Pathogenesis of Sepsis

Question 1

what are the different types iof infection

Answer 1

viral bacteria fungal parasitic

Question 2

what do we mean by the term origin of infection

Answer 2

which part of the body, was infection acquired endogenously or exogenous

Question 3

who could be at risk of infection many possibilities but choose one

Answer 3

immune compromised individual

Question 4

what does sirs stand for

Answer 4

SIRS (systemic inflammatory response

syndrome)

Question 5

define bacteraemia

Answer 5

bacteria present in the blood, which should always be sterile

Question 6

what is septicaemia

Answer 6

Septicaemia is another term used to describe blood poisoning. It is an infection caused by large amounts of bacteria entering the bloodstream. It is a potentially life-threatening infection that affects thousands of patients every year.

Question 7

what is sepsis

Answer 7

Sepsis is the body’s overwhelming and lifethreatening response to infection that can lead
to tissue damage, organ failure, and death

Question 8

what is the difference between SIRS and sepsis syndrome

Answer 8

sepsis syndrome is when you have SIRS with a presumed confirmed infectious process that explains at least 2 of SIRS criteria

Question 9

define SIRS

Answer 9

clinical response due to a non specific insult, includes two or more temp above 38 or below 36

hr greater than 90 bpm
respirations greater than 20
wbc greater than 12000mm3
or below 4000mm3

Question 10

when is sepsis syndrome no longer sepsis syndrome and now severe sepsis

Answer 10

it is when you have one or more organs with a single sign of failure(only need one sign)

Question 11

what is septic shock

Answer 11

when severe sepsis has cause failure in cvs causing refractory hypo tension

Question 12

What can cause SIRS

Answer 12

infection, but also other factors that cause inflammation e.g trauma, burns, pancreatitis

Question 13

what microbial components can cause shock

Answer 13

LPS on gram negative bacteria
lipoteichoic acid on gram positive bacteria
vascular endothelium

Question 14

What do the microbial components trigger in immune system

Answer 14

trigger toll receptors, il6, tnf , il1 release and complement cascade and depletion of protein c

Question 15

what are super antigens

Answer 15

they hijack the mhc t cell presenting stage and directly cross link them stimulating an inappropriate large immune response

Question 16

give an example of a SAG

Answer 16

Superantigens e.g. from Group A

strep, Staph aureus TSST-1

Question 17

describe the viscous cycle of anti coagulation and inflammation that can occur

Answer 17

infection causing inflammation then coagulation then inflammation and coagulation and so on, this cycle damages endothelium, causing ischemia, organ failure and then death

Question 18

what gram negative bacteria cause sepsis commonly

Answer 18

ecoli, pseudomonas, haemophilus,

Question 19

what gram positive bacteria cause sepsis commonly

Answer 19

Staph aureus, Group A Streptococci, Strep

pneumoniae, Clostridium spp.

Question 20

rank Main Causes of infection–related

shock, and mortality

Answer 20

gram neg, gram positive, parasites, fungi and viral (VHF)

Question 21

how do you diagnose sepsis

Answer 21

clinically according to sepsis criteria, determine site of origin, blood cultures, cultures of urine, iv lines, pus at operation, wbc and crp

Question 22

what are potential differentials in septic shock

Answer 22

MI, cardiac tamponade, drug Od, anaphlaxis, PE, ruptured AAA, burns trauma, pancreatitis

Question 23

how do you manage sepsis

Answer 23

fluids, antibiotics as specific as possible but wide scope before you have exact cause, dopamine, transfusion in icu, monitor abcde , blood gases and organs, ANTIMICROBIALS

Question 24

what are the outcomes of sepsis prognosis

Answer 24

mortality 30-60 percent, multi organ failure, loss of extremities prolonged hospital stay and cost

Question 25

what is the SEPSIS SIX

Answer 25

``` Administer high flow oxygen  Take blood cultures  Give broad spectrum antibiotics  Give intravenous fluid challenges  Measure serum lactate and haemoglobin  Measure accurate hourly urine output ```

Question 26

why does the sepsis six so important to sepsis campaigners

Answer 26

SSC guidelines internationally accepted gold | standard of care. doing the sepsis six in first hour can double patients chance of survival

Question 27

ideally when should a patient be given antibiotics for sepsis

Answer 27

within the hour

Question 28

why should broad spec antibiotics be used initially in patient

Answer 28

because it could be gram positive or neg and until test results come back we need to start treatment to improve patient outcomes

Question 29

what is the average course of antibiotics

Answer 29

7-10

Question 30

how should the antibiotics be administered to septic patients

Answer 30

IV

Question 31

patient has community acquired infection shock, if the origin is unknown or it is gut renal or binary what antibiotic should be given

Answer 31

Co-amoxiclav (‘Augmentin’) + gentamicin

Question 32

patient has community acquired infection shock, if the origin is unknown or it is gut renal or binary what antibiotic should be given if initial antibiotic is ineffective

Answer 32

add vancomycin because it could be resistant MRSA which is why first abx did not work

Question 33

if patient has community acquired infection shock and it is skin or soft tissue what abx should you give

Answer 33

Skin or Soft tissue | Flucloxacillin + penicillin (or amoxicillin)

Question 34

when would treatment of sepsis require clindamycin

Answer 34

consider adding clindamycin if Group A | strep or Staph aureus toxic shock. community acquired infection shock in skin or soft tissue

Question 35

Community acquired infection shock caused by pneumonia what abx do you treat with

Answer 35

Pneumonia Co-amoxiclav + doxycycline OR Cefuroxime + erythromycin

Question 36

Community acquired infection shock | Meningococcal disease what abx do you use

Answer 36

Penicillin or Ceftriaxone

Question 37

Community acquired infection shock due to malaria what abx do you use

Answer 37

Quinine

Question 38

what are the contraindications for using antimicrobial therapies for sepsis treatment

Answer 38

allergies to penicillin or cephalosporin

Question 39

Does a rash mean that penicillin/cephalosporin cannot be used

Answer 39

NO still consider using

Question 40

if the allergy to penicillin/ cephalosporin is severe what drugs can I use instead

Answer 40

Use agents such as ciprofloxacin, | vancomycin , erythromycin

Question 41

Hospital acquired infection shock Only been in a few days, no recent antibiotics. what drugs will we use

Answer 41

BECAUSE it has only been a few days we would use the same as those for community acquired infective shock

Question 42

Hospital acquired infection shock when you have been in hospital for a prolonged time or have a device attched

Answer 42

Prolonged admission/ device related consider MRSA (Vancomycin) ESBL positive GNR i.e. highly resistant GNR (Meropenem, Colistin) VRE (Linezolid and others)

Question 43

Hospital acquired infection shock more than a few days in

Answer 43

Hospital acquired infection shock  Typically use gentamicin + piperacillin-tazobactam (‘Tazocin’)  Check recent cultures and antibiotics received

Question 44

what are adjunctive measures when treating a septic patient

Answer 44

```  Remove infected catheters and devices  Drain pus, debride dead tissue  Consider lessening immunosuppression therapies  Fluid balance etc  Check gentamicin or vancomycin levels ```

Question 45

How can you help prevent sepsis

Answer 45

Wound care  Vaccination  Hand washing