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House Microbiology > Sepsis > Flashcards

Sepsis Flashcards

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1
Q

Sepsis as defined by WHO is a _____________________ caused by a ____________ to infection.

A

life-threatening organ dysfunction

dysregulated host response

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2
Q

Sepsis happens when _____________ triggers ____________ throughout your body.

A

an infection you already have

a chain reaction

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3
Q

Sepsis is a serious medical condition caused by the body’s response to an infection

T/F

A

T

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4
Q

Infection:

Presence of ______ or its _______(e.g Toxins) with ________________________ to its presence.

A

Microbes; products

an attendant inflammatory response

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5
Q

Bacteremia: Presence of _______ bacteria in _________.

A

viable

blood

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6
Q

Bacteremias may be;

Transient: Organisms comprising ________ are introduced into the blood. Eg: __________,___________, manipulative procedures.

A

normal flora

Brushing of teeth, straining during bowel movements

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7
Q

Bacteremias may be;

Intermittent: Bacteria from ________ are ______________ into blood from extravascular ________, _____ cavities or diffuse infections.

Eg: Cellulitis, Peritonitis, Septic arthritis.

A

an infected site

spasmodically released

abscesses; empyemic

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8
Q

Bacteremias may be;

Continuous: Where organisms ______________________. Eg: SABE, Infected AV Fistulas, Intra arterial catheters, Indwelling cannulae.

A

have direct access to the bloodstream

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9
Q

SOME RELATED DEFINITIONS

Septicemia: Also known as __________, this is the presence of ________________ with an accompanying ___________ to its presence

A

blood poisoning

viable bacteria in blood

inflammatory response

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10
Q

SIRS (________________________________ ):

This can be defined as a _______ or _______ response to an infection manifested by _________ of some particular conditions:

A

Systemic inflammatory response syndrome

systemic or whole body

2 or more

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11
Q

SIRS:

Temperature above ______oC or below ______oC

Heart rate above _____ beats per minute
Respiratory rate above ____ per minute

PaCO2 below _____mm Hg

White blood cell count above ______uL or below _____uL

A

38.5; 35.6

90

20; 32

12,000; 4,000

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12
Q

SEPSIS can now be more easily/accurately defined as a _________ resulting from _________.

A

systemic inflammatory response syndrome (SIRS)

infection

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13
Q

___________ + _________= Sepsis

A

Infection + SIRS

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14
Q

AETIOLOGY OF SEPSIS

Sepsis is caused by infection. Of cases with positive blood cultures,

40% -gram-________bacteria
35% - gram-______ bacteria
11% - __________
7% -______
<5% - classic pathogens

A

positive

negative

polymicrobial

fungi

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15
Q

MORTALITY RATES OF SEPSIS ACCORDING TO MICROBES

S. epidermidis- 15%
________- 20-30%
__________spp- 30%
_______spp- 40%
_____________- 50-70%

Acinetobacter spp- 50-70%

A

S. aureus

Enterococcus

Candida

Pseudomonas aeruginosa

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16
Q

MORTALITY RATES OF SEPSIS ACCORDING TO MICROBES

Gram _______ bacteria are usually more lethal.

A

negative

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17
Q

WHAT CAUSES SEPSIS?
Sepsis infections can be divided into two:

_________ acquired infections:
Gram-positive bacteria: S. pyogenes, S. pneumoniae, S. aureus Gram-negative bacteria: E. coli, N. meningitidis, L. pneumophila

____________ infections:
Gram-positive bacteria: S. aureus (MRSA), S. epidermidis (MRSE), Enterococcus spp Gram-negative bacteria: E. coli, K. pneumoniae, P. aeruginosa, Acinetobacter baumannii Fungi: Candida spp, Aspergillus spp

A

Community

Nosocomial

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18
Q

PATHOPHYSIOLOGY OF SEPSIS

• Sepsis can lead to widespread _________ and ________

A

inflammation and blood clotting.

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19
Q

PATHOPHYSIOLOGY OF SEPSIS

• Inflammation may result in _____,______,_____,_______ and ______

• Blood clotting during sepsis causes reduced blood flow to limbs and vital organs, and can lead to ________ or _______

A

redness, heat, swelling, pain,

organ failure.

organ failure or tissue damage.

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20
Q

In simple terms sepsis can be viewed as an imbalance of _____,_______,______.

A

inflammation, coagulation, and fibrinolysis

21
Q

PATHOPHYSIOLOGY OF SEPSIS

During a normal response to bacteria in the blood, the immune system releases ___________ to promote ______ of the tissue.

These mediators are known as: _____,______,_______,________,_______

A

inflammatory mediators; recovery

Tumor Necrosis Factor (TNF)
Interleukins (IL)
Cytokines
Prostaglandins
Platelet Activating Factor

22
Q

PATHOPHYSIOLOGY OF SEPSIS

The release of the inflammatory mediators starts the ________ leading to the development of ______

To maintain this , inhibitors are released to suppress _______ or _______

This is necessary to have time for the _____________________ before the ____ is gone.

Once the bacteria or antigen is isolated, the pro-inflammatory mediators attract ______ or ____ which attack the antigen and try to engulf it.

A

Coagulation Cascade; a clot

fibrinolysis or breakdown.

body to destroy the bacteria; clot

neutrophils or WBCs

23
Q

PATHOPHYSIOLOGY OF SEPSIS

To prevent the response from damaging normal tissue, _______ are released including __________ and _________

This balance restricts the inflammation response to the ___________

A

anti- inflammatory mediators

transforming growth factors and interleukins (IL-4).

local site of infection.

