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Gaby’s Green Top Guidelines > 2024 64 Sepsis > Flashcards

2024 64 Sepsis Flashcards

1
Q

What serum lactate should prompt escalation & potential discussion with critical care?

A

≥ 4

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2
Q

Babies of women treated for sepsis in what time frame should be assessed for neonatal infection?

A

Labour
24 hours before & after birth

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3
Q

Which viral cause of sepsis needs to be considered?

A

Herpes

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4
Q

What % of maternal deaths globally are caused by sepsis?

A

11%

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5
Q

What is the maternal mortality rate for sepsis in the UK?

A

2.5 per 100,000

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6
Q

What are the most common source sites for maternal bacterial sepsis?

A
  1. Pneumonia
  2. Urinary tract
  3. Genital tract
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7
Q

How many times higher than the general population is the risk of invasive Group A Strep disease, in a) pregnancy, b) postpartum up to 28 days

A

a) 20x
b) 80x

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8
Q

How is septic shock differentiated from sepsis?

A

Persisting hypotension requiring vasopressors
Persisting serum lactate > 2 despite fluid resuscitation

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9
Q

What are the maternal risk factors for developing sepsis?

A
  1. Obesity
  2. Diabetes
  3. Iron deficiency anaemia
  4. Maternal age > 35
  5. Impaired immunity
  6. Ethnic minority
  7. Renal/cardiac/liver disease
  8. History of pelvic infection
  9. Contact with iGAS
  10. IVDU
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10
Q

What are the obstetric risk factors for sepsis?

A
  1. Prolonged ROM
  2. CS
  3. Vaginal trauma
  4. Retained pregnancy tissue
  5. Amnio & other invasive procedures
  6. Multiple pregnancy
  7. Cervical cerclage
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11
Q

What are the causative organisms for maternal sepsis?

A
  1. E. Coli
  2. GBS
  3. Anaerobes
  4. Staph aureus
  5. GAS
  6. Coliforms other than e.coli
  7. Haemophilus influenzae
  8. Listeria
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12
Q

What are the non-infective causes that can masquerade as sepsis?

A
  1. Blood transfusion reactions
  2. Autoimmune disease
  3. Acute fatty liver of pregnancy
  4. Disseminated malignancy
  5. TTP
  6. Haemophagocytic lymphohistiocytosis
  7. Occult bleeding
  8. Epidural-related maternal fever
  9. Misoprostol side-effect
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13
Q

What does disseminated HSV infection most commonly get confused with?

A

HELLP syndrome
Due to HSV hepatitis

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14
Q

What are the red flags for sepsis?

A

GCS < 15
RR ≥ 25
Sats < 94%
HR > 130
BP < 90 systolic
UO < 0.5 ml/kg/hr or not PU for 12h

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15
Q

What microbes are implicated in febrile illness, presenting with chills, rigors, myalgia?

A
  1. Staph/strep esp if wounds, rash
  2. Gram -ve esp if UTI
  3. Influenza
  4. HSV septicaemia even if no other features
  5. Enteriviral/COVID
  6. Travel-related eg malaria
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16
Q

How might GAS present?

A
  1. Skin: impetigo, cellulitis
  2. Throat: tonsillitis
  3. Flu-like Sx
  4. D&V
  5. Rapid deterioration
  6. Nec fasc: disproportionate pain
  7. Late-onset after-pains
17
Q

What microbes are implicated in recurrent skin infections, beast abscess, severe mastitis, I&D scars?

A

Staph aureus

18
Q

What microbes are implicated in severe respiratory infection & haemoptysis?

A
  1. TB
  2. Staph aureus
  3. GAS
19
Q

Which microbes need to be considered in UTI?

A

ESBL: extended spectrum beta-lactamases
CPE: carbapenamase-producing enterobactericeae

20
Q

Which microbes need to be considered in acute urinary retention?

A

HSV

21
Q

Which microbes are implicated in endocarditis associated with IVDU?

A
  1. GAS
  2. PVL-producing staph aureus
  3. MRSA
  4. BBVs
22
Q

Which microbes are implicated in gastroenteritis?

A
  1. Salmonella
  2. Campylobacter
  3. Enterotoxins from staph or strep
  4. C.diff
  5. Viruses eg norovirus
23
Q

Which microbes are implicated in zoonotic infections?

A
  1. Salmonella
  2. Campylobacter
  3. Listeria
  4. C. diff
  5. Cryptosporidium
  6. Q fever
  7. Chlamydiophila
24
Q

Which multi-resistant organisms need infection control precautions?

A
  1. ESBL & CPE-producing
  2. MRSA
  3. VRE: vancomycin-resistant enterococci
25
Q

Which microbes can result in haemorrhagic rash, púrpura

A
  1. Meningococcal
  2. Pneumococcal
  3. GAS
  4. Viral haemorrhagic fever if travel eg lassa, ebola
26
Q

What is the chance of cross-reactivity with cephalosporins & carbapenems if patients have a mild rash with penicillins?

A

1-3%

27
Q

What pathogens need to be considered with a history of foreign travel?

A
  1. Parasites
  2. Malaria
  3. Typhoid
  4. Cholera
  5. Viral haemorrhagic fever
  6. Brucella
28
Q

In sepsis, what are the indications for transfer to ICU?

A
  1. Hypotension requiring vasopressors or inotropes
  2. Lactate > 4 despite fluid resus
  3. Pulmonary oedema
  4. Need for mechanical ventilation or airway protection
  5. Renal replacement therapy
  6. Decreased consciousness level
  7. Multi-organ failure
  8. Uncorrected acidosis
  9. Hypothermia
29
Q

Which antibiotics should be given empirically in life-threatening sepsis?

A

Pip/Taz or
Meropenem with clindamycin

30
Q

In which circumstances is IVIg considered for sepsis?

A

Severe unresponsive Gram +ve necrotising infections & toxic shock
Provided no congenital IgA deficiency

31
Q

Which antibiotics cover against anaerobes?

A
  1. Penicillins
  2. Meropenem
  3. Clindamycin
  4. Erythromycin
  5. Metronidazole
32
Q

What are some common anaerobes?

A
  1. Clostridia
  2. Bacterioides
  3. Peptistreptococci
33
Q

What are some common gram positive bacteria?

A
  1. MRSA
  2. Staph aureus
  3. Group A & B strep
34
Q

What are some common gram negative bacteria?

A
  1. Coliforms
  2. Pseudomonas
35
Q

Which antibiotics can be used for MRSA?

A
  1. Gentamicin
  2. Clindamycin
  3. Vancomycin
  4. Teicoplanin
    Non-systemic:
  5. Fosfomycin
  6. Trimethoprim
36
Q

Which antibiotics can be used for pseudomonas?

A
  1. Gentamicin
  2. Tazocin
  3. Meropenem
  4. Aztreonam
37
Q

Which antibiotics can be used for group A or B strep?

A
  1. Penicillins inc co-amoxiclav
  2. Cefuroxime or cefitaxime unless ESBL-producing
  3. Tazocin
  4. Meropenem unless CPE
  5. Clindamycin, although 11% GAS & 33% GBS resistance
  6. Vancomycin/teicoplanin

Gaby’s Green Top Guidelines (51 decks)

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