Why?

Bacteraemia- bacterial in the blood stream (e.g.

cleaning teeth) Septicaemia- infection of bloodstream Usually taken if patient has a fever Antibiotics started after taking blood cultures if possible but if not use broad spectrum

Source
Usually another underlying infection
E.g urinary catheter, central line, meningitis Then spreads to other organs via bloodstream

Blood samples collected and cultured

Collection
When patient spikes a fever
Most have paired bottles: aerobic and anaerobic Approx 5-10mls each bottle

Paediatric bottles available with smaller volumes

Incubated as soon as possible after collection

Culture
Most contain broth such as brain heart infusion or

tryptic soya as can grow a wide of organisms Anaerobic bottles may have reducing agent or gas to ensure anaerobic conditions Mainly for bacteria- if fungi or TB suspected can get special bottles

Types: non- automated

Bottles containing culture

media Add 5-10 mls patients blood Incubate Subculture Drawbacks takes time to subculture Contamination

Solution- provide media above bottle

Septicheck

Non- automated: radiometric

Early method- no longer used
Quicker detection C14 Labelled glucose

Produces radioactive CO2

Automated:
Different systems depending on which company has

produced it Still look at production of CO2 but use a sensor- not radioactive Continuous detection Incubated 7 days Positives indicated by a signal

Examples: Bact-alert

Bactec

Collection
http://www.youtube.com/watch?v=yz6GhnZE6KM

Identification of organisms
Still need to subculture and carry out tests
Gram stain Direct antibiotic sensitivity until organism isolated

Have to check both bottles- quite often mixed

infection

Anaerobes
Quite often have anaerobic organism as well as aerobic
Particularly if following bowel surgery Clostridia, bacterioides, fusobacteria

Incidence of infections
For some organisms (Staphylococcus aureus,

Escherichia coli and glycopeptide-resistant enterococci) it is mandatory for hospitals to supply data but for other species of bacteria data is supplied on a voluntary basis (HPA data)

The top ten monobacterial(HPA 2010)

Number of cases 26164 13499 organism 9180

Escherichia Staphylococcus, coagulase negative Staphylococcus aureus Streptococcus, nonpyogenic Klebsiella Streptococcus, pyogenic Enterococcus Pseudomonas Proteus Enterobacter

7891

4703 3997

3498 3053 1823 1558

Polymicrobial infections
Similar organisms involved, although anaerobes also

feature in top 20 Sometimes up to 5 organisms may be involved Several organisms may mean contamination Can involve fungal infections e.g. Candida

Lab diagnosis
Need to subculture from broth or bottle
If bottle has agar slope might be able to use colony

appearance Septicheck- which agar does it grow on? Gram stain and direct sensitivity from broth Identify as you would any pathogen May be polymicrobial