Generic Info on Infectious Diseases

Question 1

Discuss the 10 point approach to a pt with an infection (10 things you must consider when deciding how to treat the pt)

Answer 1

1. What is evidence for infection?
2. How severe is infection
3. Any pt factors to consider e.g. immunocompromise, travel, drugs, co-morbidities
4. Which body system/organ is affected
5. Which microorganism may be involved
6. What antimicrobial therapy is best
7. What route of administration is best
8. Any other treatment needed e.g. sepsis 6, analgesia, insulin, surgery, medication alterations etc…
9. Is there a risk of transmissin to others?
10. What planning is required fro follow up and discharge?

Question 2

Remind yourself of the difference/definitions of:

• Sepsis
• Septic shock

Answer 2

• Sepsis: life threatening organ dysfunction due to dysregulated host response to infection
• Septic shock: a subset of sepsis with profound circulatory, cellular and metabolic abnormalities associated iwth greater risk of mortality than sepsis alone. (Oxford handbook also describes it as lack of response to fluid resuscitation leading to lactate >2mmol/L or vasopressors being required to keep MAP >64mmHg)

Question 3

Remind yourself of the red flags of sepsis

Answer 3

Question 4

What antibiotic, and what dose, is given as part of sepsis 6?

Answer 4

• Meropenem IV 1g STAT
• +/- Second dose at 8hrs
• Consultant to review pt. Seek microbiology advice to see if more specific antibiotic can be used following results of blood cultures

Question 5

When should you refer a pt, with sepsis, to the critical care team? (4)

Answer 5

• SBP <90mmHg and lactate >2mmol/L after fluid resuscitation
• Has red flag sepsis and lactate >4mmol/L
• Has red flag sepsis and requires >50% O2
• Has red flag sepsis and significatn respiratory/cardiovascular/CNS or renal dysfunction