[72] Sepsis

Question 1

What is sepsis?

Answer 1

A life-threatening condition that arises when the body’s response to infection causes injury to it’s own tissues and organs

Question 2

What causes sepsis?

Answer 2

Bacterial proliferation in the blood stream leading to over reactive host response

Question 3

What parts of the immune response can lead to sepsis?

Answer 3

Release of inflammatory cytokines and activation of endothelial cells

Question 4

What are the most common causative organisms of sepsis in children in the UK?

Answer 4

• Coagulase negative Staph
• Staph aureus
• Non-pyogenic streptococci
• Streptococci pneumoniae

Question 5

Why are infections with H. Influenzae, meningococcus and pneumococcus becoming less common?

Answer 5

Due to immunisation against these organisms

Question 6

What is the most common cause of earl onset sepsis in neonates?

Answer 6

Group B strep and E. coli

Question 7

What is the most common cause of late-onset sepsis in neonates?

Answer 7

Coagulase negative staphylococcus

Question 8

What are the risk factors for developing sepsis?

Answer 8

• Sickle cell disease

- Immunodeficiency

Question 9

What are the general symptoms of sepsis in children?

Answer 9

• Poor feeding
• Miserable
• Lethargy
• Irritable

Question 10

What are the signs of sepsis?

Answer 10

• Fever
• Tachycardia
• Tachypnoea
• Low BP
• Signs of shock and multi-organ failure

Question 11

What may be an important indicator of sepsis?

Answer 11

History or signs of an ongoing infection

Question 12

What is a common sign of meningococcal septicaemia?

Answer 12

Purpuric, non-blanching rash

Question 13

What pathway is important to follow in Sepsis management?

Answer 13

Sepsis 6

Question 14

What is the sepsis 6?

Answer 14

• Antibiotics
• Oxygen
• Fluids
• Measure urine output
• Blood cultures
• Serum lactate

Question 15

What blood tests should be performed in suspected sepsis?

Answer 15

• Blood gas, lactate and glucose
• Blood culture
• FBC
• CRP
• Urea and electrolytes
• Creatinine
• Clotting screen (in high risk patients)

Question 16

How should examination and further investigations be influenced?

Answer 16

By possible sources of infection

Question 17

What further investigations could be considered?

Answer 17

• Urinalysis
• CXR
• Abdo and pelvis imaging

Question 18

What influences the antibiotic of choice?

Answer 18

• Child’s age

- Predisposition to infection

Question 19

What should be given in suspected meningococcal disease?

Answer 19

IV ceftriaxone

Question 20

For community acquired sepsis what antibiotic should be used?

Answer 20

Ceftriaxone 80mg/kg/day (maximum dose 4g daily)

Question 21

For hospital acquired sepsis (except neonates) what antibiotic should be used?

Answer 21

Check local guidelines

Question 22

What additional antibiotic should be given in children under 3 months?

Answer 22

Amoxicillin

Question 23

Why is amoxicillin also given in children under 3 months?

Answer 23

To have activity against listeria

Question 24

How should fluids be administered in sepsis?

Answer 24

IV bolus

Question 25

What should be done after administering initial IV fluid bolus?

Answer 25

Assess need for second bolus

Question 26

What should you do if no response to second IV bolus?

Answer 26

Get senior help

Question 27

What may be needed to asses the fluid balance?

Answer 27

• Central venous pressure monitoring

- Urinary cathaterisation

Question 28

When should oxygen be given to children with sepsis?

Answer 28

• Sats < 92% when breathing air

- Signs of shock