Sepsis Flashcards
what is an infection?
A pathological process caused by an invasion of normally sterile tissue or fluid or body cavity by pathogenic/potentially pathogenic micro-organisms.
infections are caused only by obligate pathogenic bacteria. True/False
False.
Infections can be caused also by opportunistic pathogens.
what is an opportunistic pathogen?
Opportunistic pathogens can cause an infectious disease in a host with depressed resistance (immunodeficiency) or if they have unusual access to the inside of the body (for example, via trauma).
Examples of opportunistic infections: oral candidiasis, vaginal yeast infection, cytomegalovirus infection, cryptococcal meningitis, pneumocystis jirovecii pneumonia, toxoplasma encephalitis
what is an obligate pathogen?
Can only replicate inside the cells of a host and therefore must infect someone in order to survive: e.g., Salmonella, Treponema pallidum, Mycobacterium tuberculosis
If a sufficient amount of bacteria is ingested (e.g., oral or contaminated foods), the disease also occurs in immunocompetent individuals.
Infection can be present without being microbiologically confirmed in the laboratory. True/False
True
what are the non-specific signs & symptoms of infection (constitutional signs)
Temperature / feels hot + sweaty Rigors Anorexia Fatigue Myalgia Arthralgia
what are constitutional symptoms of infection
A collection of nonspecific symptoms such as weight loss, fever, chills, night sweats, changes in appetite, changes in sleep, chronic pain, fatigue, and malaise. Typically evaluated on a review of systems with further evaluation based on pertinent positives and negatives.
what are B symptoms?
B symptoms refer to systemic symptoms of fever, night sweats, and weight loss which can be associated with both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. The presence or absence of B symptoms has prognostic significance and is reflected in the staging of these lymphomas.
list examples of the signs and symptoms related to the site of infection
Respiratory infection – Shortness of breath, cough, sputum
Urinary infection –frequency, dysuria, flank pain
Skin infection- -erythema, pain
Meningitis–headache, neck stiffness
Abdominal infection –pain, distension
what is the SIRS (systemic inflammatory response syndrome)
A syndrome defined by meeting 2 or more of the following criteria: 1) temperature > 38ºC or < 36ºC; 2) heart rate > 90 beats/min; 3) respiratory rate > 20 breaths/min or PaCO2 < 32 mm Hg; and 4) white blood count > 12,000 cells/mm³, < 4,000 cells/mm³, or >1% band forms. These criteria are outdated!!!!!!!!!!; sepsis and septic shock are now evaluated based on Sequential Organ Failure Assessment (SOFA) scoring.
SIRS is characterized by…
abnormal vital signs
what are the causes of SIRS?
– Infection – Ischaemia – Haemorrhage, – Inflammation (e.g. pancreatitis) – Trauma – Burns
define sepsis
Sepsis is an acute life-threatening condition characterized by organ dysfunction due to a dysregulated immune response to infection. The previously widely used term “systemic inflammatory response syndrome” (SIRS) is now considered outdated because its criteria were too simplified. Initial infection is generally bacterial and commonly of respiratory, genitourinary, gastrointestinal, dermatological, or soft tissue origin. Risk factors include immunocompromise, chronic comorbidities (e.g., diabetes mellitus), young or old age, and lengthy or invasive medical care. Patients may present with fever, tachycardia, confusion, and signs of the primary infection. Organ dysfunction is determined using a sequential organ failure assessment (SOFA) score that considers multiple parameters but may be quickly evaluated and assumed if two of the following findings are present: tachypnea, hypotension, and altered mental status. Diagnostic workup focuses on determining the responsible pathogen via cultures and identifying the source of infection (e.g., via imaging, ECG, lumbar puncture). Laboratory findings are largely nonspecific. Prompt, aggressive treatment is vital to survival and consists of resuscitation, empiric antibiotic therapy, and control of the infectious source.
define septic shock
A type of distributive shock caused by an excessive inflammatory response to disseminated infection, which leads to fluid extravasation from the vascular space and loss of intravascular volume. Defined as the requirement of vasopressors to maintain a median arterial pressure ≥ 65 mm Hg despite adequate fluid therapy, and lactate > 2 mmol/L (> 18 mg/dL) in a normovolemic patient with sepsis.
define bacteremia
The presence of bacteria in circulation. It can be harmless and transient or the result of serious infection, in which case it can lead to disseminated infection, sepsis, and septic shock.
every sepsis has an infection. True/False.
not every infection is sepsis however everybody with sepsis has an infection!