24
Q

PATHOPHYSIOLOGY OF SEPSIS

This balance of inflammatory and anti- inflammatory mediators

When the body is unable to maintain the appropriate balance, the immune response is no longer ______ but becomes _______.

________ and altered ______ quickly spread through the body.

A

local ; systemic

Inflammation and clotting

25
Q

In spesis

If this inflammatory process is ________________, the person with the infection which was once _______ could become ___________ and move into ____________ with a high probability of Death

A

not quickly corrected

localized

critically ill ; severe sepsis

26
Q

There are 3 integrated responses to sepsis

Activation of ________

Activation of ___________

Impairment of ____________

A

inflammation

coagulation

fibrinolysis

27
Q

Activation of Inflammation

There is basically a tug of war going on between the pro-inflammatory (_____,_____,______) and anti- inflammatory components (_____,______) of the body.

A

IL-1,IL- 6,TNF

IL-4, IL-10

28
Q

In sepsis, continued release of __________ overwhelms the ________ cytokines.

A

pro-inflammatory cytokines

anti- inflammatory

29
Q

Activation of Coagulation

The _______ from _______ stimulate coagulation pathways.

This results in the forming of the enzyme _______.
This produces clotting in the body.

The enhanced clotting continues making tiny clots or “ ________ ” in the vascular system which impairs blood flow and organ perfusion.

A

cytokines; inflammation

thrombin

microthrombi

30
Q

Inflammation and coagulation are closely linked.

T/F

A

T

31
Q

Activation of Fibrinolysis
Fibrinolysis, or the __________, is the body’s response to the increased ______ and _________

A

breakdown of clots

clotting and inflammation.

32
Q

Activation of Fibrinolysis

In sepsis this breakdown is inhibited or slowed because of mediators.
These mediators are called:

___________(PAI-1)

___________________________(TAFI)

A

Plasminogen Activator Inhibitor-1

Thrombin Activatable Fibrinolysis Inhibitor

33
Q

The increased levels of these 2 inhibitors (PAI-1, TAFI) suppress _______ even more, creating a state of “ _________ ”

A

fibrinolysis

coagulopathy

34
Q

The Role of Endothelium in Sepsis

Normal endothelium has _____coagulant abilities and plays a role in the body’s homeostasis abilities

A

anti

35
Q

The Role of Endothelium in Sepsis

Normal endothelium homeostasis abilities including:

_________ tone
Movement of cells and nutrients

Maintaining ________.

A

Vasomotor; blood fluidity

36
Q

When activated, endothelium also plays a role in the ______,________,_________ components of sepsis.

A

inflammatory, coagulation, and fibrinolytic

37
Q

In sepsis the endothelium becomes damaged which makes the “inflammatory process” (better or worse?) by ______________ , thereby _______________

A

Worse

releasing more cytokines (TNF-a and IL-1) causing neutrophils to stick to its’ lining.

38
Q

The “activation” of the capillary endothelium leads to increased _______ causing ____________ of the capillaries and into the extracellular spaces.

A

permeability

fluid to “leak” out

39
Q

In a nutshell;

As a result of ________:

The imbalance of Inflammation, coagulation, and Fibrinolysis and the ___________ can lead to organ failure, even death if led undetected or untreated.

A

Microbial infection

effects on endothelium

40
Q

CLINICAL DIAGNOSIS

Can be (easy or difficult?) and needs a (low or high ?) sense of suspicion.

A

Difficult; high

41
Q

CLINICAL DIAGNOSIS

A systemic or whole body response to an infection manifested by ————— of the following conditions:
Temperature above ____oC or below ______oC

Heart rate above _____ beats per minute

Respiratory rate above ___ per minute or PaCO2 below ______ Hg

White blood cell count above ______uL or below ______uL

A

two (2) or more

38.5; 35.6

90; 20

32 mm; 12,000; 4,000

42
Q

CLINICAL DIAGNOSIS

Assume sepsis in the absence of any other explanation

T/F

A

T

43
Q

Microbiology Tests

______ Culture
__________ Culture
______ Culture
Culture of ___________

A

Blood

Sputum

Urine

any focus of infection

44
Q

Blood Cultures
Source of Organism not determined in 1/3rd of cases.
Patients with positive blood cultures were 12 times more likely to die during hospitalization than those with negative blood
Quality Control
< 3% Blood cultures should be contaminated.

A
45
Q

Blood Cultures

Source of Organism not determined in ______ of cases.

Patients with positive blood cultures were _____ times more likely to die during ________ than those with negative blood

A

1/3rd

12; hospitalization

46
Q

Blood Cultures

Quality Control

_____% Blood cultures should be contaminated.

A

< 3

47
Q

ANTIBIOTIC TREATMENT OF SEPSIS

Eradication of the ____
_______ intervention
antimicrobial therapy

Control the ________
Protect ______

A

focus; surgical

inflammatory process

organ function

48
Q

The final outcome of sepsis is determined in the _________

A

First 48-72 hours

49
Q

Factors to be considered for the choice of antibiotics

___________________

The __________ of sepsis

The presence of _________

__________ or _________ in the recent past

A

Community versus hospital-acquired infections

anatomical site of the focus

underlying diseases

Diagnostic or surgical intervention

House Microbiology (93 decks)

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