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31 Cards in this Set
- Front
- Back
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Define sepsis |
A systemic inflammatory response to inflammation caused by microbial invasion of normally sterile parts of the body |
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What is the clinical definition of sepsis? |
Clinical suspicion/evidence of infection + evidence of a systemic response - 2 or more of: Temp >38 OR <36 HR >90 RR >20 OR pCO2 <4.2kPa WBC >12*10^9/L OR <4*10^9/L |
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What are the systemic symptoms that may suggest sepsis? |
Temp >38 OR <36 HR >90 RR >20 OR pCO2 <4.2kPa WBC >12*10^9/L OR <4*10^9/L |
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Define severe sepsis |
Sepsis with organ dysfunction Hypotension (Sys <90mmHg) Lactic acidosis Oliguria Confusion Liver dysfunction |
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What is the mortality of severe sepsis? |
30-50% |
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Define septic shock |
Severe sepsis w/ hypotension despite adequate fluid resuscitation |
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What is the mortality of septic shock? |
50-60% |
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Define bacteraemia |
Presence of micro-organisms in bloodstream |
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Define sepitcaemia |
Bacteraemia AND sepsis |
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Describe the pathogenesis of sepsis |
Bacteria release endotoxins (G-) or exotoxins (G+) Activates macrophages Release of inflammatory mediators Endothelial damage - Extravasation of fluid, decreased BV/albumin, DIC Poor tissue perfusion + poor lung function |
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Define SIRS |
Systemic Inflammatory Response Syndrome |
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What non-infective causes are there of SIRS? |
Trauma Burns Haemorrhage Pancreatitis Toxins Cytokine release key |
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What are the principle pathogens causing Sepsis? - Community |
Escherichia coli Strep. pneumoniae Staph. aureues Neisseria. meningitidis Streptococci, Gram- bacilli |
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What are the principle pathogens causing Sepsis? - Hospital |
S. aureus E. coli Klebsiella spp. Coag- staph Pseudomonas aerugionas Candida spp. |
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What are the common syndromes leading to Community-acquired Sepsis? |
UTI/Pyelonephritis Pneumonia Meningitis Skin/soft tissue infections Intra-abdominal sepsis Infective endocarditis Bone/Joint infection |
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Describe infective endocarditis |
Infection of the cardiac endothelium (valves) High morbidity/mortality |
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What are the risk factors for endocarditis? |
Damage to heart tissue: Valvular heart disease i.v. drug use Central venous lines Prosthetic heart valves Implantable cardiac devices |
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What are the causative organisms of endocarditis? |
S. aureus Viridans streptococci Enterococci HACEK organisms Coag- staph (PVE) |
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How does infective endocarditis present? |
Typically w/ new murmur and febrile illness Echogardiography shows vegetations |
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How is infective endocarditis diagnosed? |
Multiple blood cultures IE causes continuous bacteraemia |
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What is the treatment for infective endocarditis? |
High dose, targeted i.v. antibiotics Surgery |
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What are the main sources of Hospital Acquired Sepsis? |
Lines (peripheral/central) Urinary catheters LRTIs Wound infections Abdominal sepsis Instrumentation (ERCP/TURP) |
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What are the clinical signs for diagnosis of sepsis? |
Temp >38 or <36 Rigors Tachycardia Hypotension (early in Gram-) Hypoxia, Oliguria (later) Physical signs of source/organism |
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What laboratory tests should be performed when diagnosing sepsis? |
FBC Clotting tests CRP (inflammation) Lactate (>4 suggests poor prognosis) |
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What microbiology tests should be performed when diagnosing sepsis? |
2 Blood cultures Urine Samples from specific sites: Pus CSF Joint Aspirate Sputum |
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What is the management of Sepsis? |
ABC - Oxygen/Fluid resuscitation Mechanical ventilation, vasopressors Monitor hourly urine output (AKI) Antibiotic to cover likely organisms (w/i 1 hour admission) Source control |
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What is a good starting antibiotic for sepsis? |
Tazocin (Piperacillin/Tazobactam) |
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What guides antibiotic therapy in treating Sepsis? |
Likely source Previous microbiology Sensitivity results Severity Underlying disease/immunity |
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What are the risk factors for resistant organisms? |
Prev. isolation of organism Frequent admissions Prolonged stay on ICU Hospital stay overseas Nursing home resident Prev. antibiotic use |
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What treatment should be given for treating resistant strains? |
i.v. Vancomycin |
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What steps should be taken when following up after sepsis? |
Review to determine source Potential for recurrence Consideration of endovascular focus (continuous bacteraemia) Review CRP/ESR response Monitor renal/liver function |
