Sepsis Flashcards
What is sepsis?
is caused when the body’s immune system becomes overactive in response to an infection, causing an exagerrated inflammation which causes body tissue damage
Criteria for systemic inflammatory response syndrome (SIRS)?
- HR>90
- RR>20
- T > 38 degrees or < 36 degrees celsius
- Abnormal WBC count > 12,000 or < 4,000
- Band cells > 10%
- Low pCO2
Sepsis and SIRS?
2 SIRS criteria + Infection
Criteria for severe sepsis?
- Hypotension
- systolic BP less than or equal to 90 or MAP of less than or equal to 70. - End organ damage
- Elevated lactic acidosis
- Thrombocytopenia
- Platelets of less than 80 thousand
Septic shock?
- Severe sepsis and persistent signs of end organ dysfunction
- Mortality 50%
Normal response to infection?
non-specific inflammatory response to local infection that happens in 3 phases
3 phases of normal response to infection?
- Vasodilation - increased blood flow to site, infusion of antibodies and cells to fight infection
- Vessel permeability - antibodies and cells exit bloodstream and enter infected tissue
- Once infection is controlled, tissue repairs itself
Pathophysiology of sepsis?
- Uncontrolled, exaggerated immune response
- Endothelium damage, cell mediator activation, disruption of coagulation system homeostasis
- Vasodilation and capillary permeability
- Systemic inflammatory response
- End-organ damage, death
What is qSOFA?
quick sequential organ failure assessment score
What is the scoring of qSOFA?
The quick SOFA (qSOFA) score, includes 1 point for each of 3 criteria
1. respiratory rate ≥ 22 breaths/min
2. altered mental status, or
3. systolic blood pressure (SBP) ≤ 100 mm Hg
- A qSOFA score ≥ 2 is suggestive of sepsis and warrants treatment instantly
The infectious causes of sepsis?
- bacteria
- fungi
- parasites
- other
SIRS triggers?
- pancreatitis
- burns
- trauma
- other
Risk factors for sepsis?
- Extremes of age (old and young)
- Recent surgery, invasive procedure, illness, childbirth/pregnancy termination/miscarriage
- Immunosuppression
What extremes of age are risk factors for sepsis?
- Can’t communicate, need careful assessment
- Patients with developmental delay
- Cerebral Palsy
Diseases that increase the risk for sepsis?
- Diabetes
- Liver cirrhosis
- Autoimmune diseases (lupus, rheumatoid arthritis)
- HIV/AIDS
- Para/quadriplegics
- Sickle cell disease
- Splenectomy patients
- Compromised skin (chronic wounds, burns, ulcers
Drugs that cause an increased risk for sepsis?
- Chemotherapy
- Post-organ transplant (bone marrow, solid organ)
- Chronic steroid use
- Recent antibiotic use
- Indwelling catheters of any kind (dialysis, Foley, IV, etc)
Signs and symptoms for sepsis?
- Fever = most common (elderly and severely immunosuppressed patients may NOT mount a febrile response)
- Flu-like symptoms
- Chills/shaking (mistaken for seizure)
- Nausea/vomiting
- Mental status
- changes/fatigue/lethargy
Potential sources of infection?
- Pneumonia
- Skin infection – cellulitis, wounds
- Infection after abdominal surgery
- Urinary tract infection
- IV drug use infections
- Pressure sores
Investigations in sepsis?
- Culture
- blood, urine, pus swab, sputum - Full blood count
- Urea and creatinine& electrolytes
- Lumber puncture
- HIV tests, CD4 count, viral load
- Radiological
- CXR, USS, ECHO, CT, MRI - Serum lactate
- Blood glucose
Treatment of sepsis?
- IV fluids, crystolloids, albumin,
- Broad spectrum antibiotics within one hour of recognition until definitive culture results
- Oxygen if ARDS or O2 stats below 92
Inotropes treatment of sepsis?
- epinephrine
- vasopressin
- Dopamine
Supportive treatment of sepsis?
- ICU care
- ventilation, plone positioning in ARDS - Renal replacement for renal complications
- Glucose control
- Venous thromboembolic prophylaxis
What is neutropenic sepsis?
Common in cancer patients as a consequence of chemotherapy or direct effect of malignancies on the bone marrow (suppression)
Note: Can also be a consequence of any other causes of severe neutropenia
Definition of severe neutropenia?
Severe neutropenia is defined as an absolute neutrophil count of less than 0.5x10^9
When does neutropenic sepsis occur?
Neutropenic sepsis commonly occurs 7-14 days after starting chemotherapy
When to consider a neutropenic sepsis diagnosis?
in a patient on anti-cancer drugs with a neutrophil count of 0.5x10^9 with:
1. Temp 38 degrees celcius
2. signs and symptoms of sepsis
Pathogen that causes neutropenic sepsis?
- Coagulase-negative
- gram positive cocci are the commonest cause
- particularly staphylococcus epidermidis
Note: this is usually due to use of indwelling lines
Prophylaxis for a neutropenic patient?
Fluoloquinolones
Treatment of neutropenic sepsis?
Antibiotics must be started empirically and immediately
- do not wait for FBC results!
1. Piperacirin with tazobactam (Tazocin) a broad spectrum antibiotic combination.
2. Vancomycin can also be added if a patient has central venous lines
3. meropenem with or without vancomycin
- if still febrile and unwell after 48 hours of initial antibiotics
What do you do if you have no response after 4-6 days of treatment of neutropenic sepsis?
If no response after 4-6 days investigate for fungal sepsis and treat accordingly
- Consider G-CSF (granulocyte colony stimulating factor).
