Lecture 16 - Sepsis Flashcards
Define sepsis
Systemic illness caused by microbial invasion of normally sterile parts of the body
What predisposes sepsis? (2)
- some primary immunodeficiencies can predispose
- immune deficiencies e.g. Illness or immunosuppressive drugs.
Physical signs of sepsis
Temp >38
HR >90
Rr > 20 or pCO2
WBS > 12 x10^9 or below 4
What is severe sepsis and what are the Physical signs
1- sepsis with Organ dysfunction 2- hypotension under 90 Lactic acidosis Oliguria Confusion Liver dysfunction
What is septic shock?
Seer sepsis with hypotension despite adequate fluid resuscitation
what are endotoxins and exotoxins ?
Endo released by gram negative bacteria Exo released by gram positive
Describe the pathogenesis of sepsis
- Bacteria release toxins which activates macrophages to release inflammatory mediators.
- these damage the endothelium allowing neutrophils and albumin into tissue
- fluid follows decreasing blood pressure
- low perfusion to organs and poor lung function
- disseminated intravascular coagulation causing low platelets
What is SIRS and what can it be caused by?
Systemic inflammatory response syndrome. Can be caused by cytokines release
- trauma
- burns
- haemorrhage
- pancreatitis
- toxins
Name some organisms that can cause community acquired sepsis
E. coli S pneumoniae S aureus Other strep Other gram negs N meningitidis
Name to common causes of hospital acquired sepsis
S aureus E. coli Klebsiella sp CNS Pseudo Candida sp.
Name some common syndromes associated with community acquired sepsis
- uTi / pyelonephritis ( common young females, elderly ,catheters )
- pneumonia
- meningitis
- skin / soft tissue infections
- intro abdo sepsis ( perforated viscous and cholangitis )
- infective endocarditis
- bone and joint infections
Mortality associated with 1) severe sepsis 2) septic shock
Sever - 30-50%
Septic shock 50-60%
What is infective endocarditis ?
- Infection of the cardiac endothelium (usually heart valves)
high mortality and morbidity
name some risk factors for endocarditis
underlying valvular heart disease, intravenous drug use, indwelling central venouse lines, prosthetic heart valves, implantable cardiac devices
Which organisms have a propensity to cause infective endocarditis (and prosthetic valve endo)
- s aureus, viridans strep, enterococci, HACEK
- less common= fungi, and non-culterable bacteria
- (prosthetic is same and CNS)
