Blood Stream infections

HABEEB NATHIRA
ROLL NO. 69
4TH SEM.
Important terminologies
● Endotoxaemia is a condition when bacterial endotoxin
circulates in the blood.

● Septicaemia is a condition in which bacteria circulate and

actively multiply in the bloodstream.
● Pyaemia is essentially septicaemia with metastatic
infection.

● Bacteraemia is defined as presence of bacteria in blood

without any multiplication.
 Types of bacteremia
● TRANSIENT.

● CONTINOUS.

● INTERMITTENT.
Route of bacterial entry
Bacteria may enter the blood:

● From an infective focus or from breakage of blood vessels

adjacent to skin (normal flora).

● By introduction of contaminated material into the vascular

system directly.
 Clinical presentations
Two main categories of bloodstream
infections

● Intravascular. ● Extravascular.
Signs and symptoms of septicemia

FEVER CHILLS
 Septic Shock.
● Septic shock can be initiated by exotoxins and endotoxins.

CHARACTERISED BY
Pathophysiology of shock.
Septic shock is mediated by activated mononuclear
cells producing cytokines, such as tumour necrosis
factor and interleukins.

Gram-negative bacteria release endotoxin, which is a

lipopolysaccharide (LPS).

The core of LPS, lipid A, mediates systemic response

including fever activation of complement and certain
clotting factors.
Etiological agents of bloodstream infections.
Approach to diagnosis of bloodstream infections.
Laboratory diagnosis.
 PREPARATION OF SITE.

SPECIMEN. IDENTIFICATION.

CULTURE.
 Preparation of skin

● The skin should be prepared with 70% isopropyl alcohol

before collecting the blood sample.
 Specimen
● For infants and small children, 1-5 ml of blood is drawn for
culture.

● In adults, 7-10 ml of blood per culture is recommended.

● In patients with suspected infective endocarditis, three

samples within 24-hour period are collected ( due to
intermittent bacteremia).
 Culture
● Blood obtained by aseptic venipuncture is inoculated in
blood culture media.

BHI BROTH THIOGLYCOLATE

BROTH
● Subcultures are made on MacConkey Agar, blood agar,
chocolate agar after 24 hours, 48 hours, 5th day, 7th day,
14th day of incubation.

● The HACEK bacteria, certain fungi, and Brucella are slow

growing and may require incubation for up to two weeks.

● Coxiella burnetii and Chlamydia species do not grow in

cell-free culture media.
 Subcultures

Chocolate agar. MacConkey agar.

 Identification.
● The organism isolated on subculture is further identified
by colony morphology, Gram stain and biochemical
reactions.

● Antibiotic sensitivity test is performed by the

Kirby-Bauer disc diffusion method.
 Serology
● It is a convenient and commonly used method for
identification of Coxiella Burnetii and Chlamydia.

The tests available are -

1) Indirect immunofluorescent antibody ( IFA).

2) Complement fixation test (CFA).
3) Enzyme immunoassay ( EIA).
Other tests??
● Total count - leukocytosis.
● Erythrocyte sedimentation rate (ESR) elevated.
● C reactive protein - detectable.
● Urine - culture.
● Chest X-ray.
● Echocardiography for detection of vegetation.
● Detection of bacterial endotoxin - limbus lysate test is a
sensitive test for the detection of bacterial endotoxin.
QUIZ TIME