Bacteremia and Blood Cultures
Patients who present with a history of fevers and/or night sweats and/or chills, in the absence of focal findings on history or exam, must be evaluated for bacteremia. A thorough history, review of systems, and physical examination is required as are laboratory tests. Initial required tests include CBC, basic metabolic panel, LFTs, blood cultures, urinalysis and CXR. This is particularly important when a patient repeatedly returns with fever without an identified source. Blood cultures must be done and repeated, while other diagnoses are also considered. Blood cultures are the only test that can diagnose bacteremia. A failure to perform blood cultures and diagnose bacteremia, will result in sepsis and its sequellae complications. When bacteremia is due to endocarditis and it goes undiagnosed and untreated, complications of the endocarditis are going to occur, including septic emboli to the brain (stroke), metastatic foci of infection, valve destruction, heart failure, shock, and/or death.
Given the extremely high morbidities associated with bacterial endocarditis, timely, correct diagnosis and treatment is required. Such treatment (given positive blood cultures), require a four-to-six-week course of antibiotic, chosen based on blood culture results. A one-month course of intravenous antibiotic therapy should result in eradication of the bacteremia and resolution of the bacterial infection. Within one week of appropriate antibiotic therapy, risk of embolization and stroke decreases precipitously.