Download to read offline
Uploaded byTahseen Siddiqui
Bloodstream_Infections_CME_Presentation_ Oct 2025.pdf
Blood stream infections, Bacteremia, BSIs represent serious infections with significant morbidity and mortality. •Prompt recognition & multidisciplinary care. •Early source control, and appropriate antimicrobial therapy Device-related BSIs are largely preventable with adherence to bundles and institutional commitment. •Emerging evidence (shorter durations, stewardship) is changing practice. •Always individualize therapy based on pathogen, patient risk factors, and local antibiogram. •Stewardship improves outcomes & resistance control. •Remember — early detection ,intervention, and prevention keep the horrors of sepsis at bay. After this session, participants will be able to: •Define bloodstream infections (BSIs) and differentiate key subtypes. •Define bloodstream infections (BSIs) and differentiate key subtypes •Apply guideline-based diagnostic strategies (including IDSA recommendations) for BSIs. •Implement evidence-based management approaches—including source control, antimicrobial therapy, duration. •Describe prevention strategies (especially catheter-associated BSI prevention) •Integrate antimicrobial stewardship and prevention protocols.
More Related Content
Similar to Bloodstream_Infections_CME_Presentation_ Oct 2025.pdf
Bloodstream_Infections_CME_Presentation_ Oct 2025.pdf
- 1. Tahseen J. Siddiqui,M.D, MRCPI Infectious Disease Specialist Medical Director, Infection Control & Prevention Asst. Professor of Medicine St. George University Medical School A Spooky Tale of a Scary Affair Oct 3oth, 2025
- 2. Haunting Lessons fromthe Shadows After this session, participants will be able to: • Define bloodstream infections (BSIs) and differentiate key subtypes. • Recognize risk factors, microbiology, and clinical presentation of BSIs. • Apply guideline-based diagnostic strategies (including IDSA recommendations) for BSIs. • Implement evidence-based management approaches—including source control, antimicrobial therapy, duration. • Describe prevention strategies (especially catheter-associated BSI prevention) • Integrate antimicrobial stewardship and prevention protocols.
- 3. “Interrogation from theCrypt” Q&A (PRE CME) • Question 1: Diagnosis Which of the following best describes the IDSA-recommended diagnostic approach for suspected bloodstream infection (BSI)? • A. Obtain one set of blood cultures after antibiotics are started • B. Obtain two or more sets of blood cultures from different sites before starting antibiotics • C. Use urine cultures to confirm bacteremia • D. Delay all diagnostic testing until the patient stabilizes
- 4. “Interrogation from theCrypt” Q&A (PRE CME) Question 2: Source Control In the management of catheter-related bloodstream infection (CRBSI), which of the following is TRUE according to IDSA recommendations? • A. Catheters should always be left in place to maintain IV access • B. Catheter removal is recommended in most cases, especially with Staphylococcus aureus or Candida spp. • C. Antibiotic lock therapy alone is sufficient for S. aureus bacteremia • D. Catheter replacement should occur routinely every 5 days
- 5. “Interrogation from theCrypt” Q&A (PRE CME) Question 3: Treatment Duration According to recent IDSA-supported studies (2024), what is the recommended duration of therapy for uncomplicated bloodstream infections after culture clearance and source control? • A. 3 days • B. 7 days • C. 14 days • D. 28 days
- 6. “Interrogation from theCrypt” Q&A (PRE CME) Question 4: Prevention Which of the following infection prevention measures has the strongest evidence for reducing central line-associated bloodstream infections (CLABSI)? A. Routine catheter replacement every 7 days B. Using alcohol-only antiseptics for skin preparation C. Implementing a central line insertion bundle with hand hygiene and chlorhexidine skin prep D. Avoiding daily review of line necessity
- 7. “Bloody Business: The HauntingTruth About Bloodstream Infections” U.S. NHSN (2025 data) CLABSI rates decreased by ~50% since 2010 due to bundle care, hand hygiene, and antimicrobial stewardship
- 8. A Chilling Reviewof Bloodstream Infections • Primary BSI: No identifiable source. Direct, intravascular sourse • Secondary BSI: Originates from another site. Indirect bacteremia • Device-associated. Catheter-related bloodstream infection (CRBSI) / Central line-associated bloodstream infection (CLABSI) • Community vs Hospital Acquired. • Uncomplicated vs complicated . Sepsis/septicemia, (Pathogens like MDROs, Staphylococcus, fungemiaaureu)
- 9. Primary BSI Catheter-related BSI(CRBSI)/CLABSI: Device-associated
- 10. Secondary BSI: Originatesfrom Another Primary Site “Doors to Doom: How Pathogens Find Their Way In”.
