Bacteremia
Introduction
Introduction to bacteremia Bacteremia refers to the fact that bacteria outside the body enter the blood system through the entrance of the body surface or the entrance of the infection, and then propagate in the blood of the human body and spread with the bloodstream throughout the body. The consequences are very serious. In general, a urinary catheter or a surgical stoma on the surface of the body is prone to bacteremia. Patients with bacteremia often develop acute metastatic infections of multiple organs, and various acute infection symptoms appear. Once suspected, blood tests should be taken immediately. Once diagnosed, the infected bacteria should be treated immediately. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis meningitis
Cause
Cause of bacteremia
Invasive oral tissue surgery or routine dental procedures, infection of the lower urinary catheter, abscess incision and drainage and built-in bacterial growth, especially intravenous and intracardiac catheters, catheters and ostomy built-in Both the device and the catheter can cause transient bacteremia. The typical Gram-negative bacteremia is intermittent and opportunistic. Although this bacteremia may not affect healthy people, it is impaired and accompanied by severe disease. Patients, patients after chemotherapy, and severely malnourished can have serious consequences. The initial site of infection is usually in the lungs, genitourinary tract, gastrointestinal tract or soft tissue, including skin with acne ulcers. After surgery in a dangerous population, especially in patients with valvular heart disease, prosthetic heart valves or other endovascular prostheses.
Prevention
Bacteremia prevention
All obvious or insidious purulent lesions can be removed as soon as possible, and the occurrence of bacteremia can be reduced. Infectious diseases such as measles, influenza, and whooping cough, which are common in children, are relatively serious respiratory infections. Therefore, bacteremia occurs. For such children, it is necessary to strengthen protection. It is necessary to pay attention to any small skin wounds, and to treat them properly, environmental sanitation, personal hygiene, nutritional status and pediatric health care. The incidence of the disease will inevitably decline.
Complication
Bacteremia complications Complications peritonitis meningitis
Common complications of this disease:
1, secondary empyema.
2, suppurative pericarditis.
3. Peritonitis.
4. Meningitis.
5. Acute endocarditis.
Symptom
Symptoms of bacteremia Common symptoms Abdominal pain Gastrointestinal symptoms Diarrhea Shock Abscess Hypotension Nausea chills Bacteremia Shortness of breath
Typical short-term and low-level bacteremia is asymptomatic unless the patient is at risk of persistent or high levels of bacteremia. Typical manifestations are signs of systemic infection, including shortness of breath, chills, and elevated body temperature. And gastrointestinal symptoms (abdominal pain, nausea, vomiting, diarrhea), in the early stages of the disease, the patient's skin is often warm and alert, although if you do not measure blood pressure, often do not find hypotension, and some patients have low blood pressure late.
Some features help identify the cause and pathogenic bacteria. Most of the infections above the sputum are caused by Gram-positive bacteria, while abdominal infections, including biliary and urinary tract infections, are mostly caused by Gram-negative bacteria, except for experiments. The diagnosis can identify Gram-positive and Gram-negative bacteremia and septic shock, and there are no other reliable methods for identification.
Metastatic abscess can occur in almost any part, and can also produce characteristic symptoms and signs of affected organ infection in a wide range of cases. In the case of staphylococcal bacteremia, multiple abscess formation is common. There is 25% to 40% persistence. In patients with bacteremia, hemodynamic instability can occur and septic shock can occur.
Examine
Bacteremia examination
Pus or body fluids should be obtained from all infected sites, including infected body cavities, joint spaces, soft tissues and damaged skin for Gram staining and culture. Blood culture should include aerobic and anaerobic cultures, and should be separated by 1 hour. 2 times of blood culture, each time should be taken from different parts of the vein to take blood, 2 times of blood culture for the initial diagnosis of bacteremia is sufficient, but negative staining or culture results can not rule out bacteremia, especially previously accepted Patients with antibiotics should not rule out bacteremia. The specimens of the minimum blood culture should be taken from the appropriately prepared venous incision site. In addition, specimens of sputum, catheterization site and wound can be cultured. .
Diagnosis
Diagnosis and identification of bacteremia
diagnosis
Pus or body fluids should be obtained from all infected sites, including infected body cavities, joint spaces, soft tissues and damaged skin for Gram staining and culture. Blood culture should include aerobic and anaerobic cultures, and should be separated by 1 hour. 2 times of blood culture, each time should be taken from different parts of the vein to take blood, 2 times of blood culture for the initial diagnosis of bacteremia is sufficient, but negative staining or culture results can not rule out bacteremia, especially previously accepted Patients with antibiotics should not rule out bacteremia. The specimens of the minimum blood culture should be taken from the appropriately prepared venous incision site. In addition, specimens of sputum, catheterization site and wound can be cultured. .
Two or more of the following objective indicators may be considered as the previously known septic syndrome, ie, the current systemic inflammatory response syndrome: body temperature > 38 ° C or < 36 ° C; heart rate > 90 beats / min; Respiratory rate >20 beats/min or arterial partial pressure of carbon dioxide (PaCO2) <32mmHg; white blood cell count >12000/l or <4000/l, or immature white blood cells >10%, typical white blood cell count is initially reduced to <4000/ Ll, then rose to >15000/l in 2-6 hours, and the immature type increased significantly.
Differential diagnosis
1, sepsis: bacteria invade the blood and rapidly grow and multiply, causing systemic infection symptoms, the onset of the disease is the beginning of severe chills, followed by high fever of 40 ~ 41 ° C, accompanied by sweating, headache, nausea.
2, toxemia: bacterial toxins from the local infection of the lesion into the blood circulation, resulting in systemic sustained high fever, accompanied by a lot of sweating, pulse weak or shock, because the blood toxins in the blood can directly destroy the blood cells in the blood, so often appear Anemia, blood culture can not find bacteria, it is worth noting that serious damage, blood vessel embolism, intestinal obstruction and other diseases, although no bacterial infection, but the destruction of large areas of tissue toxins can also cause toxemia.
3, sepsis: bacteria in the body of purulent lesions, through the blood circulation "touring the country", disseminated to other parts to produce new suppurative lesions, caused by systemic infection symptoms, the characteristics of the disease is similar to sepsis, but in There are many suppurative lesions on the body, and there are even many abscesses.
