Sepsis

Question 1

Define sepsis

Answer 1

Sepsis is life-threatening organ dysfunction due to dysregulated host response to infection

Question 2

What are the sepsis clinical criteria?

Answer 2

2 points or more in the Sequential Organ Failure Assessment score (SOFA)

Question 3

How are patient’s with sepsis who are likely to have prolonged ICU admission or die in hospital promptly identified atthe bedside?

Answer 3

qSOFA score or “HAT”: 2 or more of

Hypotension (SBP < 100mmHg)
Altered mental state (GCS<15)
Tachypnoea (RR>22/min)

Question 4

Define septic shock

Answer 4

Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.

Question 5

What are the clinical criteria for septic shock?

Answer 5

SEPSIS AND (despite adequate volume resuscitation) both of:

1. Persistent hypotension requiring vasopressors to maintain MAP >65 mmHg
2. Lactate > 2 mmol/L

Question 6

What is in hospital mortality for patients with septic shock

Answer 6

> 40%

Question 7

Is the term severe sepsis currently in use

Answer 7

No

Question 8

Summarise the management of sepsis

Answer 8

Communicate, declare, get help
ABCDEFG
1. Balanced crystalloid solution 30 ml/kg fluid bolus commenced within 1 hour and completed within 3 hours. Repeat as needed. No colloid.
2. Antibiotics: broad spectrum.
3. Labs/VBG/Blood culture/Sputum/Urine

Question 9

How should fluid management be guided and when are vasopressors indicated

Answer 9

Targets

1. MAP 60 - 70 mmHg
2. Dynamic measures: PPV/SVV (preferred)
3. Static measures: SLR/CVP 8 -12/SCVO2 > 70% (more available

If patient has had > 3 L in first 3 hours and remains hypotensive –> start vasopressors - adrenalin 0.01 - 0.5 mcg/kg/minute.

Question 10

What is the name and mechanism of action of each component of co-amoxiclav

Answer 10

Amoxicillin

• Inhibits bacterial cell wall biosynthesis
• Binds one or more of the penicillin binding proteins (PBP) which inhibits the final transpeptidation step of PEPTIDOGLYCAN synthesis
• Bacteria eventually lyse due ongoing call wall autolytic enzymes while cell wall assembly is arrested.

Clavulanic acid
- Binds and inhibits beta lactamases that inactivate amoxicillin resulting in amoxicillin having an expanded activity.

Question 11

What is the mechanism of action of ceftriaxone

Answer 11

Ceftriaxone

• Inhibits bacterial cell wall biosynthesis
• Binds one or more of the penicillin binding proteins (PBP) which inhibitis the final transpeptidation step of PEPTIDOGLYCAN synthesis.
• Bacteria eventually lyse due ongoing call wall autolytic enzymes while cell wall assembly is arrested.

Question 12

State the differences between the 1st - 5th generation cephalosporins

Answer 12

1st generation: Cefazolin (IV) | Cephalexin (PO)
- More gram + cover

2nd generation: Cefuroxime (IV/PO)
- More gram - cover with less gram + cover

3rd generation: Ceftriaxone (IV) | Cefixime (PO)

• Gram + and gram - cover with
• Increasing resistance to beta lactamases
• Great penetration into most tissues
• Chlamydia trachomatis is resistant (add Azithromycin)

4th generation: Cefepime (IV)
- Broader spectrum

5th generation: Ceftazidime-avibactam (IV)
- Active against MRSA

Question 13

What is the adult dose of co-amoxiclav

Answer 13

Adult

• IV 1200mg 8 hrly
• PO 1000mg 12 hrly

Question 14

List 7 goals of the antibiotic Stewardship program

Answer 14

1. Antibiotics are actually indicated
2. Culture before administration
3. Appropriate empiric AB choice
4. Correct dose and route of administration
5. Start rapidly in severe infections
6. Early and effective source control
7. Evaluate AB appropriateness daily