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.

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 from the 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 the Crypt”
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 the Crypt”
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 the Crypt”
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 the Crypt”
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 Haunting Truth 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 Review of 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: Originates from Another Primary Site
“Doors to Doom: How Pathogens Find Their Way In”.

11. “The Triggers of Terror”
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 the Blood Snatchers:
Unmasking Deadly Pathogens in Disguise
•aureus)

13. “The Nigh of the 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 to Crypts:
The Horror of Primary Bloodstream Infections”

18. “Unmasking the Monster:
Diagnostic Rituals and How to Break the Curse”
•aureus)

19. ““Managing Bloodstream Nightmares”
“Diagnostic Approach (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. •aureus)

22. NHSN CLABSI
CRITERIA
Be careful repeating “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 or Remove <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 Bloodstream Nightmares”
“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:
The Treatment 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 aureus Bacteremia (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: Brewing the 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. Treatment Duration

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 in patients 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
•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.

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 Haunts You After This Session?
Don’t be Scared to Ask