enterococcus species, gram negative organisms and Cutibacterium are also known causes with fungal infections being a rare culprit. The definitive diagnosis is isolation of the causative organism from the synovial fluid, but signs of inflammation in the joint fluid and imaging may also aid in the diagnosis. The treatment is a combination of systemic antibiotics, debridement of infectious and necrotic tissue and local antibiotics applied to the joint space. The bacteria that usually cause prosthetic joint infections commonly form a biofilm, or a thick slime that is adherent to the artificial joint surface, thus making treatment challenging.

References

  1. ↑ Viscoli, C (2 April 2016). "Bloodstream Infections: The peak of the iceberg". Virulence. 7 (3): 248–51. doi: 10.1080/21505594.2016.1152440 . PMC   4871637 . PMID   26890622.
  2. ↑ Ochei; et al. "Pus Abscess and Wound Drain". Medical Laboratory Science : Theory And Practice. Tata McGraw-Hill Education, 2000. p. 622.
  3. ↑ Doern, Gary (September 13, 2016). "Blood Cultures for the Detection of Bacteremia". uptodate.com. Retrieved December 1, 2016.
  4. ↑ Fan, Shu-Ling; Miller, Nancy S.; Lee, John; Remick, Daniel G. (2016-09-01). "Diagnosing sepsis - The role of laboratory medicine". Clinica Chimica Acta; International Journal of Clinical Chemistry. 460: 203–210. doi:10.1016/j.cca.2016.07.002. ISSN   1873-3492. PMC   4980259 . PMID   27387712.
  5. ↑ Sligl, Wendy; Taylor, Geoffrey; Brindley, Peter G. (2006-07-01). "Five years of nosocomial Gram-negative bacteremia in a general intensive care unit: epidemiology, antimicrobial susceptibility patterns, and outcomes". International Journal of Infectious Diseases. 10 (4): 320–325. doi: 10.1016/j.ijid.2005.07.003 . ISSN   1201-9712. PMID   16460982.
  6. 1 2 Perez-Chaparro, P. J.; Meuric, V.; De Mello, G.; Bonnaure-Mallet, M. (2011-11-01). "[Bacteremia of oral origin]". Revue de Stomatologie et de Chirurgie Maxillo-Faciale. 112 (5): 300–303. doi:10.1016/j.stomax.2011.08.012. ISSN   1776-257X. PMID   21940028.
  7. ↑ Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean-Daniel (2016-02-23). "The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 315 (8): 801–810. doi:10.1001/jama.2016.0287. ISSN   1538-3598. PMC   4968574 . PMID   26903338.
  8. ↑ Yang, Lu; Tang, Zhuang; Gao, Liang; Li, Tao; Chen, Yongji; Liu, Liangren; Han, Ping; Li, Xiang; Dong, Qiang (2016-08-01). "The augmented prophylactic antibiotic could be more efficacious in patients undergoing transrectal prostate biopsy: a systematic review and meta-analysis". International Urology and Nephrology. 48 (8): 1197–1207. doi:10.1007/s11255-016-1299-7. ISSN   1573-2584. PMID   27160220. S2CID   6566177.
  9. 1 2 Scott, Michael C. (2017-02-01). "Defining and Diagnosing Sepsis". Emergency Medicine Clinics of North America. 35 (1): 1–9. doi:10.1016/j.emc.2016.08.002. ISSN   1558-0539. PMID   27908326.
  10. ↑ Smith, David A.; Nehring, Sara M. (2023), "Bacteremia", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   28723008 , retrieved 2023-12-15
  11. ↑ Ryan KJ, Ray CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. p. 881. ISBN   978-0-8385-8529-0.
  12. ↑ "Statistics". Invasive Candidiasis. United States: Centers for Disease Control and Prevention. 13 November 2019. Retrieved 24 December 2019.
  13. ↑ Wiley, Sandman, Wood, K, J, D (2020). Prescott's Microbiology. McGraw-Hill Education.{{cite book}}: CS1 maint: multiple names: authors list (link)
  14. 1 2 3 Cervera, Carlos; Almela, Manel; Martínez-Martínez, José A.; Moreno, Asunción; Miró, José M. (2009-01-01). "Risk factors and management of Gram-positive bacteraemia". International Journal of Antimicrobial Agents. 34 (Suppl 4): S26–30. doi:10.1016/S0924-8579(09)70562-X. ISSN   1872-7913. PMID   19931813.
  15. ↑ Biedenbach, Douglas J.; Moet, Gary J.; Jones, Ronald N. (2004-09-01). "Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002)". Diagnostic Microbiology and Infectious Disease. 50 (1): 59–69. doi:10.1016/j.diagmicrobio.2004.05.003. ISSN   0732-8893. PMID   15380279.
