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sepsis Flashcards

1
Q

what is infection?

A

inflammation due to microbe

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2
Q

what is sepsis?

A

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

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3
Q

what is septic shock?

A

Sepsis along with both:
Persistent hypotension (vasopressors needed to maintain MAP at >/= 65)
High lactate (>/= 2)
(with adequate fluids)

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4
Q

most common infection that leads to sepsis?

A

Lung-lower respmost common
Abdominal
UTI
Skin infection (soft tissue, bone, joint)
Other
Indwelling devices

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5
Q

Best scoring system to identify sepsis?

A

NEWS>5

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6
Q

What is measured in NEWS?

A

Respiration rate
Oxygen saturation
Systolic blood pressure
Pulse rate
Level of consciousness
Temperature

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7
Q

timeframe to do sepsis 6?

A

1 hour

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8
Q

What is sepsis 6?

A

BUFFALO
BLOOD CULTURES (and Us and Es) + all relevant sites – before antibiotics
URINE OUTPUT (HOURLY!)
FLUID RESUSCITATION
ANTIBIOTICS IV
LACTATE MEASUREMENT
OXYGEN – TO CORRECT HYPOXIA

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9
Q

How many blood cultures in endocarditis to diagnose

A

3 within an hour before antibiotics

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10
Q

Criteria to assess for likelihood of endocarditis

A

Dukes criteria

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11
Q

What investigations can be done to diagnose sepsis?

A

Cultures: blood, urine, stool, wound, tissue cultures
Microscopy: stool, urine, CSF, sputum
Serology – detects antibodies in the blood
Antigen detection
PCR/molecular studies

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12
Q

When the infectious cause is identified sensitivity for antibiotics can be done.
what tests are they

A

E test- determines the lowest concentration at which the antibiotics inhibit the growth of the organsism.

Vitek machine- gives MICs (minimum inhibitory concentrations for each)

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13
Q

What is MIC?

A

Mean inhibitory concentration
The concentration of a drug required to kill 99.9% of organisms in 18-24 hours.
Useful to guide antibiotic choice

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14
Q

What inflammatory markers can be measured in the lab?

A

White cell count
CRP
Procalcitonin (PCT)
Lactate - main one in sepsis

All rise in infection

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15
Q

What drug causes wcc to raise commonly?

A

Steroids
Lithium

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16
Q

Difference between gram negative and gram positive bacteria?

A

Gram neg- two layers in cell wall and periplasmic space causing pink staining

Gram-positive- single layer, no space causing purple staining

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17
Q

ways of identifying bacteria

A

Gram stain
Shape
MALDI-TOF
Anaerobic vs aerobic

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18
Q

What is the MALDI-TOF machine?

A

Used to identify organisms on a positive culture.
Uses mass spectrometry to identify peaks associated with particular micro-organsims

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19
Q

Common causes of gram negative sepsis?

A

E. coli
Pseudomonas aeruginosa
H. Influenza
Neisseria meningitidis
Neisseria gonorrhoea

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20
Q

Good antibiotics for gram negative?

A

Gentamicin (IV only)
Amoxicillin

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21
Q

common side effects of gentamicin

A

Nephrotoxicity
Ototoxicity

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22
Q

What drug for h. influenza

A

Amoxicillin
(doxycycline also works)

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23
Q

Does h. influenza grow on blood agar?

A

No
Chocolate agar only

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24
Q

Causes of atypical pneumonia?

