5: Microbiology of intra-abdominal sepsis and the recognition of sepsis

Question 1

What is colonisation?

Answer 1

Presence of microbe in the body without an inflammatory response

Question 2

What is infection?

Answer 2

Inflammation due to a microbe

Question 3

What is bacteraemia?

Answer 3

Presence of bacteria in the blood

Question 4

What is sepsis?

Answer 4

Systemic, damaging inflammatory response to infection

(maladaptive response)

Question 5

Sepsis is associated with organ ___.

Answer 5

failure

Question 6

In sepsis, the host’s response to infection is (strictly regulated / dysregulated).

What happens as a result of this?

Answer 6

Dysregulated

Organ failure

Question 7

What is septic shock?

Answer 7

People with sepsis who have circulatory and metabolic dysfunction

Question 8

infection (sepsis (septic shock))

Question 9

What name is given to infections which present in a non-specific way e.g endocarditis?

Answer 9

Occult

Question 10

Different infections correspond to different ___.

Answer 10

immunodeficiencies

Question 11

The peritoneal cavity is usually ___.

Answer 11

sterile

Question 12

Why does peritonitis occur?

Answer 12

Leakage of bowel contents into peritoneal cavity

Question 13

infection symptoms & signs

Question 14

SOFA score used in ICU to score patient’s sepsis

Question 15

qSOFA score for sepsis prognosis

Question 16

SIRS score

Question 17

Criteria for sepsis:

Infection + 2 or more of the 4 criteria

Question 18

SIRS is not exclusive to infection, also caused by trauma, burns, pancreatitis

Infection + 2+/4 SIRS –> sepsis

2+/4 SIRS but no infection –> not sepsis

Question 19

Septic shock = Infection + SIRS + at least one acute organ dysfunction

Question 20

What samples can be sent to Microbiology to identify the organism causing infection?

Answer 20

Blood samples

Stool samples

(urine/sputum/biopsy…)

Question 21

management of sepsis

Question 22

antibiotics to cover:

enterococci

coliforms (E. coli + ___)

anaerobes (Bacteroides, Clostridium + ____)

Question 23

organisms found in the mouth

neisseria

candida

strep viridans

Question 24

casual organisms for sepsis depend on where the perforation is

Question 25

Sepsis mortality rate depends on the time taken to administer ___.

Answer 25

antibiotics

Question 26

Gentamicin is nephrotoxin and can make you deaf so there are strict guidelines for it

Question 27

Sepsis 6

1. Give high flow oxygen (spo2 between 94-98%)
2. Fluid resuscitation (500ml saline)
3. Take blood cultures (and other relevant cultures: urine, wounds, sputum)
4. Give antibiotics
5. Measure lactate and FBC (elevated lactate is an indicator of tissue death)
6. Monitor hourly urine output (indicative of kidney function)

Question 28

amoxicillin + gentamin + metranidazole IV