Sepsis (4)

Question 1

Define infection:

Answer 1

presence of microorganisms in a normally sterile site

Question 2

Define bacteremia:

Answer 2

Culturable bacteria in the bloodstream

Question 3

What are the criteria for SIRS?

Answer 3

Need to have >2 of the following:

Temp >38 or 90
RR>20 or PaCo2 12,000 cells/ mm3 or 10% banc cells

Question 4

What is sepsis?

Answer 4

systemic response to infection

Question 5

What is severe sepsis?

Answer 5

Sepsis associated with dysfunction of organs distant from the site of infection, hypoprofusion or hypertension

Question 6

What is septic shock?

Answer 6

Sepsis w/ hypotension that persists despite fluid resuscitation that requires vasopressor therapy

Perfusion abnormalities

Question 7

SIRS is due to …

Answer 7

Procytokines and cytokines

Infectious or noninfectious insult

Question 8

What plays a critical role in SIRS?

Answer 8

TLR4…it transmits the LPS recognition signal to the interior of the cell

Question 9

What does TLR4 recognize?

Answer 9

LPS (gram - bacteria cell wall component)

Question 10

What is gram negative shock?

Answer 10

Results from the massive cytokine storm that occurs after the release of LPS

Question 11

What are some signs of sepsis?

Answer 11

Rapid breathing

changes in mental status

fever/ shaking chills

Decreased urination

Tachycardia

Nausea, vomiting, diarrhea

Question 12

What is transient bacteremia?

Answer 12

Lasts for a few minutes or a few hours

Frequently occurs after manipulation of nonsterile body sites

Question 13

What is intermittent bacteremia?

Answer 13

Bacteremia due to the same microorganism that is detected intermittently in the same patient (due to cycles of clearance and recurrence)

Associated with an undrained abscess

Question 14

What is persistent bacteremia?

Answer 14

Characteristic of infective endocarditis and other intravascular infections

Also seen in early stages of systemic bacterial infection

Question 15

Define primary BSI:

Answer 15

A BSI w/out documented primary source of infection and the source of teh organism is from an intravascular site

Question 16

What organisms typically cause infective endocardits and who is susceptible?

Answer 16

Usually develops in individuals with underlying structural cardiac defect who develop bacteremia

S. aureas, Viridans, coag negative staph, and HACEK

Question 17

What causes mycotic aneurysms?

Answer 17

Infectios cause inflammatory damage and weakening of arterial wall

Question 18

What is supprative thrombophlebitis?

Answer 18

Venous thrombosis associated with inflammation in the setting of bacteria

Question 19

Who does supprative thrombophlebitis usually occur in?

Answer 19

People with IV catheters or PIC lines

Question 20

What is secondary (extravascular) BSI?

Answer 20

BSI in which there is a documented portal of bacterial entry and/or associated site of infection

Question 21

How do you detect bacteremia?

Answer 21

3 sets of cultures over 24 hours.

Should take from different site

Question 22

Detection rates for 1 set, 2 sets and 3 sets?

Answer 22

1 set: 80%
2 sets: 90%
3 sets: 99%