- 11. “The Triggers ofTerror” What Invites the Monster Risk Factors & Sources • aureus) • Patient-related: Immunosuppression, neutropenia, IV drug use, prosthetic devices, diabetes, malignancy, hemodialysis. • Device-related: Central venous catheters, hemodialysis catheters, PICCs, Tunneled vs non –tunneled catheters, device-days • Healthcare setting: ICU, prolonged hospitalization, ventilation, broad-spectrum antibiotics • Common portals: Intravascular devices, urinary tract, respiratory tract, surgical wounds or invasive procedures
- 12. “Invasion of theBlood Snatchers: Unmasking Deadly Pathogens in Disguise • aureus)
- 13. “The Nigh ofthe Living Pathogens” • aureus) “The Day of Bloodstream Beasts”
- 14. Primary Bacteremia “Spills,Thrills, and Chills: Confronting the Scariest Infections in the Blood” • aureus) • Signs & symptoms: Fever, chills, rigors, hypotension • Organ dysfunction: Renal, hepatic, respiratory. • Complications: Endocarditis, osteomyelitis, metastatic abscesses, septic emboli, septic shock • Importance of early recognition and risk stratification (especially for S. aureus) • Persistent bacteremia → deeper infection.
- 17. ““From Catheters toCrypts: The Horror of Primary Bloodstream Infections”
- 18. “Unmasking the Monster: DiagnosticRituals and How to Break the Curse” • aureus)
- 19. ““Managing Bloodstream Nightmares” “DiagnosticApproach (IDSA Guidelines)” • aureus) • Obtain ≥2 sets of paired blood cultures before antibiotics when possible. (catheter + peripheral) or differential time to positivity • Cath-Tip cultures are no longer recommended • Imaging and source evaluation: echocardiography (esp. echocardiography (TEE) in S. aureus), CT/MRI for foci • Use of rapid diagnostics, sensitivities, and coordination with microbiology • Repeat cultures until clearance.
- 21.
- 22. NHSN CLABSI CRITERIA Be carefulrepeating “Contaminant “ blood cultures The same NHSN common commensal (CNS) is identified by a culture from two or more blood specimens collected on at least two separate blood draws on the same or consecutive calendar days AND the blood cultures are assigned separate specimen numbers, processed individually, and are reported separately
- 23. • aureus) Avoid orRemove <48 hrs Special Note on Midlines vs. PICCs PICC = Central line (terminates in SVC → included in CLABSI surveillance). Midline = NOT a central line (terminates in a peripheral vein → excluded)
- 24. ““Managing Primary BloodstreamNightmares” “Contain the Curse: Source Control and Survival” • aureus) • Key principles: • Remove or replace infected devices. (especially intravascular devices/catheters) • Aggressive evaluation and source control imperative • Multidisciplinary team involvement: • ID consult, cardiology (if endocarditis), surgery/IR intervention for abscesses • Manage prosthetic material with team input. • Early intervention lowers mortality.
- 25. “Slaying the Pathogen: TheTreatment Ritual” Empiric to Definitive aureus) • Empiric: Broad-spectrum (based on hospital antibiogram, risk factors MRSA, Pseudomonas ). • Definitive therapy: tailored to specific organism and susceptibility • Monitoring: clinical stability, repeat cultures until clearance, adjust therapy if persistent bacteremia • De-escalate per susceptibilities. • Duration: 7–14 days (uncomplicated); 4–6 weeks (complicated). • (IDSA 2024: 7-day course safe for select cases)
- 26. “Special Pathogen” Staphylococcus aureusBacteremia (SAB) • Always significant, never a contaminant. • High rate of complications, metastatic foci, endocarditis. • Risk stratification: low-risk vs high-risk (based on host factors, persistent bacteremia, implanted devices) • Evaluate for endocarditis (TTE/TEE). Metastatic infections- Imaging, repeat cultures • Remove lines. • MSSA: Nafcillin/cefazolin • MRSA: Vancomycin/daptomycin • • Duration: 14 days–6 weeks based on complexity.
- 27. “Slaying the Pathogen” S.aureus (MRSA) Bacteremia BACTEREMIA AND INFECTIVE ENDOCARDITIS, NATIVE VALVE IV vancomycin or daptomycin (6 mg per kg intravenously once per day for six weeks) is recommend INFECTIVE ENDOCARDITIS, PROSTHETIC VALVE IV vancomycin and rifampin (300 mg orally or intravenously every eight hours for at least six weeks), plus gentamicin (1 mg per kg intravenously every eight hours for two weeks). Early evaluation for valve replacement surgery is recommended.