A

Mycoplasma pneumonia
Chlamydia psittaci
Legionella pneumophilia

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25
Q

Antibiotics that work in atypical pneumonias

A

Doxicycline – not in legionella
Clarithromycin
Levofloxacin if penicillin allergic

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26
Q

UTI treatment guidelines

A

In a women:
3 days of nitrofurantoin or trimethoprim

In a man:
7 days of nitrofurantoin or trimethoprim

Complicated:
IV amoxicillin and gentamicin
step down to co-trimoxazole

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27
Q

drug for staph aureus

A

Flucloxacillin
Vancomycin (if allergic or MRSA)

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28
Q

What route does strep pyogenes cause sepsis through

A

Skin and soft tissue infection

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29
Q

where does Strep viridans infect

A

Endocarditis
Doesn’t cause gut infection- this where it lives

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30
Q

Strep antibiotics

A

Penicillins are still okay

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31
Q

Where do enterococci cause sepsis ?

A

Infective endocarditits
UTI

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32
Q

Antibiotics for enterococci

A

Amoxicillin
If resistant: vancomycin
VRE- vacomycin resistant enterococcus use a weirdo antibiotic

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33
Q

Strep haemolysis test

A

Beta haemolysis
Group A strep
e.g. strep pyogenes

Alpha haemolysis
Strep viridans
Strep pneumonia

Gamma haemolysis
Enterococci

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34
Q

List some gram positive bacilli

A

Listeria monocytogenes (atypical meningitis in alcoholics, diabetics, over 65 and immunosurpressed)

Bacillus
b. Anthracis (anthrax)
b. Cereus (food poisoning after reheated rice)

Clostridia
c. Difficile (diarrhoea after antibiotics)
c. Tetani (tetanus)
c. Perfringes (soft tissue infection)

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35
Q

Do antibiotics work in abscesses?

A

No – they require drainage

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36
Q

Mechanism (really simplified) of antibiotic resistance?

A

Antibiotics are only able to kill certain strains of bacteria
Bacteria with certain traits survive
These bacteria are now able to multiply and colonise

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37
Q

4cs of c. diff

A

Co amox
Cephalosporins (cef- drugs)
Clindamycin
Ciprofloxacin

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38
Q

How often should you review iv abx?

A

Daily

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39
Q

Whats source control in sepsis?

A

Eliminate the source of infection, control ongoing contamination, and restore premorbid anatomy and function

Strategies used to achieve source control include drainage of purulent collections, open or percutaneously, removal of the infected and/or necrotic tissue (debridement), creation of diverting ‘ostomies’, and removing obstruction, among others.

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40
Q

Are people fixed after sepsis goes away?

A

No
Many physical and mental symptoms persist

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41
Q

Clinical signs of community acquire pneumonia

A

Cough
Increased sputum
Chest pain
Dyspnoea
Fever
CXR with infilitrates
Needs to be acquired in the community (or first 24 hours in the hospital)

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42
Q

typical bug of CAP?

A

Strep. pneumonia

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43
Q

Atypical pneumonia bugs

A

Mycoplasma pneumonia
Legionella pneumonia
Chalmydophilia pneumonia
Chlamydia psittacci
Viruses

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44
Q

Pneumonia type common in the immunosurpressed

A

Pneumocystis jiroveci - HIV patients+CF
Aspergillus sp. – after organ transplant!
Endemic mycoses
TB

45
Q

Common in cf

A

Straph aureus
H. influenza
Strep pneumonia

Main 2
Pseudomonas aeruginosa
Burkholderia cepacia

46
Q

Diagnosing CAP

A

Sputum culture
Viral PCR
Additional tests – antigen/biomarkers

47
Q

Treating CAP

A

use curb65
CONFUSION
UREA >7
RR >/ 30
BP- SBP < or =90
DBP< or =60

0-2 - Amoxicillin 1g tds IV/PO(5 days)- if penicillin allergic- Doxycycline 200mg PO on day one then 100mg od or IV Clarithromycin

3-5 - Co-amox IV 1.2g tds + Doxy PO 100mg bd- if pen allergic IV Levofloxacin

48
Q

Neutropenic sepsis?

A

Sepsis +
Neutrophil count <0.5 or <1 if on chemo in last 21 days

49
Q

treatment for neutropenic sepsis

A

piperacillin and tazobactam (add gentamicin if high risk)

50
Q

When would you suspect malaria?

