Sepsis

Question 1

Major pathogens of sepsis in children <2 months

Answer 1

E. coli
GBS
Listeria monocytogenes (uncommon)
Consider HSV

Question 2

Major pathogens of sepsis in older children

Answer 2

Neisseria meningitidis
Streptococcus pneumonias
Staph aureus (MSSA or MRSA)
Group A streptococcus

Question 3

Sepsis or septic shock should be considered in patients with a suspected or proven bacterial infection and if they have any of the following:

Answer 3

Altered conscious state
Unwell appearance +/- non-blanching rash
Features of cardiovascular dysfunction: reduced peripheral perfusion, pale/cool/mottled skin, CRT >2, tachycardia, decreased UO, narrow pulse pressure
Tachypnoea +/- hypoxia +/- grunting (not adequately explained by respiratory illness)
Unexplained pain
Fever or hypothermia

Question 4

Features of warm shock

Answer 4

Bounding pulses, widened pulse pressure, flushed skin with rapid cap refill
(More common in older children/adolescents)

Question 5

Features of cold shock

Answer 5

Narrow pulse pressure, prolonged cap refill

More common neonates

Question 6

Mechanism of toxin-mediated sepsis

Answer 6

Superantigens from toxin-producing strains of Staph aureus or GAS

Question 7

Antibiotics for empiric treatment of sepsis at various ages

Answer 7

<7 days: benpen 60mg/kg BD, cefotaxime 50mg/kg BD
7-28 days: benpen 60mg/kg Q6-8H, cefotaxime 50mg/kg Q6-8H
1-2 months*: benpen 60mg/kg Q4-6H, cefotaxime 50mg/kg Q6H
>2 months: ceftriaxone 100mg/kg (max 4g) daily or cefotaxime 50mg/kg (max 2g) Q6H, fluclox 50mg/kg (max 2g) Q6H

*Consider adding acyclovir 20mg/kg Q8H if HSV suspected <3 months (mottled rash, seizures, hepatitis)

Question 8

Additional antibiotics in oncology patients

Answer 8

Piptaz 100mg/kg (max 4g) Q6H

If severely unwell or high risk, add amikacin and vancomycin

Question 9

Additional therapies in suspected toxin-mediated disease

Answer 9

Clindamycin 15mg/kg (max 900mg) Q8H

IVIG