NCC content Flashcards
late-onset sepsis
- presents after DOL7
- pathogens similar to early onset
- increased predilection for CNS
- less severe systemic & cardiovascular symptoms
early-onset sepsis
- presents in first 3 days of life
- multisystem fulminate illness
- can have rapid progression to septic shock
- increased mortality
nosocomial pathogens
- staphylococci (epi, staph aureus, MRSA)
- gram negative rods (pseudomonas, klebsiella, proteus, serratia)
- fungal (candida)
systemic inflammatory response (SIRS): when things go wrong with the normal inflammatory response
- widespread inflammatory response: formation of mediators
- initiated by variety of insults
- encompasses several stages of infection: sepsis, sepsis cascade
- symptoms: hypotension, third spacing, micro thrombi, further mediator release, DIC
what is the septic triad?
- endotoxin
- tumor necrosis factor (TNF)
- interleukin-1
describe an endotoxin
- cell wall component of bacteria
- released by bacteria when it dies or multiplies
- can be present in absence of positive blood culture
what does endotoxin do to the body?
- produces breakdown of microvascular endothelium (which can lead to third spacing and hypotension)
- initiates complement cascade and coagulation
- initiates release of platelet activating factor (PAF) which creates microthrombi
describe tumor necrosis factor
- mimics effects of endotoxin
- secretory product of monocyte/macrophage system
- levels rise immediately after endotoxin release
- promotes release of IL-1, which acts synergistically with TNF further magnifying clinical symptoms
describe interleukin-1
released in response to TNF
- synergistic effect with TNF
- potentiates hypertension
- induces hyper dynamic cardiovascular function
- stimulates leukocytosis, fever, metabolic changes
which group of bacteria is hypoglycemia associated with?
-gram negative infections
what kind of sugar response to preterm babies have with sepsis?
hyperglycemia
what indicates a left shift on I/T ratio?
> 0.2
what levels are concerning with ANC?
500-1000 intermediate risk
when to get an LP
- those with clinical signs or positive blood culture for EOS
- should be done for all LOS work-ups
concerning LP findings
- *pleocytosis, elevated protein, low glucose)
- increased WBC (0-32 in 1st month, no higher than 10 after 1 month)
- protein: term 20 to 170; preterm 65-150
- traumatic taps: 1 leukocyte for every 700 RBCs; should be repeated according to the literature, calculations not accurate
what is the gold standard method for getting a urine culture?
-suprapubic
gram negative bugs
- e.coli
- klebsiella
- enterobacter
- pseudomonas
- proteus
gram positive bugs
- GBS
- staph species
- enterococcus
- group A strep
- listeria
what do add for potentially resistant nosocomial bugs
add a penicillinase-resistant drug
- nafcillin
- oxacillin
- vancomycin
