Sepsis

Question 1

Define sepsis

Answer 1

When the body’s response to infection causes injury to its own tissues and organs
Sepsis = infection + SIRS

Question 2

Define SIRS

Answer 2

Systemic Inflammatory Response Syndrome = inflammatory response to infection that affects the whole body

Question 3

Define severe sepsis and septic shock

Answer 3

Sepsis + organ dysfunction = severe

Sepsis + hypotension = septic shock

Question 4

Outline the pathogenesis of sepsis

Answer 4

Immune system stimulation -> pro inflammatory cytokine release

Fever, vasodilation, capilar permeability, WBC activity increases, reduced myocardial function

Hypovolaemia, hyperaemia, hypotension = hypo perfusion of tissues = anaerobic respiration and acidosis = end organ damage and MOF

Question 5

Test abnormality typical in sepsis?

Answer 5

Temperature <36 or >38
>90 bpm
RR >20 breaths/min
High WCC, high RR, high HR, altered cognition and low systolic bp <100

Question 6

Sepsis 6 treatment? (within 1 hour)

Answer 6

High flow O2
IV antibiotics
IV fluid
Take blood culture
FBC and serum lactate
Start urine output measurement

Question 7

Outline host microbe interactions in both health and disease

Answer 7

Health: commensal, symbiotic or colonisation
Disease: infection = when microbes invade and multiply on an area of the body where they aren’t usually present

Question 8

What are common microbial causes of pneumonia?

Answer 8

Haemophilus Influenzae
Streptococcus Pneumoniae
Staphylococcus Aureus

Question 9

What’s the qSOFA?

Answer 9

SOFA = sequential organ failure assessment (scoring system used in intensive care)

Need to have more than 1 of:
Reduced consciousness
RR>22/min
SBP<100mmHg

Question 10

What are the red flags of sepsis?

Answer 10

Purpuric rash
HR >130
SBP <90
RR >25
SaO2 <91%
Low GCS
Lactate >2mmol

Question 11

What’s CURB-65?

Answer 11

Confusion
Urea >7
RR >30
SBP <90
age >65 years

Mortality risk assessment in community acquired pneumonia (IV treatment if score >2)

Question 12

Which antibiotic group does ceftriaxone belong to and what’s it used for?

Answer 12

Cephalosporin beta-lactam
Bactericidal as interferes with cell wall synthesis so kills bacteria

Abdominal sepsis, bacterial meningitis and orthopaedic infections

Question 13

What’s an antifolate antibiotic?

Answer 13

Trimethoprim
Inhibits folic acid synthesis and therefore DNA synthesis = bacteriostatic
Used for UTIs
NOT PREGNANT WOMEN

Question 14

What are nitroimadozles used for?

Answer 14

Anaerobic infections eg abscesses

Metronidazole: target bacterial DNA structure and function = bacteriostatic but bactericidal at high doses