Bacteremia Treatment and Prevention
How is treatment for bacteremia?
Antibiotics therapy are the mainstay of treatment of bacteremia, and are often begun before positive identification of the bacteria is made. Close observation is required to guard against septic shock. Since bacteremia is usually associated with an existing infection elsewhere in the body, finding and treating this infection is an important part of treatment.
The first step in the treatment of children with FWS is to use a combination of age, temperature, and screening laboratory test results to determine the risk for serious bacterial infection or occult bacteremia. Low-risk children are generally monitored as outpatients. Children who do not fit low-risk criteria are treated with empiric antibiotics either as inpatients or as outpatients.
Numerous studies have compared the effectiveness of oral antibiotics and parenteral antibiotics in reducing complications of occult bacteremia. Parenteral antibiotics were generally found to be significantly more effective than oral treatment or no treatment in reducing the sequelae of occult bacteremia, most importantly meningitis.
Meningococcal bacteremia is rare but important because of its high rates of morbidity and mortality. Parenteral antibiotics are significantly more effective than no treatment or oral antibiotics in reducing complications. The risk of developing meningitis with no antibiotic therapy is 50%, the risk is 29% with oral antibiotic therapy, and it is 0% with intramuscular and intravenous antibiotic therapy.
In young infants and debilitated or immunocompromised patients, Salmonella bacteremia can have serious complications. The risk of serious complications in previously healthy children aged 3-36 months with Salmonella bacteremia is small. Empiric oral antibiotics have not been proven to prevent focal complications or persistence of bacteremia in children with occult nontyphoidal Salmonella bacteremia. However, some form of antibiotic treatment, oral or intravenous, is recommended for all children with Salmonella bacteremia and for young infants and immunocompromised children with Salmonella gastroenteritis.
The choice of empiric antibiotic treatment is primarily based on the likely causes of bacteremia for a given patient and the likelihood of resistance.
In very young infants, bacterial causes are most commonly acquired from the mother during childbirth. For neonates younger than 1 month, Streptococcus species and E coli are the most common pathogens. Treatment with ampicillin and gentamicin is widely accepted for patients in this age group; ampicillin and cefotaxime may also be used. Third-generation cephalosporins are useful in older infants and children, but they are not active against Listeria and are not recommended as a single-agent therapy in the empiric treatment of neonates younger than 1 month who are at risk for occult bacteremia.
The causes of bacteremia in infants aged 1-3 months are a combination of organisms. Empiric antibiotics used in practice vary in this age group. Some practitioners use ampicillin and gentamicin, some use ampicillin and cefotaxime. The empiric treatment of infants and children aged 3-36 months at risk for occult bacteremia usually involves ceftriaxone. This third-generation cephalosporin has broad-spectrum gram-positive and gram-negative coverage, is active against all likely community-acquired pathogens in this age group, and is resistant to beta-lactamases produced by some pathogenic organisms. Ceftriaxone has the longest half-life of the third-generation cephalosporins, and high serum concentrations can be sustained for 24 hours with a single dose.
How is prevention for bacteremia?
Prevention of bacteremia are preventing the infections. Good personal hygiene, especially during viral illness, may reduce the risk of developing bacterial infection. Treating bacterial infections quickly and thoroughly can minimize the risk of spreading infection. During medical procedures, the burden falls on medical professionals to minimize the number and duration of invasive procedures, to reduce patients' exposure to sources of bacteria when being treated.