Sepsis

Question 1

subset of sepsis cases in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality risk.

Answer 1

Septic Shock

Question 2

dysregulated host response to infection that leads to acute organ dysfunction

Answer 2

Sepsis

Question 3

Sepsis-3 Clinical Criteria

Answer 3

1) a suspected infection and
2) acute organ dysfunction
> increase by two or more points from baseline (if known) on the sequential (or sepsis-related) organ failure assessment (SOFA) score

Question 4

1) Sepsis + need for vasopressor therapy to elevate mean arterial pressure to ≥65 mmHg
2) Serum lactate concentration >2.0 mmol/L despite adequate fluid resuscitation

Answer 4

Septic shock

Question 5

Most frequent sources of Sepsis

Answer 5

1. Pneumonia: Most common cause
2. Intraabdominal
3. Genitourinary

Question 6

Most common gram positive isolates in Sepsis

Answer 6

Staphylococcus aureus

Streptococcus pneumoniae

Question 7

Most common gram negative isolates in Sepsis

Answer 7

Escherichia coli
Klebsiella species
Pseudomonas aeruginosa

Question 8

Risk factors for increased risk for infection

Answer 8

1. Chronic diseases (e.g., HIV infection, chronic obstructive pulmonary disease, cancers)
2. Immunosuppresion

Question 9

Risk factors for progression of infection to organ damage

Answer 9

1. Underlying health status
2. Preexisting organ function
3. timeliness of treatment

Question 10

Risk factors for Sepsis

Answer 10

Age, sex, and race/ethnicity all influence the incidence of sepsis

Highest at the extremes of age
Higher in males
Higher in blacks

Question 11

Causes of reduced oxygen delivery in Sepsis and Septic Shock

Answer 11

1. Hypotension
2. Reduced red-cell deformability
3. microvascular thrombosis

Question 12

Sepsis- associated immune suppression and death

Answer 12

Enhanced apoptotic cell death especially of B cells, CD4+ T cells, and follicular dendritic cells

Question 13

Most common secondary infections in Sepsis

Answer 13

1. catheter-related bloodstream infections
2. ventilator-associated infections
3. abdominal infections

Question 14

Evidence of tissue hypoperfusion

Answer 14

oliguria, altered mental status, poor peripheral perfusion, hyperlactemia

Question 15

Causes of Hypotension in Sepsis

Answer 15

Frank hypovolemia
Maldistribution of blood flow and intravascular volume due to diffuse capillary leakage
Reduced systemic vascular resistance
Depressed myocardial function

Question 16

AKI in Sepsis

Answer 16

documented in >50% of septic patients

increasing the risk of in-hospital death by six- to eightfold

Question 17

Other manifestations of Sepsis

Answer 17

ileus, elevated aminotransferase levels, altered glycemic control, thrombocytopenia and disseminated intravascular coagulation, adrenal dysfunction, and sick euthyroid syndrome.

Question 18

Findings in Sepsis

Answer 18

Tachycardia heart rate, >90 beats per min: was present in >50% of encounters
Tachypnea RR > 20 breaths per min
Hypotension systolic blood pressure, ≤100 mmHg
Hypoxia (SaO2, ≤90%)
Leukocytosis (WBC count, >12,000/μL: fewer than one-third of patients leukopenia (WBC count, <4000/μL) in fewer than 5%

Question 19

Less common findings

Answer 19

Serum hypoalbuminemia, troponin elevation, hypoglycemia, and hypofibrinogenemia.

Question 20

Logic Statement of Sepsis

Answer 20

sepsis = f (threat to life | organ dysfunction | dysregulated host response | infection)

Question 21

SOFA

Answer 21

Systolic blood pressure ≤100 mmHg

Serum creatinine ≥1.2 mmHg

PaO2/FiO2 ratio ≤300

Platelets ≤150 k/uL

Glasgow coma scale <15

Bilirubin ≥1.2 mg/dL

Mechanical ventilation Present/absent

Vasopressors Present/absent

Vasopressors More than 1

Question 22

SOFA score diagnosis for Sepsis

Answer 22

With ≥2 new SOFA points

at ≥10% risk of in-hospital death

Question 23

qSOFA: score of ≥2 points has a predictive value for Sepsis

Answer 23

systolic hypotension (≤100 mmHg), tachypnea (≥22 breaths/min), or altered mentation

Question 24

Causes of increased Lactate

Answer 24

Alcoholic intoxication, liver disease, diabetes mellitus, administration of total parenteral nutrition, or antiretroviral treatment

Question 25

Empiric therapy choice

Answer 25

suspected site of infection, the location of infection onset (i.e., the community, a nursing home, or a hospital), the patient’s medical history, and local microbial susceptibility patterns

Question 26

Antibiotic delay

Answer 26

For every 1-h delay among patients with sepsis, a 3–7% increase in the odds of in-hospital death is reported

Question 27

Initial Management Bundles: within 3 HOURS

Answer 27

1) early admin-istration of appropriate broad-spectrum antibiotics, (2) collection of blood for culture before antibiotic administration, (3) measure-ment of serum lactate levels

Question 28

Management bundles: within 6 HOURS

Answer 28

1) an intravenous fluid bolus, (2) treatment with vasopressors for persistent hypotension or shock, and (3) re-measurement of serum lactate levels