Types Of Bacteremia

Bacteremia may be transient, continuous, or intermittent. Transient, incidental bacteremia may occur spontaneously or with such minor events as brushing teeth or chewing food. Other conditions in which bacteria are only transiently present in the bloodstream include manipulation of infected tissues, instrumentation of contaminated mucosal surfaces, and surgery involving nonsterile sites. These circumstances may also lead to significant septicemia.

In septic shock, bacterial endocarditis, and other endovascular infections, organisms are released into the bloodstream at a fairly constant rate (continuous bacteremia). Also, during the early stages of specific infections, including typhoid fever, brucellosis, and lep-tospirosis, bacteria are continuously present in the bloodstream.

In most other infections, such as in patients with undrained abscesses, bacteria can be found intermittently in the bloodstream. Of note, the causative agents of meningitis, pneumonia, pyogenic arthritis, and osteomyelitis are often recovered from blood during the early course of these diseases. In the case of transient seeding of the blood from a sequestered focus of infection, such as an abscess, bacteria are released into the blood approximately 45 minutes before a febrile episode.

Figure 52-1 Vegetations of bacterial endocarditis. Arrow indicates the vegetations. (Courtesy Celeste N. Powers, MD, PhD, Virginia Commonwealth University Medical Center, Medical College of Virginia Campus, Richmond, Va.)

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