Infection/Sepsis Flashcards by a pov

the presence of a microbe in the human body without an inflammatory response

colonisation

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inflammation due to a microbe

infection

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the presence of a viable bacteria in the blood

bacteraemia

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dysfunction caused by a dysregulated host response to infection

sepsis

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is a subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality

septic shock

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general signs/symptoms of sepsis

local 
pain
tenderness
guarding
blood PR in some
systemic:
fever
chills or rigors
nausea/vomiting
constipation or diarrhoea
malaise - anorexia

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how does peritonitis occur

peritoneal cavity normally sterile, leakage of bowel contents results in peritonitis

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what can peritonitis be secondary to

perforated duodenal ulcer, appendix, diverticulum, tumour

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SOFA score

to assess for organ dysfunction due to sepsis (inc resp, cardio, renal dysfunctions)

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qSOFA

assesses for mortality rather than diagnosis

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what is the SIRS criteria

and what can it also be caused by?

temp >38 or <36
HR >90/min
RR >20/min or PaCO2 <32mmhg
WBC >12000 or <4000
when two or more criteria are present

trauma, burns, pancreatitis
pneumonia
UTI

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how does infection lead to septic shock

colonisation -> infection -> SIRS (mortality 5-10%) -> sepsis -> septic shock

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how is septic shock decided

sepsis plus signs of at least one acute organ dysfunction (renal, resp, hepatic, haematological, CNS, unexplained, CV- sepsis with hypotension refractory to adequate volume resuscitation

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how is diagnosing infection done

microbiology, WCC, CRP, platelets/clotting
radiology
serology
PCR

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what are the bacteraemia sources in the community

E. coli (urine, abdomen)
S.pneumoniae (resp)
s.aureus (usually MSSA - skin)

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what are the bacteraemia sources in the hospital

E.coli ( catheter related or abdomen) 
S.aureus (usually MRSA- line or wound related)
CNS (line/prosthesis related)
Enterococci (urine, wound, line)
Klebsiella  (urine, wound)
Pseudomonas spp,.

E. coli and similar organisms that inhabit the large bowel, such as Klebsiella sp., Proteus sp., Enterobacter sp.,
Serratia sp. etc.

coliforms

Organisms that grow better with oxygen, but can also grow without it, e.g. staphylococci, streptococci, enterococci and coliforms (i.e.the majority of human pathogens)

aerobic organisms

Organisms that require oxygen for growth, such as Pseudomonas sp.

strict aerobes

Organisms that WILL NOT grow in the presence of oxygen, such as Clostridium sp., Bacteroides sp., and anaerobic cocci
Present in large numbers in the large bowel

strict anaerobes

infection management

Antibiotic Management 
Supportive management : 
FLUIDS
ANALGESIA
NEED FOR SURGERY : EXPLORATION, INCISION-EXCISION AND DRAINAGE ETC 
VTE PROPHYLAXIS
O2 
CONTROL OF ELECTROLYTE BALANCE
NEED FOR TRANSFUSION

what are the 9 steps in antimicrobial therapy of serious infections

What is the likely source of infection and severity?
Based on assessment of likely source most likely pathogen/s?
Risk assessment of community vs healthcare acquired infection
Risk assessment of likelihood of antibiotic resistance
Bactericidal activity (some static drugs with good tissue penetration do well)
Non-toxic, well-tolerated
Route of administration: Parenteral administration, at least initially
Duration. Usually 7-14 days – if complicated longer 4—6 weeks
Low risk of C.difficile, especially in elderly patients

intra-abdominal treatment anaerobes

metronidazole

intra-abdominal treatment streptococci and enterococci

amoxicillin

intra-abdominal treatment aerobic coliforms

gentamicin

why is clindamycin avoided in intra-abdominal infections

risk of C. difficile infection

what would you treat for amoxicillin resistant strept, enterococci (RARE)

vancomycin

how are abscesses managed

large abscesses have no blood supply therefore antibiotic dont work well to penetrate skin, small ones can be treated with antibiotics but large need incision and drainage

symptoms of sepsis

are nonspecific: -specific to an infectious source (eg, cough and dyspnea may suggest pneumonia, pain and purulent exudate in a surgical wound may suggest an underlying abscess). - Arterial hypotension (eg, systolic blood pressure [SBP] <90 mmHg, mean arterial pressure [MAP] <70 mmHg, an SBP decrease >40 mmHg, or less than two standard deviations below normal for age). Because a sphygmomanometer may be unreliable in hypotensive patients, an arterial catheter may be needed - Temperature >38.3 or <36ºC. - Heart rate >90 beats/min or more than two standard deviations above the normal value for age. - Tachypnea, respiratory rate >20 breaths/minute.

Signs of end-organ perfusion:

Warm, flushed skin may be present in the early phases of sepsis. As sepsis progresses to shock, the skin may become cool due to redirection of blood flow to core organs. Decreased capillary refill, cyanosis, or mottling may indicate shock. •Additional signs of hypoperfusion include altered mental status, obtundation or restlessness, and oliguria or anuria. •Ileus or absent bowel sounds are often an end-stage sign of hypoperfusion.

There are no universally accepted criteria for individual organ dysfunction in MODS. However, progressive abnormalities of the following organ-specific parameters are commonly used to diagnose MODS and are also used in scoring systems to predict ICU mortality. organ dysfunction signs are:

Respiratory – Partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio Haematology – Platelet count Liver – Serum bilirubin Renal – Serum creatinine (or urine output) Brain – Glasgow coma score Cardiovascular – Hypotension and vasopressor requirement

how is sepsis recognised in an emergency

central crushing chest!!!! pain FAST MES >4 and SIRS

how do we treat sepsis?

``` recognised (NEWS), resuscitate with BUFALO, refer to consultant B - take blood cultures U - monitor urine output F - start IV fluid resuscitation A - give IV antibiotics L - check lactate O - given oxygen to target saturation ```