  16. ↑ Lowy, Franklin D. (1998-08-20). "Staphylococcus aureus Infections". New England Journal of Medicine. 339 (8): 520–532. doi:10.1056/NEJM199808203390806. ISSN   0028-4793. PMID   9709046.
  17. 1 2 3 Schwartz, Brian (2016). Current Medical Diagnosis and Treatment 2017. New York: McGraw Hill. pp. Chapter 33. ISBN   978-1-25-958511-1.
  18. 1 2 3 4 Cohen-Poradosu, Ronit (2015). Harrison's Principles of Internal Medicine 19th Edition. New York: McGraw Hill. pp. Chapter 201. ISBN   978-0-07-180215-4.
  19. ↑ Mayer, Robert (2015). Harrison's Principles of Internal Medicine 19th Edition. New York: McGraw Hill. pp. Chapter 110. ISBN   978-0-07-180215-4.
  20. ↑ Arias, Cesar (2015). Harrison's Principles of Internal Medicine 19th Edition. New York: McGraw Hill. pp. Chapter 174. ISBN   978-0-07-180215-4.
  21. ↑ Kasper, Dennis (2015). Harrison's Manual of Medicine. New York: McGraw Hill. pp. Chapter 87. ISBN   978-0-07-182852-9.
  22. ↑ Gaynes, Robert; Edwards, Jonathan R.; National Nosocomial Infections Surveillance System (2005-09-15). "Overview of nosocomial infections caused by gram-negative bacilli". Clinical Infectious Diseases. 41 (6): 848–854. doi: 10.1086/432803 . ISSN   1537-6591. PMID   16107985.
  23. ↑ Diekema, D. J.; Beekmann, S. E.; Chapin, K. C.; Morel, K. A.; Munson, E.; Doern, G. V. (2003-08-01). "Epidemiology and outcome of nosocomial and community-onset bloodstream infection". Journal of Clinical Microbiology. 41 (8): 3655–3660. doi:10.1128/JCM.41.8.3655-3660.2003. ISSN   0095-1137. PMC   179863 . PMID   12904371.
  24. 1 2 High, Kevin (2017). Geriatric Medicine and Gerontology 7th Edition. New York: McGraw Hill. pp. Chapter 125. ISBN   978-0-07-183345-5.
  25. ↑ Luzzaro, F.; Viganò, E. F.; Fossati, D.; Grossi, A.; Sala, A.; Sturla, C.; Saudelli, M.; Toniolo, A.; AMCLI Lombardia Hospital Infectious Study Group (2002-12-01). "Prevalence and drug susceptibility of pathogens causing bloodstream infections in northern Italy: a two-year study in 16 hospitals". European Journal of Clinical Microbiology & Infectious Diseases. 21 (12): 849–855. doi:10.1007/s10096-002-0837-7. ISSN   0934-9723. PMID   12525919. S2CID   13043807.
  26. ↑ Deen, Jacqueline; von Seidlein, Lorenz; Andersen, Finn; Elle, Nelson; White, Nicholas J.; Lubell, Yoel (2012-06-01). "Community-acquired bacterial bloodstream infections in developing countries in south and southeast Asia: a systematic review". The Lancet. Infectious Diseases. 12 (6): 480–487. doi:10.1016/S1473-3099(12)70028-2. ISSN   1474-4457. PMID   22632186.
  27. ↑ Kurtz, Jonathan R; Goggins, J. Alan; McLachlan, James B. (October 2017). "Salmonella infection: Interplay between the bacteria and host immune system". Immunology Letters. 190: 42–50. doi:10.1016/j.imlet.2017.07.006. PMC   5918639 . PMID   28720334.
  28. 1 2 3 Peleg, Anton Y.; Hooper, David C. (2010-05-13). "Hospital-Acquired Infections Due to Gram-Negative Bacteria". The New England Journal of Medicine. 362 (19): 1804–1813. doi:10.1056/NEJMra0904124. ISSN   0028-4793. PMC   3107499 . PMID   20463340.
  29. ↑ Graff, Larissa R.; Franklin, Kristal K.; Witt, Lana; Cohen, Neal; Jacobs, Richard A.; Tompkins, Lucy; Guglielmo, B. Joseph (2002-02-15). "Antimicrobial therapy of gram-negative bacteremia at two university-affiliated medical centers". The American Journal of Medicine. 112 (3): 204–211. doi:10.1016/s0002-9343(01)01092-0. ISSN   0002-9343. PMID   11893347.
