A friend of mine was just diagnosed with septicemia. The doctor said there was a "little" infection in my friend's blood and put him on a very strong antibiotic (I'm not sure what antibiotic, but supposedly the strongest he could give). My friend also just had an artificial heart valve installed three months ago to correct a congenital defect. He is only 27. How might he have contracted this blood poisoning? Is it extremely serious? Could it be life-threatening to him (given his recent surgery)? Finally, what could be expected for recovery -- to the point that he is feeling back to his "old self"?

L.

Let me start by defining some terms. "Sepsis" is usually defined as a whole-body toxic condition caused by microorganisms or their products spreading from a local area of infection. "Septicemia" is a state of sepsis in which the organisms are also found in the blood. This is usually a very serious condition that can result in death if treatment is not given promptly. Even if the appropriate treatment is given, the patient may still not recover. "Bacteremia" means that bacteria are in the blood, but the patient may or may not be seriously ill. These terms are all used loosely and the fact that your friend was told he had "septicemia" does not necessary mean he is gravely ill.

Another point I want to make before I address your friend's case specifically is the concept of an antibiotic's "strength." This is a concept that is not really based in fact. Certain antibiotics are more effective than others against a given bacterium, but there could be several antibiotics that would likely produce the same outcome. The final outcome does not have much to do with which specific antibiotic was chosen, so long as that antibiotic is active against that bacterium. This is important to know, because many people think that all that has to be done to cure their infection is choosing the "strongest" antibiotic. (If that were the case, why would we ever use a "weak" antibiotic?)

I am concerned about your friend's case. When a person gets a bacterial infection in his blood, the first question is "Where did the bacteria come from?" Any serious infection at any site can cause bacteria to spill into the blood. However, you do not describe your friend as having pneumonia, a urinary tract infection, a skin infection or any other local infection. When there is no clear original source of a bloodstream infection, we have to wonder if the infection is located in the most important organ in the cardiovascular system -- the heart. What can happen is that the lining of the heart valves can become infected, a condition called endocarditis. This infection is quite serious, in that it can then affect multiple organs. Also, the heart valves can become damaged, resulting in heart failure, which may necessitate valve surgery.

Knowing exactly which bacterium is in the blood is extremely important. Not all bacteria have the same propensity for infecting the heart valves. Also, knowing which bacterium it is could give a clue as to the source of the infection. What worries me most about endocarditis in your friend's case is that he has an artificial heart valve. These valves can become infected when bacteria enter the bloodstream. Even normal valves can occasionally become infected, but the risk for artificial valves is much, much higher.

What the physicians are probably doing is identifying the organism in your friend's blood, giving high doses of antibiotics intravenously and evaluating the artificial valve to determine if it is involved. If it is infected, then at a minimum, he would need a long course of intravenous antibiotics. There is also a chance he would need another surgery to replace this valve.