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PHRM 865: Theraputics V > Lecture 31: Sepsis > Flashcards

Lecture 31: Sepsis Flashcards

1
Q

What does Bactermia or Fungemia mean?

A
  • Presence of viable bacteria or fungi in the blood
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2
Q

What are the requirements for the SIRS

A
  • Temperature > 100.4
  • HR > 90 bpm
  • RR > 20
  • WBC < 4000 or > 12000
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3
Q

What is the definition of Sepsis?

A
  • Life-threatening Organ Dysfunction caused by a dysregulated host response
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4
Q

What is the SOFA score and are they recommended anymore?

A
  • Sequnetial [Sepsis-Related] Organ Failure Assessment
  • Shows organ dysfunction
  • 2021 guidelines recommed AGAINST use of SOFA
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5
Q

What is Septic Shock?

A
  • Underlying circulatory, cellular and metabolic abnormalities
  • Patients are getting Vasopressors to maintain
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6
Q

What are som eof the factors that can lead to increased incidence of Sepsis?

A
  • Immunocompromised Patients
  • Invasive Devices
  • Life-sustaining Technology
  • Infections by resistanct organisms
  • Age
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7
Q

What are some of the Gram (-) bacteria that could causes Sepsis?

A
  • Enterobacterales [E.Coli, Klebsiella]: based on the intrgrity of the GI (trauma, wounds, ulcers…)
  • P. Aeruginosa
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8
Q

What are some of the Gram (+) bacteria that can cause Sepsis?

A
  • Staph
  • Strep Pneumoniae
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9
Q

What are some of the Fungi that can cause Sepsis?

A
  • C. Albcains
  • C. Glabrate, Parapsilosis, Troicalis, Krusei
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10
Q

What happens with the Endotoxins within the Mircobial Pathogensis for Sepsis?

LPS? Mediators: Anti and Pro? Peptidoglycin?

A
  • 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
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11
Q

What are the General Variables for the diagnostic criteria for Sepsis?

A
  • Fever
  • HR > 90 BPM
  • Tachypnea
  • Altered Mental Status
  • Arterial Hypotension
  • Edema
  • Repsiratory Alkalosis
  • Hyperglycemia
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12
Q

What are some of the Inflammatory Variables for the Diagonsis of Sepsis?

A
  • Leukocytosis
  • Increased Bands
  • C-Reactive Protein [shows inflammation]
  • Procalitonin [shows infection]
  • Organ Dysfunctions
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13
Q

What are some of the Organ Dysfunctions for Sepsis?

A
  • Hypoxemia
  • Oliguria
  • AKI
  • Ileus
  • Thrombocytopenia
  • Hyperbilirubinemia
  • AST/ALT
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13
Q

Wh

What are some of the principles of therapy for the treatment of Sepsis?

A
  • Remove caths, drain [SOURCE CONTROL]
  • Treat early; Aggressively
  • Give 1 or more agents to most likely
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14
Q

What are some of the things that should be completed in the first 3 hours presentation of sepsis?

A
  • Measure lactate conc.; repeat in 2h if > 18
  • Get blood cultures
  • Give broad spec drugs
  • give Lactated Ringers in the 1st hour
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15
Q

What are some of the things that should be done within the first 6 hours of presentation of sepsis?

A
  • Give vasopressors to get MAP > 65- norepinephrine is 1st
  • MAP not good - + vaspressin
  • MAP still not good - + epinephrine
16
Q

What are some of the procedures/conditions and most likely bacteria for Urogential System?

A
  • Caths, Prostatis, UTIs, Prostatectomy
  • E. Coli, P. Aeruginosa
17
Q

What are some of the procedures/conditions and most likely bacteria for Respiratory?

A
  • Intubation, Vomiting, Bronchoscopy, Coma
  • P. Auruginosa, E. Coli, S. Aureus
18
Q

What are some of the procedures/conditions and most likely bacteria for Bowel?

A
  • Trauma, Endoscopy, obstruction
  • E. Coli
19
Q

What are some of the procedures/conditions and most likely bacteria for Reproductive system?

A
  • Abortion, Post-partum, tampons
  • E. Coli
20
Q

What are some of the procedures/conditions and most likely bacteria for Skin?

A
  • Burns, IV caths, IV drugs
  • P. Aeruginosa
21
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired pneumonia?

A
  • Ceftriaxone + Azithromycin [better than FQs because of anti-inflammatory]
  • Ceftriaxone + Moxi or Levo
22
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired UTI?

E. Coli

A
  • 3rd or 4th gen Cephal [Ceftriaxone]
  • Pip/tazo? [dont really need]
  • Cirpo or Levo [if resistance]
23
Q

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

A
  • 3rd or 4th gen cephalo [Ceftriaxone] + metro
  • Pip/Tazo
  • Ertapenem
  • Cirpo or Levo + Metro
24
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Community acquired Cellulitis?

Staph or Strep

A
  • Vancomycin
  • Linezolid
  • Daptomycin
25
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired HAP/VAP?

A
  • Antipseudo B-lactam + AGs
  • Antipseudo FQ + Vancomycin or Linezolid
26
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired UTI?

P. Aerugniosa??

A
  • Cefepime +/- Tobra or Antipseudo FQ
  • Pip/Tazo +/- Tobra or Antipseudo FQ
27
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired Intra-abdominal Infections?

A
  • Pip/Tazo
  • Carbapenems [NOT ertapenem]
  • Cefepime + Metro
28
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Hospital acquired Cellulitis?

Necrotizing??

A
  • Pip/Tazo + Vancomycin [+clindamycin if necrotizing]
  • Pip/Tazo + Linezolid
29
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Thermal Burns?

A
  • Antipseudo B-lactam + AGs [tobra] + Vancomycin

Body is clearence drugs VERY fast so this should be a CI or HUGE doses

30
Q

What is the suggested antimircobal regimen for EMPIRIC therapy of sepsis in non-neutropenic adults with Indwelling Vascular Cath infection?

Staph or Strep

A
  • Vancomycin
  • Daptomycin
  • Linezolid
31
Q

What is the duration of therpay and when should you start/stop antibiotics?

A
  • Duration: 7-10 day
  • PCT conc. < 0.25 = STOP & PCT conc. > 0.5 = CHANGE
32
Q

What are the vasopressors that are used and what is the GOAL for them?

A
  • Noerpinephrine [1st] –> Vasopressin –> Epinephrine –> Dopmine –> Phylephine
  • GOAL fo MAP = 65
33
Q

What is important to know about Hyperglcemia during sepsis?

A
  • IV Insulin to keep glucose between 144 - 180
  • Overaggressive can make outcomes worse

PHRM 865: Theraputics V (42 decks)

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