Sepsis is a laboratory diagnosis. True/False.
False.
It is a clinical diagnosis
sepsis is characterized by organ dysfunction. True/False
True
why it is important to define sepsis?
• Sepsis is the primary cause of death from infection, especially if not recognised and treated promptly –
• Definitions of ‘sepsis’ provide a framework for clinical intervention
(i.e. facilitates recognition of patients that require resuscitation)
what is the main reason for the poor outcome of sepsis?
90% of cases with the poor outcome due to inadequate recognition
what is the etiology of sepsis
- Common primary infections: respiratory, genitourinary, gastrointestinal, skin, and soft tissue infections
- Pathogens
- Bacterial: gram-positive bacteria (most common in the US), gram-negative bacteria
- Fungal, viral, or parasitic infection (rare)
what are the risk factors of sepsis?
- Age: < 1 year or > 75 years
- Primary comorbidities (diabetes mellitus, cirrhosis, community-acquired pneumonia, bacteremia (presence of bacteria in circulation), alcoholism)
- Immunosuppression (neutropenia, corticosteroid treatment, cancer, asplenia, HIV, renal failure)
- Intensive care or prolonged admission (nosocomial infections, immunosuppressive medications)
- Recent antibiotic or corticosteroid treatment
- Invasive medical devices (e.g., endotracheal tubes, intravenous lines, urinary catheters)
sepsis is primarily caused by G- bacteria. True/False
False
The most common cause are G+ bacteria
what condition is the most common cause of sepsis?
Pneumonia is the most common condition leading to sepsis.
define febrile neutropenia
A condition characterized by fever in patients with a neutrophil count ≤ 500/μL. Increases risk of severe bacterial infection. Etiologies include chemotherapy, bacterial infection, aspergillosis, candidiasis, and herpes virus infections.
what are the signs of new organ dysfunction in sepsis?
1) Lactate>2mmol/L (following adequate initial fluid resuscitation)
2) Systolic BP <90 or MAP <65 or Systolic BP more than 40 below patients normal
3) new need for oxygen to achieve saturation >90%
4) creatinine >170 microMol/L or urine output <0.5 ml/Kg for 2 hours
5) Bilirubin >32microMol/L
6) glucose >7.7 mmol/L (in the absence of diabetes)
7) platelets < 100.000
8) acutely altered mental status
what is the SOFA score?
A scoring system used to assess the severity of organ dysfunction and the risk of mortality. Commonly used in intensive care units (ICUs). Considers partial arterial pressure of oxygen, platelet count, bilirubin, mean arterial pressure (or vasopressor requirement), Glasgow Coma scale score, creatinine, and urine output. A simplified version of the SOFA score (the qSOFA score) identifies patients at increased risk for in-hospital mortality with suspected infection outside the ICU.
what is the lactate level in septic shock?
> 2mmol/L
how much should be the BP to diagnoses cardiovascular dysfunction in sepsis?
Systolic BP <90 or MAP <65 or Systolic BP more than 40 below patients normal
define respiratory dysfunction in sepsis
new need for oxygen to achieve saturation >90%
define renal dysfunction in sepsis
creatinine >170 microMol/L or urine output <0.5 ml/Kg for 2 hours
define liver dysfunction in sepsis
Bilirubin >32microMol/L
what hematological parameters are present in sepsis?
platelets < 100.000
define CNS dysfunction in sepsis
acutely altered mental status (Glasgow Coma scale)
