Lecture 31: Sepsis Flashcards
What does Bactermia or Fungemia mean?
- Presence of viable bacteria or fungi in the blood
What are the requirements for the SIRS
- Temperature > 100.4
- HR > 90 bpm
- RR > 20
- WBC < 4000 or > 12000
What is the definition of Sepsis?
- Life-threatening Organ Dysfunction caused by a dysregulated host response
What is the SOFA score and are they recommended anymore?
- Sequnetial [Sepsis-Related] Organ Failure Assessment
- Shows organ dysfunction
- 2021 guidelines recommed AGAINST use of SOFA
What is Septic Shock?
- Underlying circulatory, cellular and metabolic abnormalities
- Patients are getting Vasopressors to maintain
What are som eof the factors that can lead to increased incidence of Sepsis?
- Immunocompromised Patients
- Invasive Devices
- Life-sustaining Technology
- Infections by resistanct organisms
- Age
What are some of the Gram (-) bacteria that could causes Sepsis?
- Enterobacterales [E.Coli, Klebsiella]: based on the intrgrity of the GI (trauma, wounds, ulcers…)
- P. Aeruginosa
What are some of the Gram (+) bacteria that can cause Sepsis?
- Staph
- Strep Pneumoniae
What are some of the Fungi that can cause Sepsis?
- C. Albcains
- C. Glabrate, Parapsilosis, Troicalis, Krusei
What happens with the Endotoxins within the Mircobial Pathogensis for Sepsis?
LPS? Mediators: Anti and Pro? Peptidoglycin?
- LPS is outer membrane of Gram (-); gets lysed
- Pro: TNF-a; IL-1; IL-6; IL-12; PAF; TXA2
- Anti: IL-1 antagonist; IL-4; IL-10
- Peptidoglycan exhibits proinflammatoruy
What are the General Variables for the diagnostic criteria for Sepsis?
- Fever
- HR > 90 BPM
- Tachypnea
- Altered Mental Status
- Arterial Hypotension
- Edema
- Repsiratory Alkalosis
- Hyperglycemia
What are some of the Inflammatory Variables for the Diagonsis of Sepsis?
- Leukocytosis
- Increased Bands
- C-Reactive Protein [shows inflammation]
- Procalitonin [shows infection]
- Organ Dysfunctions
What are some of the Organ Dysfunctions for Sepsis?
- Hypoxemia
- Oliguria
- AKI
- Ileus
- Thrombocytopenia
- Hyperbilirubinemia
- AST/ALT
Wh
What are some of the principles of therapy for the treatment of Sepsis?
- Remove caths, drain [SOURCE CONTROL]
- Treat early; Aggressively
- Give 1 or more agents to most likely
What are some of the things that should be completed in the first 3 hours presentation of sepsis?
- Measure lactate conc.; repeat in 2h if > 18
- Get blood cultures
- Give broad spec drugs
- give Lactated Ringers in the 1st hour
What are some of the things that should be done within the first 6 hours of presentation of sepsis?
- Give vasopressors to get MAP > 65- norepinephrine is 1st
- MAP not good - + vaspressin
- MAP still not good - + epinephrine
What are some of the procedures/conditions and most likely bacteria for Urogential System?
- Caths, Prostatis, UTIs, Prostatectomy
- E. Coli, P. Aeruginosa
What are some of the procedures/conditions and most likely bacteria for Respiratory?
- Intubation, Vomiting, Bronchoscopy, Coma
- P. Auruginosa, E. Coli, S. Aureus
What are some of the procedures/conditions and most likely bacteria for Bowel?
- Trauma, Endoscopy, obstruction
- E. Coli
What are some of the procedures/conditions and most likely bacteria for Reproductive system?
- Abortion, Post-partum, tampons
- E. Coli
What are some of the procedures/conditions and most likely bacteria for Skin?
- Burns, IV caths, IV drugs
- P. Aeruginosa
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired pneumonia?
- Ceftriaxone + Azithromycin [better than FQs because of anti-inflammatory]
- Ceftriaxone + Moxi or Levo
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired UTI?
E. Coli
- 3rd or 4th gen Cephal [Ceftriaxone]
- Pip/tazo? [dont really need]
- Cirpo or Levo [if resistance]
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired Intra-abdominal infections?
Enterobacterales or GI bacteria
- 3rd or 4th gen cephalo [Ceftriaxone] + metro
- Pip/Tazo
- Ertapenem
- Cirpo or Levo + Metro
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired Cellulitis?
Staph or Strep
- Vancomycin
- Linezolid
- Daptomycin
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired HAP/VAP?
- Antipseudo B-lactam + AGs
- Antipseudo FQ + Vancomycin or Linezolid
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired UTI?
P. Aerugniosa??
- Cefepime +/- Tobra or Antipseudo FQ
- Pip/Tazo +/- Tobra or Antipseudo FQ
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired Intra-abdominal Infections?
- Pip/Tazo
- Carbapenems [NOT ertapenem]
- Cefepime + Metro
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired Cellulitis?
Necrotizing??
- Pip/Tazo + Vancomycin [+clindamycin if necrotizing]
- Pip/Tazo + Linezolid
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Thermal Burns?
- Antipseudo B-lactam + AGs [tobra] + Vancomycin
Body is clearence drugs VERY fast so this should be a CI or HUGE doses
What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Indwelling Vascular Cath infection?
Staph or Strep
- Vancomycin
- Daptomycin
- Linezolid
What is the duration of therpay and when should you start/stop antibiotics?
- Duration: 7-10 day
- PCT conc. < 0.25 = STOP & PCT conc. > 0.5 = CHANGE
What are the vasopressors that are used and what is the GOAL for them?
- Noerpinephrine [1st] –> Vasopressin –> Epinephrine –> Dopmine –> Phylephine
- GOAL fo MAP = 65
What is important to know about Hyperglcemia during sepsis?
- IV Insulin to keep glucose between 144 - 180
- Overaggressive can make outcomes worse