- 28. “Antibiotic Alchemy: Brewingthe Right Potion” • aureus)
- 29. Treatment Duration &Stewardship • Treatment of secondary bacteremia is the treatment of the primary source of infection ( UTI/PNA/etc.) • Traditional durations for complicated primary bacteremia: often 4–6 weeks from the last negative blood culture. (especially with endocarditis/metastatic infection) • Decision on duration must consider pathogen, source, host- factors, clearance of bacteremia, presence of metastatic foci • Incorporate stewardship: avoid unnecessarily prolonged therapy, minimize resistance, reduce costs • Emerging evidence supports shorter durations (e.g., 7 days) in selected uncomplicated primary bloodstream infections
- 30.
- 32. Institutional Measures Stewardship &Quality Improvement • Optimize antibiotic duration/selection/ iv-to-po conversion • Monitor antibiogram trends. • Implement CLABSI prevention bundles. • Feedback on infection rates. • Strengthen safety culture. • BSI surveillance metrics (CLABSI rates, device utilization ratio)Use of checklists and insertion/maintenance bundles • Peer feedback and audits • Role of antimicrobial stewardship teams and infection prevention teams
- 33. Prevent CRBSI inpatients with long-term catheters (e.g., hemodialysis, oncology, TPN).
- 34. Shadows Ahead: Fresh Haunts& Hard Lessons • Shorter antibiotic durations (validated 2024). • Rapid diagnostic tools (PCR, MALDI-TOF). • Rising resistance (ESBL, MRSA, CRE). • Multidrug-resistant organisms (MDROs) causing BSIs • Fungal bloodstream infections (e.g., Candida auris ) and emerging treatments • Biofilm-related device infections—diagnostic & therapeutic complexity • Stewardship critical for sustainability
- 36. Bewitching Takeaways • BSIsrepresent serious infections with significant morbidity and mortality. • Prompt recognition & multidisciplinary care. • Early source control, and appropriate antimicrobial therapy Device-related BSIs are largely preventable with adherence to bundles and institutional commitment. • Emerging evidence (shorter durations, stewardship) is changing practice. • Always individualize therapy based on pathogen, patient risk factors, and local antibiogram. • Stewardship improves outcomes & resistance control. • Remember — early detection ,intervention, and prevention keep the horrors of sepsis at bay.
- 37. “The Final Autopsy:Your Questions Revealed” (Post CME) • Question 1: • Which of the following best describes the IDSA-recommended diagnostic approach for suspected bloodstream infection (BSI)? • A. Obtain one set of blood cultures after antibiotics are started • B. Obtain two or more sets of blood cultures from different sites before starting antibiotics • C. Use urine cultures to confirm bacteremia • D. Delay all diagnostic testing until the patient stabilizes • Correct Answer: B. Obtain two or more sets of blood cultures from different sites before starting antibiotics
- 38. “The Final Autopsy:Your Questions Revealed” (Post CME) • Question 2: • In the management of catheter-related bloodstream infection (CRBSI), which of the following is TRUE according to IDSA recommendations? • A. Catheters should always be left in place to maintain IV access • B. Catheter removal is recommended in most cases, especially with Staphylococcus aureus or Candida spp. • C. Antibiotic lock therapy alone is sufficient for S. aureus bacteremia • D. Catheter replacement should occur routinely every 5 days • Correct Answer: B. Catheter removal is recommended in most cases, especially with Staphylococcus aureus or Candida spp.
- 39. “The Final Autopsy:Your Questions Revealed” (Post CME) • Question 3: • According to recent IDSA-supported studies (2024), what is the recommended duration of therapy for uncomplicated bloodstream infections after culture clearance and source control? • A. 3 days • B. 7 days • C. 14 days • D. 28 days • Correct Answer: B. 7 days
- 40. “The Final Autopsy:Your Questions Revealed” (Post CME) • Question 4: • Which of the following infection prevention measures has the strongest evidence for reducing central line-associated bloodstream infections (CLABSI)? • A. Routine catheter replacement every 7 days • B. Using alcohol-only antiseptics for skin preparation • C. Implementing a central line insertion bundle with hand hygiene and chlorhexidine skin prep • D. Avoiding daily review of line necessity • Correct Answer: C. Implementing a central line insertion bundle with hand hygiene and chlorhexidine skin prep
- 41. “Thank You What HauntsYou After This Session? Don’t be Scared to Ask