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BDS2 BAMS Immunology > 6. Sepsis and Infective Endocarditis > Flashcards

6. Sepsis and Infective Endocarditis Flashcards

1
Q

Definition of bacteraemia

A

Transient presence of bacteria in the bloodstream

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2
Q

Definition of septicaemia

A

Persistent presence of bacteria in the bloodstream with attendant signs and symptoms

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3
Q

Definition of sepsis

A

Infection and SIRS

SIRS with a presumed/confirmed infectious process

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4
Q

Definition of SIRS

A

Systemic inflammatory response syndrome

A clinical response arising from a non-specific insult

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5
Q

Clinical features of SIRS (4)

A

Temperature <36C or >38C
HR/pulse >90bpm
Respiratory rate >20bpm or PaCO2 < 4.3pKa
WCC <4,000cells/mm3 or >12,000cells/mm3

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6
Q

Types of sepsis (3)

A

Sepsis
Severe sepsis
Septic shock

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7
Q

Definition of severe sepsis

A

Sepsis with one or more signs of organ dysfunction/failure (includes microvascular opening/rash)

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8
Q

Types of organ failure (7)

A 
Cardiovascular (refractory hypotension)
Renal
Respiratory
Hepatic
Haematological
CNS
Metabolic acidosis
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9
Q

Definition of septic shock

A

Sepsis plus shock refractory to fluid resuscitation

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10
Q

What is sepsis (2)

A

Uncontrolled, unregulated, self-sustaining intravascular inflammation
Involves a cytokine storm

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11
Q

Definition of cytokine storm (2)

A

Unregulated simultaneous release of pro-inflammatory and anti-inflammatory elements out of balance
Extending to otherwise normal tissue

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12
Q

Reactions to sepsis

A

Endothelial damage
Microvascular dysfunction
Impaired tissue oxygenation
Organ injury

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13
Q

Gram negative septicaemia clinical features result from

A

Endotoxin release

Mainly hospital-acquired (E. coli)

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14
Q

Gram positive septicaemia clinical features result from

A

Teichoic acid and peptidoglycan from cell wall

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15
Q

Sources of infection (4)

A

Skin
Respiratory tract
Bone/joint infections
Oral cavity

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16
Q

Who does fungal septicaemia affect

A

Immunosuppressed hosts (disease of the diseased)

17
Q

Septicaemia treatment (3)

A

Aggressive early treatment (IV antibiotics, oxygen, blind empirical antibiotics)
Modify treatment when culture available
Identify and remove source

18
Q

Septicaemia diagnosis (4)

A

Blood cultures
Cultures of other infected sites
Detection of microbial products in serum
Molecular methods (PCR)

19
Q

Sepsis 6 (6)

A 
Give O2 to keep SATS >94%
Take blood cultures
Give IV antibiotics
Give fluid challenge
Measure lactate
Measure urine output
20
Q

Sepsis 6 - Why should you give O2 to keep SATS >94%

A

To maintain oxygen supply to organs, decreasing risk of failure

21
Q

Sepsis 6 - Why should you take blood cultures

A

To identify source of infection and pathogen causing it

22
Q

Sepsis 6 - Why should you give IV antibiotics

A

To get rid of the infection-causing pathogen

23
Q

Sepsis 6 - Why should you give fluid challenge

A

Maintain hydration - challenge patient to drink certain amount

24
Q

Sepsis 6 - Why should you measure lactate

A

Measurement of tissue dysfunction

25
Q

Sepsis 6 - Why should you measure urine output

A

Measurement of metabolism of tissue and organs (urea conc.)

26
Q

Definition of infective endocarditis

A

Microbial infection of the endothelial lining of the heart

27
Q

Manifestation of infective endocarditis

A

Vegetations on heart valves, involves microbial colonisation of thrombi on surface irregularities

28
Q

What does infective endocarditis cause

A

Haemodynamics and blood flow of heart to change, allowing bacteria to enter blood and accumulate in valves

29
Q

Treatment of infective endocarditis

A

Surgical valve removal and prosthetic heart valve insertion

30
Q

Problems with prosthetic heart valve

A

More suitable site for pathogens to adhere to

31
Q

Infective endocarditis portals of entry (3)

A

Oral cavity
Skin breach
Haematological spread

32
Q

Patients at higher risk of infective endocarditis (6)

A 
Acquired valve disease
Prosthetic valve
Structural congenital heart disease
Previous endocarditis
Hypertrophic cardiomyopathy
Recurrent bacteraemia
33
Q

Infective endocarditis diagnosis (4)

A

Clinical signs
Blood cultures (x3 over 24hrs)
Echocardiography
DUKE criteria (positive micro blood cultures, evidence of endocardial involvement)

34
Q

Infective endocarditis antimicrobial treatment (4)

A

Broad-spectrum initially, guide by lab results
Consider multiple drug combo
Monitor drug levels
Cardiac monitoring

BDS2 BAMS Immunology (10 decks)

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