Blood stream infections
-
Upload
abhijit-chaudhury -
Category
Documents
-
view
253 -
download
4
Transcript of Blood stream infections
![Page 1: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/1.jpg)
BLOOD STREAM INFECTIONS:Definitions and Significance.
Dr Abhijit Chaudhury
![Page 2: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/2.jpg)
Classical Terms
Bacteremia: Presence of Bacteria in blood.
Transient: Manipulation/Surgery in infected/colonized area
Intermittent: Abdominal/Pelvic abscess
Continuous: Endocarditis/Intravascular infections/ First week of Typhoid , Brucellosis.
Septicaemia: Presence of microbes or their toxins in blood.
![Page 3: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/3.jpg)
Recently Introduced Terms
BLOOD STREAM INFECTION: Presence and active multiplication of organisms in blood.
Primary: Point of entry or focus of infection cannot be determined/ Originates from I/V catheters.
Secondary: Distant site (focus) of infection present.
![Page 4: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/4.jpg)
Community acquired BSI: Those Detected within 48 hrs of admission
Nosocomial BSI: Signs and symptoms detected after 48 hrs of admission
![Page 5: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/5.jpg)
SEPSIS SPECTRUMConsensus Committee of American Experts (1992)
Definitions:Systemic Inflammatory Response Syndrome (SIRS)
:Systemic response to a wide range of stresses. Two or more of the following: Temperature : > 380 C or < 360 C Heart Rate > 90/min Tachypnea > 20 /min or Hyperventilation (PaCO2 <32 mm Hg, 4.3kPa) Leukocytes > 12,000 or < 4,000/mm3 or > 10% immature neutrophils
![Page 6: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/6.jpg)
Sepsis Spectrum
![Page 7: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/7.jpg)
Limitations of SIRS Definition
![Page 8: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/8.jpg)
![Page 9: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/9.jpg)
Sepsis Spectrum and Mortality
7-17%Sepsis
400,000
20-53%Severe Sepsis300,000
Septic Shock
53-63%Approximately 200,000 patients have septic shock annually
Balk, R.A. Crit Care Clin 2000;337:52
Incidence Mortality
![Page 10: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/10.jpg)
Bacteremia in the Preantibiotic Era
Streptococcus pneumoniae Group A Streptococcus Staphylococcus aureus Salmonella spp Haemophilus influenzae Neisseria meningitidis
![Page 11: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/11.jpg)
a. Nosocomial BSI
b. Community Acquired BSI
CHANGING TRENDS IN PATHOGEN PATTERN IN BSI.
![Page 12: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/12.jpg)
PRIMARY BLOOD STREAM INFECTION In many cases the primary focus/ route of
entry remains unknown (Appx. 20%) Therapeutic/Diagnostic medical devices
coming in direct contact with blood- (Device Related Bacteremia ,Maki 1977).
Various types of venous catheters, arterial lines - Catheter Related BSI (CR-BSI).
Entry of organisms through: 1. Contamination of Infusate 2. Contamination of Catheter hub and lumen 3. Contamination of Skin at insertion site
![Page 13: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/13.jpg)
![Page 14: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/14.jpg)
CR-BSI, S.aureus Bacteremia
Jensen AG. Journal Hospital Infection 2002;52:29-36
![Page 15: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/15.jpg)
Secondary BSI
Focus of Infection most commonly in LUNGS, URINARY TRACT, ABDOMEN, INFECTED SURGICAL SITE.
Gram negative pathogens more commonly involved.
5-12% cases may be due to fungi, particularly Candida.
![Page 16: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/16.jpg)
Predisposing Conditions and Agents in BSI.
GRAM NEGATIVE PATHOGENS: Diabetes mellitus Lymphoproliferative diseases Liver cirrhosis Burns Invasive procedures or devices Neutropenia Indwelling urinary catheter
![Page 17: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/17.jpg)
Predisposing Conditions--GRAM POSITIVE PATHOGENS: Intravascular Catheters Indwelling mechanical devices Burns Neutropenia Intravenous drug users FUNGI: Neutropenia Broad spectrum antimicrobial therapy
![Page 18: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/18.jpg)
Neonatal BSI Commonly manifests as meningitis, almost
always preceded by bacteremia. Risk Factors: Prematurity, low birth weight,
premature rupture of membrane, prolonged labour.
Mortality: 30-40%, Permanent defects:30% of survivors.
Gram negative bacteria: E.coli, Klebsiella, Enterobacter etc.
Gram Positive: Group B Streptococcus (S.agalactiae), Listeria.
![Page 19: Blood stream infections](https://reader033.fdocuments.us/reader033/viewer/2022042511/559997ca1a28abdb278b4865/html5/thumbnails/19.jpg)
Conclusion Sepsis may be obvious or subtle early in its course. There is a high mortality and morbidity Clinical characteristics
Community-acquired vs. hospital acquired Presence or absence of an apparent primary focus. Role of intravascular catheters: Diagnosis of exclusion or
laboratory criteria Take appropriate cultures Treatment 1.Need to initiate empiric therapy 2.Choice of initial therapy depends on Knowledge of local
organisms / susceptibilities
Aggressive management is crucial in determining the patient’s survival.
THE END