Pathophysiology and Treatment of Sepsis

Question 1

Sepsis

Answer 1

Life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

Septic shock

Answer 2

A subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone

Question 3

Populations at greater risk

Answer 3

• Very young (< 1 year) and older adults (>75 years) or
the very frail
• Those with impaired immune system due to illness or medication
• Those who have had surgery/invasive procedure in last 6 weeks
• Anyone with breach of skin integrity (cuts, burns, blisters, skin infection
• People who misuse drugs intravenously
• People with indwelling lines or catheters
• Women who are pregnant, have given birth or had a termination of pregnancy or miscarriage in last 6 weeks
• Neonates

Question 4

Breach of Host Barrier Integrity physical barriers

Answer 4

• Physical barriers – Skin

– Mucous membranes

Question 5

Breach of Host Barrier Integrity obvious physical breaches

Answer 5

– Catheters
– Wounds
– Burns
– Thorn pricks 
– Insect bites

Question 6

Breach of Host Barrier Integrity subtle breaches

Answer 6

– Epithelial cell damage

Question 7

Main Factors Affecting Infection

Answer 7

• Virulence of pathogen • Bioburden
• Portal of entry
• Host susceptibility
• Temporal evolution

Question 8

endotoxin

Answer 8

part of a bug that can elicit inflammatory response

Question 9

exotoxin

Answer 9

exotoxin is something that is secreted by the bug

Question 10

Host Innate Immunity

Answer 10

First line of defence against pathogenic insult

Question 11

Main immune cell molecules

Answer 11

– Toll-like receptors (TLRs)
– Phagocytes
– Complement
- LPS

Question 12

inflammatory markers

Answer 12

– Interleukins (ILs)

– Tumour necrosis factor alpha (TNFα) – Reactive oxygen species (ROS)

Question 13

Effects of TNFα and IL-1 on the body = Acute phase response

Answer 13

• Fever
• Hypotension
• Increased HR
• Corticosteroid and ACTH release
• Release of neutrophils

Question 14

Effects of TNFα and IL-1 on the CVS

Answer 14

• Generalised vasodilation (NO.)
• Increased vascular permeability(activated leukocytes)
• Intravascular fluid loss
• Myocardial depression (tissue hypoxia)
• Circulatory shock

Question 15

who to screen for sepsis?

Answer 15

1. Presents with unexplained illness
2. Clearly looks unwell and has a likely infective cause OR presents with (or subsequently deteriorate to) an individual parameter score of 3 or aggregate score of 4 or higher on NEWS/ locally derived equivalent

Question 16

General Prescribing Considerations in Sepsis

Answer 16

• patient history (underlying disease, immune status, prior antibiotic use, prior infection, or colonization with multidrug-resistant organisms)
• potential source of infection
• microbial resistance patterns within the
community, hospital, or intensive care unit (ICU)
• patient organ dysfunction
• associated drug toxicities (such as nephrotoxicity with aminoglycosides)

Question 17

Respiratory

Answer 17

cover with broad spectrum, consider pseudomonas and MRSA

Question 18

Urine

Answer 18

cover for G-ve and Pseudomonas

Question 19

Abdo

Answer 19

cover for G-ve/+ve and anaerobes

Question 20

Soft tissue/joint cover for

Answer 20

G-ve/+ve/anaerobes

Question 21

CNS

Answer 21

cover for meningitis

Question 22

Primary Care role

Answer 22

• Ensure GPs and ambulance services can give antibiotics to patients with high risk criteria in the pre-hospital settings in location where transfer time is more than 1 hour
• Ensure patients know of diagnosis and follow- up

Question 23

• Short-term complications

Answer 23

organ dysfunction, coagulation disorders

Question 24

• Longterm dysfunctions

Answer 24

neurological dysfunction, increased mortality rate for at least a year