A

Up to 1 year post travel to an affected area
Fever
Reduced GCS
Seizures
Respiratory distress
Abnormal bleeding

51
Q

What bug causes malaria

A

Plasmodium falciparum

52
Q

How do you diagnose malaria?

A

3 x thick and thin films (over time)
Can do a rapid antigen- not that helpful but fast

53
Q

Whats enteric fever

A

Typhoid
Paratyphoid

54
Q

How can typhoid present

A

Travel to area plus
Maybe asymptomatic
Anaemia
DIC
Meningitis/encephalopathy
Shock
Myocarditis
Bronchitis
Pneumonia
Hepatitis
GI bleed

55
Q

How does dengue fever present?

A

Within 14 days of returning from an endemic area
With fever, arthralgia, leukopaenia
Rash- blanches to your hand

56
Q

how dengue fever managed

A

Supportive

57
Q

most common root of meningitis

A

Ears- otitis media
Nasopharynx
Parameningeal e.g sinusitis, mastoiditis
Haematogenous eg infective endocarditis

58
Q

types of meningitis

A

Acute Pyogenic → bacterial
Acute Aseptic → viral, non-infectious
Acute Focal Suppurative → abscess, empyema
Chronic Bacterial → TB
Fungal

59
Q

what is pyogenic meningitis

A

The pia-arachnoid layer is congested w/ a thick layer of suppurative exudate (pus) that covers the leptomeninges

60
Q

Pathogen causes of pyogenic meningitis

A

Strep. Pneumoniae → extracellular *pneumococcal
Neisseria meningitidis → intracellular *meningococcal
Listeria monocytogenes → gram +ve
H. influenzae

61
Q

epidemiology of meningitis

A

Neonates → Listeria, Group B Strep.
Unvaccinated kids → H. influenzae
Age 10-21 → Neisseria meningitidis , Strep. Pneumoniae
Age 21-65 → Strep. Pneumoniae
Age 65+ → Strep. Pneumoniae
Immunocompromised →Listeria
Head Trauma → Staph. Aureus
Cribriform plate fracture → Strep. Pneumoniae

62
Q

complications of meningitis

A

SNHL- most common
Limb loss
Blindness
Cerebral palsy

63
Q

what is aseptic meningitis

A

meningitis that comes back negative on culture

64
Q

most common cause of aseptic meningitis

A

Viral- entero, coxsackie, mumps, HSV, VZV

65
Q

Diagnostic tools for viral meningitis

A

stool PCR + culture, throat swab, LP PCR, HIV

66
Q

treatment for viral meningitis

A

supportive

67
Q

Lumbar puncture appearance for bacterial ,viral and fungal

Gross appearance difference

A

Bacterial- cloudy or frankly plurpent
Viral- Clear/ slightly turbid
Fungal- clear

68
Q

Lumbar puncture appearance for bacterial ,viral and fungal

Csf pressure

A

Bacterial- slightly high
Viral- high
Fungal- very high

69
Q

Lumbar puncture appearance for bacterial ,viral and fungal

Cell present

A

Bacterial- Neutrophils
Viral- Lymphocytes
Fungal- Lymphocytes

70
Q

Lumbar puncture appearance for bacterial ,viral and fungal

Protein

A

Bacterial- very high
Viral- slightly high
Fungal- high

71
Q

Lumbar puncture appearance for bacterial ,viral and fungal

Glucose

A

Bacterial- low
Viral- normal
Fungal- low

72
Q

Lumbar puncture appearance for bacterial ,viral and fungal

Bacteriology

A

Bacterial- causitive organism
Viral- sterile
Fungal- fungi

73
Q

when to CT before LP

A

Papilloedema
GCS <13
Hx of CNS disease
Seizure /focal neuro deficit
Stroke
Immunocompromised

