B2 W2 - Severe Infection and Sepsis

Question 1

What is the definition of infection?

Answer 1

Infection is defined as the invasion and multiplication of pathogenic microbes in an area of the body where they are not normally present, which normally leads to disease.

Question 2

What does SIRS stand for, and what is it?

Answer 2

SIRS stands for systemic inflammatory response syndrome. It is an inflammatory response to infection or a non-infectious insult that affects the whole body.

Question 3

How was sepsis defined in 1991?

Answer 3

Sepsis was defined as the situation where the body’s response to infection causes injury to its own tissues and organs.

Question 4

What are the criteria for severe sepsis according to the 1991 definition?

Answer 4

Severe sepsis was defined as sepsis (infection plus SIRS) along with organ dysfunction.

Question 5

What characterises septic shock?

Answer 5

Septic shock is a severe form of sepsis characterised by low blood pressure despite fluid administration, along with perfusion abnormalities.

Question 6

What are some examples of perfusion abnormalities in septic shock?

Answer 6

Perfusion abnormalities include reduced conscious level, decreased urine output, and lactic acidosis.

Question 7

Why was the SIRS definition updated in 2001?

Answer 7

The SIRS definition was updated to include additional parameters found to be linked with sepsis through data analysis.

Question 8

What two parameters were added to the SIRS definition in 2001?

Answer 8

Blood glucose (excluding patients with diabetes) and altered mental status were added to the SIRS definition.

Question 9

What is a “red flag” feature in the context of sepsis?

Answer 9

“Red flag” features are clinical signs that indicate a high likelihood of severe sepsis, such as a purpuric rash, extremely high heart rate, or very low blood pressure.

Question 10

How was the definition of sepsis redefined in 2016?

Answer 10

The 2016 definition shifted focus to organ dysfunction and poor prognosis, aligning more with what was previously termed “severe sepsis”.

Question 11

What is the key qualitative definition of sepsis according to the 2016 guidelines?

Answer 11

Sepsis is defined as “a life-threatening organ dysfunction due to a dysregulated host response to infection”.

Question 12

How is septic shock defined in the 2016 guidelines?

Answer 12

Septic shock is a subset of sepsis where profound circulatory, cellular, and metabolic abnormalities significantly increase mortality.

Question 13

What is the SOFA score?

Answer 13

The SOFA score is a comprehensive scoring system used in intensive care to identify organ dysfunctionin sepsis.

Question 14

What does qSOFA stand for, and what is its purpose?

Answer 14

qSOFA stands for quick SOFA. It is a bedside score using respiratory rate, altered cognition, and low blood pressure to identify patients with suspected infection who are likely to have poor outcomes.

Question 15

What are the three criteria used in the qSOFA score?

Answer 15

The qSOFA score assesses respiratory rate, mental status (using the Glasgow Coma Scale), and systolic blood pressure.

Question 16

What are some severe infections that can potentially lead to sepsis?

Answer 16

Severe infections that can lead to sepsis include meningitis, encephalitis, pneumonia, infective endocarditis, pyelonephritis, cellulitis, necrotizing fasciitis, and septic arthritis.

Question 17

What is the Sepsis Six?

Answer 17

The Sepsis Six is a bundle of care measures that should be implemented quickly for patients with suspected sepsis.

Question 18

List the six components of the Sepsis Six.

Answer 18

The Sepsis Six includes: (1) High-flow oxygen, (2) Blood cultures, (3) Empirical antibiotics, (4) Full blood count and lactate measurement, (5) Intravenous fluid resuscitation, (6) Accurate urine output measurement.

Question 19

What should be done if a patient doesn’t respond to the Sepsis Six?

Answer 19

If a patient does not respond to the Sepsis Six, the critical care team should be contacted for further management.

Question 20

What are some concerns regarding the heightened awareness of sepsis?

Answer 20

There are concerns that sepsis awareness has led to an overdiagnosis of sepsis and overuse of antibiotics in patients without confirmed infection.

Question 21

What potential negative consequences can arise from the overuse of antibiotics?

Answer 21

Overuse of antibiotics can lead to diagnostic difficulties by suppressing microbial growth and contribute to the development of antibiotic resistance.

Question 22

What is Early Goal-Directed Therapy (EGDT) and when is it used in sepsis management?

Answer 22

EGDT is a more intensive treatment approach used in sepsis when a patient does not respond to the initial Sepsis Six bundle. It involves close monitoring of central venous pressure and may necessitate the use of vasopressors and inotropes to stabilise blood pressure and support heart function.

Question 23

Explain the role of steroids in treating sepsis.

Answer 23

While steroids are immunosuppressants, they can be beneficial in certain sepsis cases where the body’s overwhelming inflammatory response is causing more harm than good. Steroids help to dampen this excessive inflammation. They have proven to be particularly effective in improving the prognosis of COVID-19 patients experiencing severe sepsis-like complications.

Question 24

Why are local sepsis protocols and antibiotic guidelines important?

