Empiric Therapy of Bacteremia

Bacteremia is a serious finding requiring urgent assessment. It is either a result of direct bacterial infection of endovascular tissue or, much more commonly, a reflection of uncontrolled bacterial infection at a specific body site. It is not a diagnosis but often leads quickly to or confirms one. For more information concerning clinical aspects of sepsis see Severe Infections and Sepsis Syndrome.

This document is designed to help with the initial response to a first report of bacteremia from the microbiology laboratory.

For information concerning the technical aspects of performing blood cultures see Blood Culturing

When a blood culture bottle is “flagged” as positive by the automated blood culturing instrument, the technologist performs a Gram stain and phones the findings to the ward or ordering physician.

There are a limited number of possibilities. The organism will be Gram negative or Gram positive. It will be a coccus or a bacillus. For some types, extra information concerning specifics of shape and cellular arrangement will also be given.

Gram negative bacilli

These may be described as “resembling coliforms”, “resembling fusiforms” or “thin”

Gram negative bacilli resembling coliforms

Gram positive cocci

These will be described as “in clusters”, “in chains” “in pairs”, or “in pairs and chains”.

Gram positive cocci in clusters