By Dr. Somaya Banaei Resident of General Surgery Herat-Afghanistan

1. Bacteremia
And
Sepsis
Under Observation:
Sp. Jami
By:
Dr. Somaya Banaei
January
20
20

2. Bacteremia
Bacteremia is the presence of
bacteria in the bloodstream.
It can occur spontaneously,
during certain tissue infections,
with use of indwelling GU or IV
catheters, or after dental, GI,
GU, wound-care, or other
procedures

3. Bacteremia
Bacteremia may cause
METASTATIC INFECTIONS
including endocarditis, especially in
patients with valvular heart
abnormalities. Transient bacteremia
is often asymptomatic but may cause
fever.

4. Bacteremia has many possible causes
 Catheterization of an infected lower urinary tract
 Surgical treatment of an abscess or infected wound
 Colonization of indwelling devices, especially IV and
intra cardiac catheters, urethral catheters, and ostomy
devices and tubes

5. Suggests Sepsis Or Septic Shock.

6. Septic Shock Develops In 25 To 40% Of Patients With Significant
Bacteremia.
Sustained Bacteremia May Cause Metastatic Focal Infection Or
Sepsis.

7. Development of Bacteremia symptoms
usually suggests more serious infection,
such as sepsis or septic shock

8. Bacteremia vs Septicemia
Septicemia is a serious bloodstream infection. It’s
also known as blood poisoning.
Septicemia occurs when a bacterial infection
elsewhere in the body, such as the lungs or skin,
enters the bloodstream.

9. Sepsis
Sepsis is a clinical syndrome of life-threatening organ
dysfunction caused by a dysregulated response to
infection.
Septicemia Can Progress To Sepsis and Sepsis Is A
Serious Complication Of Septicemia.

12. Sepsis Is One Of Top Killers In U.S. Hospital
And World Wide

13. Sepsis Is One Of Top Killers In U.S. Hospital
And World Wide

14. Etiology
Hospital-acquired Gram- Bacilli Or Gram+ Cocci
Rarely, It Is Caused By Candida Or Other Fungi
Immunocompromised Patients
Patients With Chronic And Debilitating Diseases.
A SSI Should Be Suspected As The Cause Of Sepsis And Septic
Shock In Patients Who Have Recently Had Surgery

17. Fever
Oliguria
Tachycardia
Hyperglycemia
Leukocytosis
Vasodilatation
High cardiac out put
Sings includes

20. Risk Factors

21. • Diabetes mellitus
• Cirrhosis
• Leukopenia
• Invasive devices
• Prior treatment with antibiotics or corticosteroids
Common causative sites of infection include the
Lungs , The Urinary, Biliary, And GI Tracts.
Predisposing factors include

22. Inflammatory
Stimulus
Proinflammatory
Mediators
TNF And IL-1
Neutrophil–
endothelial Cell
Adhesion
Activate The
Clotting
Mechanism
Generate
Microthrombi Other Mediators
Pathophysiology
Negative Feedback
Mechanism

23. Diagnosis
 Clinical manifestations
 BP, heart rate, and oxygen monitoring
 CBC with differential, electrolyte panel and
creatinine, lactate
 CVP, PaO2, and ScvO2 readings
 Cultures of blood, urine, and other potential sites
of infection, including wounds in surgical patients

24. S
O
F A
The Sequential Organ Failure Assessment (SOFA)
Score criteria identify patients who should have further
clinical and laboratory investigation (all 3 criteria must be
present):
Respiratory rate ≥ 22/min
Altered mentation
Systolic BP ≤ 100 mm Hg

25.  Perfusion restored with IV fluids and
sometimes vasopressors
 Oxygen support
 Broad-spectrum antibiotics
 Source control
 Sometimes other supportive measures
(eg, corticosteroids, insulin)
Treatment

26. Patients with septic shock should be treated in an
ICU. The following should be monitored hourly:
 CVP, PaO2 , or ScvO2
 Pulse oximetry
 Blood glucose, lactate, and electrolyte levels
 Renal function
Treatment

27. Perfusion Restoration
ISOTONIC CRYSTALLOID (0.9% SALINE)
ALBUMIN
1 L of crystalloid is given rapidly.
Most patients require a minimum of 30 mL/kg in the first 4 to 6 h.
However, the goal of therapy is not to administer a specific volume of fluid
but to achieve tissue reperfusion without causing pulmonary edema due to
fluid overload.

28. Antibiotics
Suspected Sources
Antibiograms
Broad-spectrum Gram + And Gram - Bacterial
Empiric Antifungal Drug In
Immunocompromised Patients

29. Gram Positive

30. Gram Negative

32.  IV And Urinary Catheters
 Endotracheal Tubes
 Abscesses
 Necrotic And Devitalized Tissues
Source control