Module 9 - GTG 64b - Bacterial Sepsis Following Pregnancy Flashcards
Define puerperal sepsis.
Genital tract sepsis that occurs up to 6 weeks post natal.
What is the most common focus of puerperal sepsis?
Endometritis.
Define sepsis.
Life threatening systemic reaction to infection in which there are systemic manifestations as a result of infection.
Define severe sepsis.
Infection + organ dysfunction or tissue hypo-perfusion.
(lactate 4+).
Define septic shock.
Presence of hypotension despite adequate fluid replacement.
If inotropes are required, move the patient to ITU.
Who is at increased risk of sepsis?
Obese, diabetic, immunocompromised, anaemic women.
Close contact with GAS positive patient.
PID, vaginal discharge, PROM, RPOC.
Procedures eg perineal repair, amniocentesis, LSCS, cervical cerclage.
What is the ‘other’ name for GAS?
Group A Streptococcus
(Streptocuccus pyogenes).
What are the most common causative organisms for puerperal sepsis?
GAS
E Coli
Staph. aureus
Strep. pneumoniae
(also think MSRA).
What is the resistance rate to cephalosporins and beta lactams?
12%
What proportion of pharyngitis is viral vs baterial?
90% viral
10% bacteria
What criteria are used to diagnose pharyngitis?
Centor criteria.
What are the most common causative organisms to cause regional anaesthetic site infections?
Staph. aureus
streptococcus
Gram negative rods.
What can happen to temperature of a patient if they are septic?
Pyrexial
Hypothermic
Normothermic!
What are the red flags for sepsis?
Pyrexia >38 (or <35)
RR>20
Chest or abdominal pain
Rash
Offensive discharge
Which analgesic medication should be avoided in septic patients and why?
NSAIDs
(Impedes polymorphs to fight GAS).
Define early puerperal sepsis.
<12 PN
Likely to be streptococcal eg GAS.
Within what time frame should abx given if sepsis is suspected?
Within 1 hour
What is the risk of fluid replacement in puerperal sepsis?
Post natal women can develop pulmonary oedema more frequently.
Within what timeframe should lactate be measured when sepsis is suspected?
Within 6 hours.
Above what lactate value indicates severe sepsis / tissue hypo-perfusion?
4+
What clinical features will be present if a patient presents with abscess or pus infection?
Thrombocytosis (raised pl)
Rising CRP
Swinging pyrexia
What combination of antibiotics gives the broadest spectrum cover?
PipTaz (or carbapenem)
and Clindamycin.
What antibiotics can be prescribed for MSRA?
Vancomycin or teicoplanin.
What group of bacteria is covered with metronidazole?
ANaerobic
A maculopapular or blaching rash that develops after starting antibiotics is likely caused by what?
Bacterial exotoxins
(NOT allergy).
In bacterial sepsis, when is IVIG indicated?
Severe strep/staph that has not responded to other treatments.
What is the mechanism of action for IVIG in bacterial sepsis?
Immunomodulatory.
Neutralises exotoxin’s super-antigen effects.
Inhibits TNF and IL
When does IVIG have no advantage in treatment?
Endotoxin producing bacteria.
When is IVIG contra-indicted?
Congenital deficiency of immunoglobulin A.
If GAS is isolated in mum OR baby, who should be treated?
Both should be treated for GAS.
Why is it important to monitor for GAS in breastfed babies?
Because GAS can be passed in breast milk.
Which 2 bacterial infections warrant prophylactic antibiotics for close contacts?
GAS
N Meningitidis.
What is the difference between TTTS and STSS?
TTTS = staphylococcal
STSS = streptococcal.
