1 Septicemia, & Sepsis

MICROBIOLOGY
BLOOD & LYMPHATIC SYSTEM

Jehad H. Elhissi
MD, MRCP, MPH, PHD
10 Credits Hours
Curriculum
 Septicemia, sepsis, brucellosis
 Bacterial zoonosis (Anthrax, Plague, Pasteurella, Tularemia,
leptospirosis, Lyme diseases)
 Rickettsia diseases
 HSV 1 & 2, VZV, EBV, CMV, Roseola infantum, HHV7, Kaposi
sarcoma
 Yellow fever, Dengue fever, Ebola, Leishmania, Trypanosoma
Bacteremia
Septicemia
sepsis
Differences between bacteremia & septicemia
Bacteremia Septicemia
■ Is the simple presence of bacteria in ■ Is the presence & multiplication of
the blood. bacteria in the blood.
■ Is not as dangerous as Septicemia. ■ Is a potentially life-threatening infection.
■ Less amount of bacteria are present ■ Large amounts of bacteria are present in
in blood. the blood.
■ This may occur through a wound or ■ It can arise from infections throughout
infection, or through a surgical the body, including infections in the
procedure or injection. lungs, abdomen, & urinary tract.
■ Toxins are not produced. ■ Toxins may be produced by bacteria.
■ Bacteremia usually causes no ■ It shows symptoms like chills, fever,

symptoms or it may produce mild prostration, very fast respiration &/or
fever. heart rate.
Differences between bacteremia & septicemia
Bacteremia Septicemia
■ It can resolve without treatment. ■ Untreated septicemia can quickly
progress to sepsis.
■ Rapidly removed from the
bloodstream by the immune system. ■ Antibiotics will be used to treat the
bacterial infection th
■ Caused by Staphylococcus,
Streptococcus, Pseudomonas, ■ Staphylococci, are thought to cause
Haemophilus, E. coli, dental more than 50% of cases of sepsis.
procedures, UTI, Other commonly implicated
peritonitis, Clostridium bacteria include Streptococcus
difficile colitis, IV drug use, & pyogenes, E. coli, Pseudomonas
colorectal cancer. aeruginosa, & Klebsiella species
Sepsis
■ Sepsis is a life-threatening organ dysfunction caused by a dysregulated
host response to infection.
■ If not recognized early & managed promptly, it can lead to septic shock,
multiple organ failure & death.
■ It is most frequently a serious complication of infection, particularly in

low- & middle-income countries where it represents a major cause of
maternal, neonatal morbidity & mortality.
Sepsis: Who is at risk?
■Anyone affected by an infection, severe injury, or serious NCD can progress to sepsis but vulnerable
populations are at higher risk including:
• older persons
• pregnant
• neonates
• hospitalized patients
• patients in ICU
• people with HIV/AIDS
• patient with liver cirrhosis
• patient with cancer,
• patient with kidney disease,
• patient with autoimmune diseases,
• people with no spleen.
Sepsis: Signs & symptoms
Sepsis is a medical emergency & can present with various signs & symptoms at
different times. Warning signs & symptoms include:
• fever or low temperature & shivering

• altered mental status
• difficulty breathing/rapid breathing
• increased heart rate
• weak pulse/low blood pressure
• low urine output
• cyanotic or mottled skin
• cold extremities
• extreme body pain or discomfort
Initial investigations
■ CBC, chemistries, LFTs, & coagulation studies including D-dimer level. Results from
these studies may support the diagnosis, indicate the severity of sepsis, & provide a
baseline to follow the therapeutic response.
■ Serum lactate – An elevated serum lactate (eg, >2 mmol/L or greater than the
laboratory upper limit of normal) may indicate the severity of sepsis & is used to
follow the therapeutic response
■ Peripheral blood cultures (aerobic & anaerobic cultures from at least two different
sites)
■ Microbiologic cultures from suspected sources (eg, sputum, urine, IV
catheter, wound or surgical site, body fluids) from readily accessible sites
■ Drawing blood for cultures through an indwelling or central IV catheter

should be avoided whenever possible, since ports are frequently
colonized with skin flora, thereby increasing the likelihood of false-
positive blood culture.
■ Urine analysis
■ Arterial blood gas (ABGs) may reveal acidosis, hypoxemia, or hypercapnia.
■ Imaging targeted at the suspected site of infection is warranted (eg, chest

radiography, CT of chest &/or abdomen).
■ Procalcitonin –its value in de-escalating antibiotic therapy is well established

in populations, in particular, those with community-acquired pneumonia &
respiratory tract infections
■ The reference value for procalcitonin in adults is less than 0.1 ng/mL. Levels greater than
0.25 ng/mL can indicate the presence of an infection.
INITIAL RESUSCITATIVE THERAPY
■ The initial resuscitation is the rapid restoration of perfusion & the early administration of
antibiotics.
1. Tissue perfusion is predominantly achieved by the aggressive administration of IV fluids, usually,

normal saline given at 30 mL/kg (actual body weight), started by one hour & completed within
the first three hours following the presentation.
2. Treating metabolic acidosis — Whether metabolic acidosis associated with sepsis should be
treated with bicarbonate.
3. Empiric antibiotic therapy (first hour) — Prompt identification & treatment of the site(s) of
infection is the primary therapeutic intervention, with most other interventions being purely
supportive.
INITIAL RESUSCITATIVE THERAPY
4. Identification of suspected source — Empiric antibiotics should be

targeted at the suspected source(s) of infection which is typically
identified from the initial brief history & preliminary laboratory
findings & imaging
End

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MICROBIOLOGY

BLOOD & LYMPHATIC SYSTEM

■ Bacteremia usually causes no ■ It shows symptoms like chills, fever,

■ It is most frequently a serious complication of infection, particularly in

• fever or low temperature & shivering

■ Drawing blood for cultures through an indwelling or central IV catheter

■ Imaging targeted at the suspected site of infection is warranted (eg, chest

■ Procalcitonin –its value in de-escalating antibiotic therapy is well established

1. Tissue perfusion is predominantly achieved by the aggressive administration of IV fluids, usually,

4. Identification of suspected source — Empiric antibiotics should be

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