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A13AMC @ UoN > L19 - Bloodstream Infections & Serious Sepsis > Flashcards

L19 - Bloodstream Infections & Serious Sepsis Flashcards

1
Q

Define sepsis

A

A systemic inflammatory response to inflammation caused by microbial invasion of normally sterile parts of the body

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2
Q

What is the clinical definition of sepsis?

A 
Clinical suspicion/evidence of infection + evidence of a systemic response - 2 or more of:
Temp >38 OR <36
HR >90
RR >20 OR pCO2 <4.2kPa
WBC >12*10^9/L OR <4*10^9/L
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3
Q

What are the systemic symptoms that may suggest sepsis?

A

Temp >38 OR <36
HR >90
RR >20 OR pCO2 <4.2kPa
WBC >1210^9/L OR <410^9/L

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4
Q

Define severe sepsis

A 
Sepsis with organ dysfunction
Hypotension (Sys <90mmHg)
Lactic acidosis
Oliguria
Confusion
Liver dysfunction
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5
Q

What is the mortality of severe sepsis?

A

30-50%

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6
Q

Define septic shock

A

Severe sepsis w/ hypotension despite adequate fluid resuscitation

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7
Q

What is the mortality of septic shock?

A

50-60%

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8
Q

Define bacteraemia

A

Presence of micro-organisms in bloodstream

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9
Q

Define septicaemia

A

Bacteraemia AND sepsis

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10
Q

Describe the pathogenesis of sepsis

A

Bacteria release endotoxins (G-) or exotoxins (G+)
Activates macrophages
Release of inflammatory mediators
Endothelial damage - Extravasation of fluid, decreased BV/albumin, DIC
Poor tissue perfusion + poor lung function

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11
Q

Define SIRS

A

Systemic Inflammatory Response Syndrome

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12
Q

What non-infective causes are there of SIRS?

A 
Trauma
Burns
Haemorrhage
Pancreatitis
Toxins
(Cytokine release key)
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13
Q

What are the principle pathogens causing Sepsis? - Community

A 
Escherichia coli
Strep. pneumoniae
Staph. aureus
Neisseria. meningitidis
Streptococci, Gram- bacilli
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14
Q

What are the principle pathogens causing Sepsis? - Hospital

A 
S. aureus
E. coli
Klebsiella spp.
Coag- staph
Pseudomonas aeruginosa
Candida spp.
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15
Q

What are the common syndromes leading to Community-acquired Sepsis?

A 
UTI/Pyelonephritis
Pneumonia
Meningitis
Skin/soft tissue infections
Intra-abdominal sepsis
Infective endocarditis
Bone/Joint infection
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16
Q

Describe infective endocarditis

A

Infection of the cardiac endothelium (valves)

High morbidity/mortality

17
Q

What are the risk factors for endocarditis?

A 
Damage to heart tissue:
Valvular heart disease
i.v. drug use
Central venous lines
Prosthetic heart valves
Implantable cardiac devices
18
Q

What are the causative organisms of endocarditis?

A 
S. aureus
Viridans streptococci
Enterococci
HACEK organisms
Coag- staph (PVE)
19
Q

How does infective endocarditis present?

A

Typically w/ new murmur and febrile illness

Echogardiography shows vegetations

20
Q

How is infective endocarditis diagnosed?

A

Multiple blood cultures

IE causes continuous bacteraemia

21
Q

What is the treatment for infective endocarditis?

A

High dose, targeted i.v. antibiotics

Surgery

22
Q

What are the main sources of Hospital Acquired Sepsis?

A 
Lines (peripheral/central)
Urinary catheters
LRTIs
Wound infections
Abdominal sepsis
Instrumentation (ERCP/TURP)
23
Q

What are the clinical signs for diagnosis of sepsis?

A 
Temp >38 or <36
Rigors
Tachycardia
Hypotension (early in Gram-)
Hypoxia, Oliguria (later)
Physical signs of source/organism
24
Q

What laboratory tests should be performed when diagnosing sepsis?

A

FBC
Clotting tests
CRP (inflammation)
Lactate (>4 suggests poor prognosis)

25
Q

What microbiology tests should be performed when diagnosing sepsis?

A 
2 Blood cultures
Urine
Samples from specific sites:
Pus
CSF
Joint Aspirate
Sputum
26
Q

What is the management of Sepsis?

A 
ABC - Oxygen/Fluid resuscitation
Mechanical ventilation, vasopressors
Monitor hourly urine output (AKI)
Antibiotic to cover likely organisms (w/i 1 hour admission)
Source control
27
Q

What is a good starting antibiotic for sepsis?

A

Tazocin (Piperacillin/Tazobactam)

28
Q

What guides antibiotic therapy in treating Sepsis?

A 
Likely source
Previous microbiology
Sensitivity results
Severity
Underlying disease/immunity
29
Q

What are the risk factors for resistant organisms?

A 
Prev. isolation of organism
Frequent admissions
Prolonged stay on ICU
Hospital stay overseas
Nursing home resident
Prev. antibiotic use
30
Q

What treatment should be given when treating resistant bacterial strains?

A

i.v. Vancomycin

31
Q

What steps should be taken when following up after sepsis?

A 
Review to determine source
Potential for recurrence
Consideration of endovascular focus (continuous bacteraemia)
Review CRP/ESR response
Monitor renal/liver function

A13AMC @ UoN (20 decks)

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