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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?

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
Which microbes can result in haemorrhagic rash, púrpura
1. Meningococcal 2. Pneumococcal 3. GAS 4. Viral haemorrhagic fever if travel eg lassa, ebola
26
What is the chance of cross-reactivity with cephalosporins & carbapenems if patients have a mild rash with penicillins?
1-3%
27
What pathogens need to be considered with a history of foreign travel?
1. Parasites 2. Malaria 3. Typhoid 4. Cholera 5. Viral haemorrhagic fever 6. Brucella
28
In sepsis, what are the indications for transfer to ICU?
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
Which antibiotics should be given empirically in life-threatening sepsis?
Pip/Taz or Meropenem with clindamycin
30
In which circumstances is IVIg considered for sepsis?
Severe unresponsive Gram +ve necrotising infections & toxic shock Provided no congenital IgA deficiency
31
Which antibiotics cover against anaerobes?
1. Penicillins 2. Meropenem 3. Clindamycin 4. Erythromycin 5. Metronidazole
32
What are some common anaerobes?
1. Clostridia 2. Bacterioides 3. Peptistreptococci
33
What are some common gram positive bacteria?
1. MRSA 2. Staph aureus 3. Group A & B strep
34
What are some common gram negative bacteria?
1. Coliforms 2. Pseudomonas
35
Which antibiotics can be used for MRSA?
1. Gentamicin 2. Clindamycin 3. Vancomycin 4. Teicoplanin Non-systemic: 5. Fosfomycin 6. Trimethoprim
36
Which antibiotics can be used for pseudomonas?
1. Gentamicin 2. Tazocin 3. Meropenem 4. Aztreonam
37
Which antibiotics can be used for group A or B strep?
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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