Surgical procedures of the genitourinary tract, intestinal tract, or hepatobiliary tract can also lead to gram negative bacteremia. Pseudomonas and Enterobacter species are the most important causes of gram negative bacteremia in the ICU. Bacteremia risk factors
There are several risk factors that increase the likelihood of developing bacteremia from any type of bacteria. These include:

HIV infection
Diabetes Mellitus
Chronic hemodialysis
Solid organ transplant
Stem cell transplant
Treatment with glucocorticoids
Liver failure
Asplenia

Mechanism
Bacteremia can travel through the blood stream to distant sites in the body and cause infection (hematogenous spread). Hematogenous spread of bacteria is part of the pathophysiology of certain infections of the heart (endocarditis), structures around the brain (meningitis), and tuberculosis of the spine (Potts disease). Hematogenous spread of bacteria is responsible for many bone infections (osteomyelitis).Prosthetic cardiac implants (for example artificial heart valves) are especially vulnerable to infection from bacteremia. Prior to widespread use of vaccines, occult bacteremia was an important consideration in febrile children that appeared otherwise well. Diagnosis
Bacteremia is most commonly diagnosed by blood culture, in which a sample of blood drawn from the vein by needle puncture is allowed to incubate with a medium that promotes bacterial growth. If bacteria are present in the bloodstream at the time the sample is obtained, the bacteria will multiply and can thereby be detected.Any bacteria that incidentally find their way to the culture medium will also multiply. For example, if the skin is not adequately cleaned before needle puncture, contamination of the blood sample with normal bacteria that live on the surface of the skin can occur.
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