Bloodstream infections can be primary or secondary. Diagnosis can be made if an organism is identified in the laboratory or based on clinical grounds.
Signs and Symptoms of Bloodstream Infection
Signs and symptoms in patients > 12 months of age:
(1) fever ( > 38 °C)
(2) chills
(3) hypotension (systolic pressure <= 90 mm Hg)
(4) oliguria (< 20 mL/hr)
Signs and symptoms in patients <= 12 months of age:
(1) fever ( > 38 °C)
(2) apnea
(3) bradycardia
Clinical sepsis - all of the following:
(1) at least one of the signs and symptoms for age
(2) no other recognized cause for signs and symptoms
(3) at least one of the following:
(3a) blood culture not done or
(3b) no organism detected in blood or
(3c) no antigen detected in blood
(4) no apparent infection at another site
(5) physician institutes appropriate antimicrobial therapy for sepsis
Secondary bloodstream infection - both of the following
(1) recognized pathogen isolated from blood culture
(2) both of the following:
(2a) pathogen is not associated with an intravascular device
(2b) pathogen causing infection at another site
Laboratory-confirmed Bloodstream Infection
Criteria 1:
(1) recognized pathogen isolated from blood culture
(2) at least one of the following:
(2a) pathogen is associated with an intravascular device
(2b) pathogen not causing infection at another site
Criteria 2:
(1) at least one of the signs and symptoms for age
(2) at least one of the following:
(2a) common skin contaminant isolated on blood culture isolated from 2 blood cultures drawn on separate occasions AND not related to infection at another site
(2b) common skin contaminant isolated on blood culture AND isolated from a patient with an intravascular access device AND physician institutes appropriate antimicrobial therapy
(2c) positive antigen test on blood AND organism identified not related to infection at another site
Common skin contaminants include:
(1) diphtheroids
(2) Bacillus species
(3) Proprionibacterium species
(4) coagulase negative staphylococcus
(5) Micrococcus species)
