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Bloodstream infections: mechanisms of pathogenesis and opportunities for intervention

Nature Reviews Microbiology volume 23, pages 210–224 (2025)Cite this article

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Abstract

Bloodstream infections (BSIs) are common in hospitals, often life-threatening and increasing in prevalence. Microorganisms in the blood are usually rapidly cleared by the immune system and filtering organs but, in some cases, they can cause an acute infection and trigger sepsis, a systemic response to infection that leads to circulatory collapse, multiorgan dysfunction and death. Most BSIs are caused by bacteria, although fungi also contribute to a substantial portion of cases. Escherichia coli, Staphylococcus aureus, coagulase-negative Staphylococcus, Klebsiella pneumoniae and Candida albicans are leading causes of BSIs, although their prevalence depends on patient demographics and geographical region. Each species is equipped with unique factors that aid in the colonization of initial sites and dissemination and survival in the blood, and these factors represent potential opportunities for interventions. As many pathogens become increasingly resistant to antimicrobials, new approaches to diagnose and treat BSIs at all stages of infection are urgently needed. In this Review, we explore the prevalence of major BSI pathogens, prominent mechanisms of BSI pathogenesis, opportunities for prevention and diagnosis, and treatment options.

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Fig. 1: Primary sites that can seed bloodstream infections and opportunities for prevention and treatment.
Fig. 2: Pathogens use diverse strategies to infect initial sites and disseminate into the bloodstream.
Fig. 3: Mechanisms of pathogen survival in the bloodstream.

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Authors and Affiliations

  1. Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA

    Caitlyn L. Holmes & Michael A. Bachman

  2. Department of Microbiology & Immunology, University of Michigan Medical School, Ann Arbor, MI, USA

    Caitlyn L. Holmes, Harry L. T. Mobley & Michael A. Bachman

  3. Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI, USA

    Owen R. Albin

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Holmes, C.L., Albin, O.R., Mobley, H.L.T. et al. Bloodstream infections: mechanisms of pathogenesis and opportunities for intervention. Nat Rev Microbiol 23, 210–224 (2025). https://doi.org/10.1038/s41579-024-01105-2

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