Infections - sepsis

Question 1

what is one of the leading causes of death in children?

Answer 1

Severe sepsis

Question 2

what age is the peak incidence of sepsis?

Answer 2

Infants <1y: 1 in 200
Children 1-4y: 1 in 2000
Children 5-15y: 1 in 5000

Question 3

What is sepsis?

Answer 3

SIRS + suspected or proven infection

Question 4

What is Severe Sepsis ?

Answer 4

Sepsis + organ dysfunction

Question 5

What is Septic Shock ?

Answer 5

Sepsis + CVS dysfunction

Question 6

what are features of SIRS (4)

• you need 2 or more of these

Answer 6

> 38C or < 36C (temp)

• WCC = 15 x 109/L or <5 x 109/L

Tachycardia
>2SD above normal for age

Tachypnoea
>2SD above normal for age

Question 7

List some high risk symptoms

Answer 7

pale/blue

• no response to social cues
• does not stay awake or wake up when roused
• weak-high pitched cry
• grunting
• tachypnoea RR>60 breaths
• chest indrawing
• reduced skin turgor
• age < 3 months, temp >38
• non-blaching rash
• bulging fontanelle
• neck stiffness
• status epilepticus
• focal neuro signs and seizures

Question 8

more immediate risk symptoms?

Answer 8

• nasal flaring
• tachypnea >50
• crackles in chest
• tachycardia >160
• dry mucous membranes
• poor feeding
• reduced urine output
  riggers
• swelling of limbs

Question 9

what is the sepsis 6 in a child?

Answer 9

temperate <36 or >38
tachycardia
poor peripheral perfusion - cap refill >2 seconds
- altered mental state
tachypnoea 
hypotension

Question 10

who might be at risk of sepsis?

Answer 10

infants less than 3 months 
immunocompromised 
recent surgery
lines/indwelling devices
complex neurodisability
clinical suspicion

Question 11

How to quickly manage sepsis?

• what do you add if they are less than 1 month old?

Answer 11

• OXYGEN
• IV access, blood glucose, blood lactate , cultures
• IV or oral Anti b’s - broad spectrum -
• Cefotaxime/Ceftriaxone)
  add IV Amoxicillin if <1m old

Question 12

why are infants less than 3 months more likely to get sepsis?

Answer 12

• Increased risk bacterial infection
• Increased risk sepsis
• Increased risk meningitis
• May have minimal signs & symptoms
• Presentation often non-specific
• May not mount a febrile response (~50%)
• Deteriorate quickly

Question 13

what features in an infant history makes them more at risk of sepsis?

Answer 13

• Prematurity (< 37/40)
• PROM
• Maternal pyrexia/chorioamnionitis
• Maternal GBS (this pregnancy)
• Previous child with GBS
• Maternal STI (Chlamydia,
• Gonorrhoea, Syphilis, HSV)

Question 14

steps 4 and 5 in management?

Answer 14

fluids - 20mls/kg crystalloid

inotropic

Question 15

what must you not forget in initial management?

Answer 15

GLUCOSE

• 2ml/kg 10% dextrose

Question 16

investigations for sepsis include? BLOODS

Answer 16

FBC (leukocytosis, thrombocytopaenia)
CRP
Coagulation screen (DIC)
Blood gas (metabolic acidosis, raised lactate)
Glucose
Blood culture

Question 17

investigations for sepsis include? CULTURES

Answer 17

Blood
Urine
CSF (including send to virology)
+/- stool (micro + virology)

Question 18

investigations for sepsis include? - IMAGING

Answer 18

CXR

Question 19

Most common organisms causing sepsis in neonates <1 month ? (3)

Answer 19

Group B Streptococcus
Escherichia coli
Listeria monocytogenes

Question 20

Most common organisms causing sepsis in older infants and children? (4)

Answer 20

Streptococcus pneumoniae
Neisseria meningitidis
Group A Streptococcus
Staphylococcus aureus

Question 21

what are the 5 stages in the pathogenesis of sepsis?

Answer 21

• Secretion of pro and anti-inflammatory cytokines
• Activation of complement
• Activation and mobilisation of leukocytes
• Activation of coagulation and inhibition of fibrinolysis
• Increased apoptosis