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)
presentation of infective endocarditis
New murmer and febrile illness
complications e.g. embolism (stoke)
classic signs e.g. oslers nodes (dont see as much any more)
echocardiography may show vegitations
Treatment for invasive endocarditis (2)
high dose IV antibiotics
surgery - valve replacement may be required
Name some possible infections causing hospital acquired sepsis
lines peripheral and central, urinary catheters, LRTIs, wound infections, abdo sepsis
symptoms of sepsis
- temp >38 or below 36
- rigors
- tachycardia
- hypotension
- later hypoxia, oliguria
- physical signs of source or orgamism e.g. meningism, murmer
- pneumonia
What lab and microbiology tests would you do for sepsis?
LABS = FBC, clotting, CRP and lactate levels ( shows if blood perfusing tissues properly) MICRO = blood cultures X 2, urine, samples from pus CSF joint asparate sputum
How would you manage a patient that came in with sepsis?
- AirwaysBreatingOxygen - give oxygen or fluid resuscitation (to raise BP)
- seek help from seniors
- might need critical care - mechanical ventilators or -vasopressors e.g noradrenaline
- moniter urine output (actue kidney injury in 20-50%)
- antibiotic therapy in 1 hour of sever sepsis
- source control e.g. drain abscess
How would you decide which antibiotics to give for sepsis?
- likely source
- previous microbiology e.g. MRSA
- local guidelines
- sensitivity results when available ( not immediate)
- severity of sepsis
- underlying disease and immunity
Risk factors for infection with resistant organisms?
frequent hosp admissions, previous isolation of organism, prolonged hosp stay, hosp overseas, nursinghome resistant (MRSA), previous antibiotic use
How would sepsis be followed up?
- review upon recovery - determine source. is there potential re-occurrence?
- review CRP and ESR response
- monitor renal and liver function
- consider endocarditis- positive blood cultures persisting despite antibiotics? multiple sites of infection?