  30. ↑ Brigden, M. L. (2001-02-01). "Detection, education and management of the asplenic or hyposplenic patient". American Family Physician. 63 (3): 499–506, 508. ISSN   0002-838X. PMID   11272299.
  31. ↑ Agarwal, Anil; Aggarwal, Aditya N. (2016-08-01). "Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis". Indian Journal of Pediatrics. 83 (8): 817–824. doi:10.1007/s12098-015-1806-3. ISSN   0973-7693. PMID   26096866. S2CID   1561868.
  32. ↑ Guay, David R. (2012-02-01). "Antimicrobial prophylaxis in noncardiac prosthetic device recipients". Hospital Practice. 40 (1): 44–74. doi:10.3810/hp.2012.02.947. ISSN   2154-8331. PMID   22406882. S2CID   10854052.
  33. ↑ "UpToDate". www.uptodate.com.
  34. 1 2 Coburn, Bryan; Morris, Andrew M.; Tomlinson, George; Detsky, Allan S. (2012-08-01). "Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?". JAMA. 308 (5): 502–11. doi:10.1001/jama.2012.8262. ISSN   0098-7484. PMID   22851117.
  35. 1 2 3 4 5 6 Hall, Keri K.; Lyman, Jason A. (2016-12-16). "Updated Review of Blood Culture Contamination". Clinical Microbiology Reviews. 19 (4): 788–802. doi:10.1128/CMR.00062-05. ISSN   0893-8512. PMC   1592696 . PMID   17041144.
  36. ↑ Holland, TL; Arnold, C; Fowler VG, Jr (1 October 2014). "Clinical management of Staphylococcus aureus bacteremia: a review". JAMA. 312 (13): 1330–41. doi:10.1001/jama.2014.9743. PMC   4263314 . PMID   25268440.
  37. 1 2 3 4 5 Seifert, Harald (2009-05-15). "The Clinical Importance of Microbiological Findings in the Diagnosis and Management of Bloodstream Infections". Clinical Infectious Diseases. 48 (Supplement 4): S238–S245. doi: 10.1086/598188 . ISSN   1058-4838. PMID   19374579.
  38. 1 2 "IDP200 Pathophysiology of Infectious Diseases, Fall 2004/2005 - Tufts OpenCourseWare". ocw.tufts.edu. Retrieved 2016-12-07.
  39. ↑ Medical Microbiology, 27e. New York: McGraw-Hill Education. 2016. pp. Chapter 9. ISBN   9780-0-71-82498-9 – via accessmedicine.mhmedical.com/content.aspx?bookid=1551&Sectionid=94106209.
  40. ↑ Sherris Medical Microbiology, 6e. New York: McGraw-Hill. 2014. pp. Infectious Diseases: Syndromes and Etiologies. ISBN   9780-0-7-181821-6 – via accessmedicine.mhmedical.com/content.aspx?bookid=1020&Sectionid=56968846.
  41. ↑ Cohen-Poradosu, Ronit (2015). Harrison's Principles of Internal Medicine, 19e. New York: McGraw-Hill. pp. Chapter 201. ISBN   978-0-07-180215-4 – via accessmedicine.mhmedical.com/content.aspx?bookid=1130&Sectionid=79736907.
  42. ↑ Forner, Lone; Larsen, Tove; Kilian, Mogens; Holmstrup, Palle (2006-06-01). "Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation". Journal of Clinical Periodontology. 33 (6): 401–407. doi:10.1111/j.1600-051X.2006.00924.x. ISSN   1600-051X. PMID   16677328.
  43. ↑ Kaplan, MD, Lewis (2016-08-16). "Systemic Inflammatory Response Syndrome: Background, Pathophysiology, Etiology". Medscape.
  44. 1 2 Hooper, David (2016). Harrison's Principles of Internal Medicine 19th Edition. New York: McGraw Hill. pp. Chapter 170. ISBN   978-0-07-180215-4.
  45. 1 2 Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P. (2011-02-01). "Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases. 52 (3): e18–55. doi: 10.1093/cid/ciq146 . ISSN   1537-6591. PMID   21208910.
  46. 1 2 3 Russo, Thomas (2016). Harrison's Principles of Internal Medicine 19th Edition. New York: McGraw Hill. pp. Chapter 186. ISBN   978-0-07-180215-4.
  47. 1 2 Mermel, Leonard A.; Allon, Michael; Bouza, Emilio; Craven, Donald E.; Flynn, Patricia; O'Grady, Naomi P.; Raad, Issam I.; Rijnders, Bart J. A.; Sherertz, Robert J. (2009-07-01). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 49 (1): 1–45. doi:10.1086/599376. ISSN   1537-6591. PMC   4039170 . PMID   19489710.
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