Pathogenesis of Sepsis Flashcards
what are the different types iof infection
viral bacteria fungal parasitic
what do we mean by the term origin of infection
which part of the body, was infection acquired endogenously or exogenous
who could be at risk of infection many possibilities but choose one
immune compromised individual
what does sirs stand for
SIRS (systemic inflammatory response
syndrome)
define bacteraemia
bacteria present in the blood, which should always be sterile
what is septicaemia
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.
what is sepsis
Sepsis is the body’s overwhelming and lifethreatening response to infection that can lead
to tissue damage, organ failure, and death
what is the difference between SIRS and sepsis syndrome
sepsis syndrome is when you have SIRS with a presumed confirmed infectious process that explains at least 2 of SIRS criteria
define SIRS
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
when is sepsis syndrome no longer sepsis syndrome and now severe sepsis
it is when you have one or more organs with a single sign of failure(only need one sign)
what is septic shock
when severe sepsis has cause failure in cvs causing refractory hypo tension
What can cause SIRS
infection, but also other factors that cause inflammation e.g trauma, burns, pancreatitis
what microbial components can cause shock
LPS on gram negative bacteria
lipoteichoic acid on gram positive bacteria
vascular endothelium
What do the microbial components trigger in immune system
trigger toll receptors, il6, tnf , il1 release and complement cascade and depletion of protein c
what are super antigens
they hijack the mhc t cell presenting stage and directly cross link them stimulating an inappropriate large immune response
give an example of a SAG
Superantigens e.g. from Group A
strep, Staph aureus TSST-1
describe the viscous cycle of anti coagulation and inflammation that can occur
infection causing inflammation then coagulation then inflammation and coagulation and so on, this cycle damages endothelium, causing ischemia, organ failure and then death
what gram negative bacteria cause sepsis commonly
ecoli, pseudomonas, haemophilus,
what gram positive bacteria cause sepsis commonly
Staph aureus, Group A Streptococci, Strep
pneumoniae, Clostridium spp.
rank Main Causes of infection–related
shock, and mortality
gram neg, gram positive, parasites, fungi and viral (VHF)
how do you diagnose sepsis
clinically according to sepsis criteria, determine site of origin, blood cultures, cultures of urine, iv lines, pus at operation, wbc and crp
what are potential differentials in septic shock
MI, cardiac tamponade, drug Od, anaphlaxis, PE, ruptured AAA, burns trauma, pancreatitis
how do you manage sepsis
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
what are the outcomes of sepsis prognosis
mortality 30-60 percent, multi organ failure, loss of extremities prolonged hospital stay and cost
what is the SEPSIS SIX
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
why does the sepsis six so important to sepsis campaigners
SSC guidelines internationally accepted gold
standard of care. doing the sepsis six in first hour can double patients chance of survival
ideally when should a patient be given antibiotics for sepsis
within the hour
why should broad spec antibiotics be used initially in patient
because it could be gram positive or neg and until test results come back we need to start treatment to improve patient outcomes
what is the average course of antibiotics
7-10
how should the antibiotics be administered to septic patients
IV
patient has community acquired infection shock, if the origin is unknown or it is gut renal or binary what antibiotic should be given
Co-amoxiclav (‘Augmentin’) + gentamicin
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
add vancomycin because it could be resistant MRSA which is why first abx did not work
if patient has community acquired infection shock and it is skin or soft tissue what abx should you give
Skin or Soft tissue
Flucloxacillin + penicillin (or amoxicillin)
when would treatment of sepsis require clindamycin
consider adding clindamycin if Group A
strep or Staph aureus toxic shock. community acquired infection shock in skin or soft tissue
Community acquired infection shock caused by pneumonia what abx do you treat with
Pneumonia
Co-amoxiclav + doxycycline
OR Cefuroxime + erythromycin
Community acquired infection shock
Meningococcal disease what abx do you use
Penicillin or Ceftriaxone
Community acquired infection shock due to malaria what abx do you use
Quinine
what are the contraindications for using antimicrobial therapies for sepsis treatment
allergies to penicillin or cephalosporin
Does a rash mean that penicillin/cephalosporin cannot be used
NO still consider using
if the allergy to penicillin/ cephalosporin is severe what drugs can I use instead
Use agents such as ciprofloxacin,
vancomycin , erythromycin
Hospital acquired infection shock
Only been in a few days, no recent
antibiotics. what drugs will we use
BECAUSE it has only been a few days we would use the same as those for community acquired infective shock
Hospital acquired infection shock when you have been in hospital for a prolonged time or have a device attched
Prolonged admission/ device related consider
MRSA (Vancomycin)
ESBL positive GNR i.e. highly resistant GNR
(Meropenem, Colistin)
VRE (Linezolid and others)
Hospital acquired infection shock more than a few days in
Hospital acquired infection shock
Typically use gentamicin + piperacillin-tazobactam
(‘Tazocin’)
Check recent cultures and antibiotics received
what are adjunctive measures when treating a septic patient
Remove infected catheters and devices Drain pus, debride dead tissue Consider lessening immunosuppression therapies Fluid balance etc Check gentamicin or vancomycin levels
How can you help prevent sepsis
Wound care
Vaccination
Hand washing