Answer 24

Local guidelines are essential because they are tailored to the specific hospital environment, taking into account factors like local patterns of antimicrobial resistance. This ensures that patients receive the most appropriate empirical antibiotics even before a definitive microbiological diagnosis is confirmed.

Question 25

What are “sepsis sniffers” and what is their function?

Answer 25

“Sepsis sniffers” are technological systems used in some hospitals to continuously monitor patients’ vital signs, such as fever, heart rate, and blood pressure. They are designed to trigger an alert to the medical team if a patient’s vital signs suggest they may be developing sepsis, allowing for early intervention.

Question 26

What is a Sepsis Response Team (SRT) and what is its role in managing sepsis?

Answer 26

A SRT is a specialised multidisciplinary team, often found in hospitals, dedicated to quickly responding to suspected sepsis cases. When alerted, the SRT can promptly assess the patient, initiate the Sepsis Six bundle, and provide aggressive resuscitation measures as needed.

Question 27

What are some concerns related to the overemphasis on sepsis awareness?

Answer 27

While increased awareness is crucial for early sepsis detection, there’s a worry that the heightened focus has led to overdiagnosis and potentially unnecessary antibiotic use in patients who may not have true sepsis. This overuse can make it difficult to obtain accurate microbiological diagnoses and contributes to the rise of antibiotic resistance.

Question 28

Describe the quantitative criteria used to define Systemic Inflammatory Response Syndrome (SIRS) in 1991.

Answer 28

To meet the SIRS definition in 1991, a patient needed to exhibit two or more of the following criteria:Temperature: Greater than 38°C or less than 36°CHeart Rate: Greater than 90 beats per minuteRespiratory Rate: Greater than 20 breaths per minute or PaCO2 less than 32 mmHgWhite Blood Cell Count: Greater than 12,000/mm3, less than 4,000/mm3, or more than 10% immature bands

Question 29

What are the organs particularly susceptible to dysfunction in severe sepsis?

Answer 29

Severe sepsis can lead to dysfunction in many organs, but these are particularly vulnerable:Kidneys: Acute kidney injury can occur, impairing the kidneys’ ability to filter waste and regulate fluids.Lungs: Adult respiratory distress syndrome (ARDS) can develop, leading to severe breathing difficulties and low blood oxygen levels.Cardiovascular System: Both the heart and blood vessels can be affected, potentially resulting in septic shock—a life-threatening condition characterized by a dangerous drop in blood pressure and inadequate blood flow to vital organs.

Question 30

What is the most common cause of sepsis globally, and what challenge does it pose in a UK context?

Answer 30

Malaria is the leading cause of sepsis worldwide.This presents a challenge in the UK because standard sepsis protocols, which often focus on bacterial infections, may not be entirely applicable to patients with malaria.

Question 31

Explain each step of the Sepsis Six bundle and its purpose.

Answer 31

The Sepsis Six is a set of interventions designed to rapidly stabilize patients with suspected sepsis:High-flow oxygen: Administering high-flow oxygen helps increase the amount of oxygen in the bloodstream, combating the tissue hypoxia (lack of oxygen) that is a key feature of sepsis.Blood cultures (two sets from different sites): Taking blood cultures from two separate sites helps ensure that at least one sample remains uncontaminated, increasing the chances of identifying the causative microorganism. However, results typically take 24-48 hours.Empirical antibiotics: Broad-spectrum antibiotics are given as soon as possible, even before culture results are available. This empirical approach aims to cover a wide range of potential pathogens while awaiting a definitive diagnosis.Full blood count and lactate measurement: These tests provide valuable information about the severity of the inflammatory response and the degree of tissue hypoperfusion. An elevated lactate level indicates anaerobic respiration, a sign of inadequate oxygen delivery to the tissues.Intravenous fluid resuscitation: Rapid intravenous fluid administration helps address hypovolemia (low blood volume), a common problem in sepsis. Even if the patient doesn’t have low blood pressure, fluid resuscitation is important.Accurate urine output measurement: Close monitoring of urine output, often requiring a urinary catheter, provides crucial information about kidney function. The kidneys are particularly susceptible to damage in sepsis, making urine output a sensitive indicator of organ dysfunction.

Question 32

Outline the concerns raised about the potential overemphasis on sepsis awareness, particularly regarding antibiotic use.

Answer 32

While raising sepsis awareness is crucial for early detection and treatment, there is a growing concern that this has led to a degree of “sepsis hysteria,” as described by sepsis expert Mervyn Singer.Singer argues that this heightened focus may result in the overdiagnosis of sepsis and the inappropriate administration of antibiotics to patients who do not truly have the condition.He specifically challenges the recommendation that antibiotics should be given within one hour of presentation for all suspected sepsis cases, citing a lack of strong evidence to support this practice.Excessive antibiotic use has several negative consequences:It can hinder accurate microbiological diagnosis because antibiotics can suppress bacterial growth, making it difficult to identify the causative organism in cultures.It contributes significantly to the growing problem of antibiotic resistance, as overuse promotes the development and spread of resistant bacteria.