Bacteremia (also Bacteraemia or Bacteræmia) is the presence of bacteria in the blood.

The blood is normally a sterile environment, so the

detection of bacteria in the blood (most commonly with blood cultures) is always abnormal.
Bacteria can enter the bloodstream as a severe complication of infections (like pneumonia or meningitis), during surgery (especially when
involving mucous membranes such as the gastrointestinal tract), or due to catheters and other foreign bodies entering the arteries or veins
(including intravenous drug abuse).
Bacteremia can have several consequences. The immune response to the bacteria can cause sepsis (blood poisoning) and septic shock, which has
a relatively high mortality rate. Bacteria can also use the blood to spread to other parts of the body (which is called hematogenous spread),
causing infections away from the original site of infection. Examples include endocarditis or osteomyelitis. Treatment is with antibiotics, and
prevention with antibiotic prophylaxis can be given in situations where problems are to be expected.
Definition
Bacteremia is the presence of viable bacteria in the blood stream. Bacteremia is different from sepsis (so-called blood poisoning or toxemia),
which is a condition where bacteremia is associated with an inflammatory response from the body (causing systemic inflammatory response
syndrome, characterised by rapid breathing, low blood pressure, fever, etc.). For example, a dental procedure (or even brushing your teeth)
introduces a detectable amount of bacteria into the bloodstream, but these are unable to replicate in the blood of most people. Some patients with
prosthetic heart valves however need antibiotic prophylaxis for dental surgery because bacteremia might lead to endocarditis (infection of the
interior lining of the heart). Salmonella - which is assumed to only cause gastroenteritis in much of the middle-class or developed world - can
cause a specific and virulent form of bacteremia in the developing world, especially in Africa. This form of bacteremia is particularly deadly to
infants and people whose immune systems have been damaged by HIV, according to studies done by the Universities of Malawi and Liverpool at
the Wellcome Trust Clinical Research Programme in Blantyre. Researchers announced in March 2008 in the Journal of Clinical Investigation that
a study of 352 Malawian children had revealed antibodies against salmonella when the bacteria leaves the safety of the cells and moves into the
bloodstream, and these antibodies may form the basis of an eventual vaccine.
Septicemia is an ill-defined non-scientific term introducing more confusion between sepsis and bacteremia: it suggests there is something in the
bloodstream causing sepsis.
Causes
In the hospital, indwelling catheters are a frequent cause of bacteremia and subsequent nosocomial infections, because they provide a means by
which bacteria normally found on the skin can enter the bloodstream. Other causes of bacteremia include dental procedures (occasionally
including simple tooth brushing), herpes (including herpetic whitlow), urinary tract infections, intravenous drug use, and colorectal cancer.
Bacteremia may also be seen in oropharyngeal, gastrointestinal or genitourinary surgery or exploration.
Consequences
Bacteremia, as noted above, frequently elicits a vigorous immune system response. The constellation of findings related to this response (such as
fever, chills, or hypotension) is referred to as sepsis. In the setting of more severe disturbances of temperature, respiration, heart rate or white
blood cell count, the response is characterized as septic shock, and may result in multiple organ dysfunction syndrome.
Bacteremia is the principal means by which local infections are spread to distant organs (referred to as hematogenous spread). Bacteremia is
typically transient rather than continuous, due to a vigorous immune system response when bacteria are detected in the blood. Hematogenous
dissemination of bacteria is part of the pathophysiology of meningitis and endocarditis, and of Pott's disease and many other forms of
osteomyelitis.
Diagnosis
Bacteremia is most commonly diagnosed by blood culture, in which a sample of blood is allowed to incubate with a medium that promotes
bacterial growth. Since blood is normally sterile, this process does not normally lead to the isolation of bacteria. If, however, bacteria are present
in the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected. Any bacteria that incidentally find
their way to the culture medium will also multiply. For this reason, blood cultures must be drawn with great attention to sterile process.
Occasionally, blood cultures will reveal the presence of bacteria that represent contamination from the skin through which the culture was
obtained. Blood cultures must be repeated at intervals to determine if persistent — rather than transient — bacteremia is present.

Bacteremia is the presence of bacteria in the bloodstream (see also Bacterial Infections: Bacteremia (Occult)).
• Bacteremia may result from ordinary activities (such as toothbrushing), dental or medical procedures, or from infections (such as
pneumonia or a urinary tract infection).
• Having an artificial joint or heart valve, or heart valve abnormalities increases the risk that bacteremia will persist or cause problems.
• Bacteremia usually causes no symptoms, but sometimes bacteria accumulate in certain tissue or organs and cause serious infections.
• People at high risk of complications from bacteremia are given antibiotics before certain dental and medical procedures.
Usually, bacteremia, particularly if it occurs during ordinary activities, does not cause infections because bacteria typically are present only in
small numbers and are rapidly removed from the bloodstream by the immune system. However, if bacteria are present long enough and in large
enough numbers, particularly in people who have a weakened immune system, bacteremia can lead to other infections and sometimes trigger a
serious bodywide response called sepsis.
Bacteria that are not removed by the immune system may accumulate in various places throughout the body, causing infections there, as in the
following:
• Tissues that cover the brain (meningitis)
• The sac around the heart (pericarditis)
• The cells lining the heart valves and the heart (endocarditis)
 • Bones (osteomyelitis)
• Joints (infectious arthritis)
In bacteremia, bacteria particularly tend to lodge and collect on structures such as abnormal heart valves, and any artificial material present in the
body, such as intravenous catheters and artificial (prosthetic) joints and heart valves. These collections (colonies) of bacteria may remain attached
to the sites and continuously or periodically release bacteria into the bloodstream.
Causes
Ordinary activities sometimes cause bacteremia in healthy people. For example, vigorous toothbrushing can cause bacteremia because bacteria
living on the gums around the teeth are forced into the bloodstream. Bacteria may also enter the bloodstream from the intestine during digestion.
Bacteremia that occurs during ordinary activities rarely leads to infections.
Dental or medical procedures can lead to bacteremia. During dental procedures (as during tooth cleaning by a dental hygienist), bacteria living on
the gums may become dislodged and enter the bloodstream. Bacteremia may also occur when catheters are inserted into the bladder or tubes are
inserted into the digestive or urinary tract. Bacteria may be present at the site of insertion (such as the bladder or intestine). So even though sterile
techniques are used, these procedures may move bacteria into the bloodstream. Surgical treatment of infected wounds, abscesses, and pressure
sores can dislodge bacteria from the infected site, causing bacteremia.
In some bacterial infections, such as pneumonia and skin abscesses, bacteria may periodically enter the bloodstream, causing bacteremia. Many
common childhood bacterial infections cause bacteremia.
Injecting recreational drugs can cause bacteremia because the needles used are usually contaminated with bacteria.
Symptoms and Diagnosis
Usually, bacteremia that results from ordinary events such as dental procedures causes no symptoms. People with bacteremia from other causes
sometimes have fever. If people with bacteremia have a fever, a rapid heart rate, and rapid breathing, sepsis is likely.
If bacteremia is suspected, doctors usually do blood tests to try to grow the bacteria in the laboratory (blood cultures).
Prevention and Treatment
People who are at high risk for complications of bacteremia (such as those who have an artificial heart valve or joint or certain heart valve
abnormalities) are often given antibiotics before procedures that can cause bacteremia:
• Dental procedures
• Surgical treatment of infected wounds
• Insertion of bladder catheters
Antibiotics help prevent bacteremia and thus infections and sepsis from developing.
If an infection or sepsis develops, it is treated.