Sepsis Flashcards
What is neutropenic sepsis?
Neutropenic sepsis is a common complication of cancer therapy, usually due to chemotherapy, occurring 7-14 days after treatment. It is defined as a neutrophil count of < 0.5 * 10^9 in a patient undergoing anticancer treatment with a temperature higher than 38ºC or other signs of clinically significant sepsis.
What is the most common cause of neutropenic sepsis?
Coagulase-negative, Gram-positive bacteria, particularly Staphylococcus epidermidis, are the most common cause, often due to the use of indwelling lines in cancer patients.
What prophylaxis should be offered for neutropenic sepsis?
Patients likely to have a neutrophil count of < 0.5 * 10^9 due to treatment should be offered a fluoroquinolone.
What is the immediate management for neutropenic sepsis?
Antibiotics must be started immediately, without waiting for WBC results. NICE recommends starting empirical antibiotic therapy with piperacillin with tazobactam (Tazocin).
When should alternative antibiotics be considered in neutropenic sepsis?
If patients are still febrile and unwell after 48 hours, an alternative antibiotic such as meropenem is often prescribed, possibly with vancomycin.
What should be done if patients are not responding after 4-6 days of treatment?
Investigations for fungal infections should be ordered rather than starting antifungal therapy blindly.
What is sepsis?
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.
What are the updated classifications of sepsis?
Sepsis is classified into sepsis and septic shock, with septic shock being a more severe form associated with a greater risk of mortality.
What criteria indicate heightened risk of mortality in suspected infection?
A quickSOFA (qSOFA) score of >= 2, which includes a respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100mmHg or less.
What are the red flag criteria for risk stratification in sepsis?
Red flag criteria include: unresponsive state, systolic BP <= 90 mmHg, heart rate > 130/min, respiratory rate >= 25/min, needs oxygen to maintain SpO2 >= 92%, non-blanching rash, not passed urine in last 18 hours, lactate >= 2 mmol/l.
What are the ‘sepsis six’ interventions?
- Administer oxygen to keep saturations > 94%. 2. Take blood cultures. 3. Give broad-spectrum antibiotics. 4. Give intravenous fluid challenges (500ml crystalloid over < 15 minutes). 5. Measure serum lactate. 6. Measure accurate hourly urine output.
What is the SOFA score?
The Sequential (Sepsis-Related) Organ Failure Assessment Score (SOFA) grades abnormality by organ system and requires laboratory variables for full computation.
What does a SOFA score of 2 or more indicate?
A SOFA score of 2 or more reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection.
qSOFA score
Management - red flag and amber flag criteria
SOFA score - 0 to 4