73
Q

when is LP condraindicated

A

Raised ICP

74
Q

Meningitis Treatment

A

Bacterial- ABX + steroid

steroid- dexamethasone

ABX- 1st line -IV ceftriaxone
pen allergic- IV chloramphenicol+ vancomycin

75
Q

what comes up on stain for fungal

Fungal treatment for Meningitis

A

Indian pink stain

IV amphotericin B or flucytosine

76
Q

Suspect meningitis in GP- what do you give

A

IM Benzylpenicillin

77
Q

what is encephalitis+ investigation+ treatment

A

infection of the brain parenchyma

MRI- bright white in temporal lobes

IV aciclovir

78
Q

Causes of encephalitis

A

VZV- chicken pox virus
HSV- older patients

79
Q

symptoms of encephalitis

A

Mainly neurological
psychosis
seizure
fever
meningism
speech disturbance

80
Q

Pathology of guillain barr

A

B cells secrete Ab that attack pathogens, however the Ag on pathogens matches those on the myelin sheath

81
Q

diagnostic test for GB

A

LP- rule out other causes

82
Q

whats botulism pathology

A

exotoxin acts on motor neuron terminals to block vesicle docking in presynaptic membrane, irreversibly inhibiting Ach release.

83
Q

signs of botulism

A

Rapid onset weakness w/out sensory loss
Ascending paralysis

84
Q

a person with multiple brain abscesses will get it through which mechanism of infection

A

Haematogenous spread

85
Q

what is neutropenic sepsis

A

Temp >38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 10^9/L or lower.

86
Q

causes of neutropenic sepsis

A

chemotherapy is the main reason

immunosuppression, medications e.g. clozapine, methotrexate, sulphasalazine, carbimazole

87
Q

most common infective pathogen in neutropenic sepsis

A

gm -ve, pseudomonas, aspergillus

passmed says gram + due to lines in chemo but leactures say otherwise

88
Q

treatment for neutropenic sepsis

A

piperacillin+tazobactam

in septic shock add gentamicin

89
Q

what is a commensal

A

organism present in body that doesn’t produce inflam response

90
Q

what is definition of infection

A

presence of an organism w/ inflam response

91
Q

what is definition of bacteraemia

A

presence of bacteria in the blood

92
Q

what is definition of SIRS

A

dysregulated host response in response to stimuli (infective or non)

93
Q

what is definition of severe sepsis

A

intermediate between sepsis and full septic shock

94
Q

sepsis antibiotics

A

amox, metronidazole, gent all IV
if allergy- Vanc, met, gent all IV

95
Q

sepsis scoring

A

NEWS and qSOFA

96
Q

qSOFA- what’s in it

A

GCS reduction
RR = OR >22
Systolic BP < or = 100

score >2 means concern

97
Q

antibiotics in sepsis of unknown cause

A

Amox, met and gent

If P.a- vanc, met and gent

98
Q

antibiotics in sepsis of meningitis

A

IV ceftriaxone + dexamethasone

if P.a- IV chloramphenicol + vanc

99
Q

antibiotics in sepsis of severe CAP

A

Co-amox + doxy

100
Q

antibiotics in sepsis of severe HAP

A

amox + gent

101
Q

antibiotics in sepsis of C.Diff

A

oral vanc

102
Q

antibiotics in sepsis of UTI

A

amox + gent
if P.A- co-trimoxazole

103
Q

endocarditis for Native valve indolent

A

Amoxicillin IV 2g 4 hourly + Gentamicin

104
Q

confirmed endocarditis sepsis in native valve

A

flucloxacillin 2g IV 4-6 hrs

105
Q

endocarditis sepsis which is mrsa in native valve

A

vanc + gent + rifam (3-5 after starting other antibiotics)

106
Q

endocarditis sepsis with risk factors for resistant pathogens

A

vanc + meropenem

107
Q

prosthetic valve endocarditis

A

vanc + gent + rifam (3-5 after starting other antibiotics)

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