Sepsis Cases Notes

Question 1

What is the Sepsis 6 mnemonic?

Answer 1

BUFALO
B - Blood Cultures
U - Urine Output
F - Fluids
A - Antibiotics
L - Lactate
O - Oxygen

Question 2

What is the main treatment for C.Diff?

Answer 2

Oral Vancomycin
- IV is ineffective as it is an Intra-luminal disease of the bowel.

Question 3

What tests would you do for an Infection with C.Diff?
Blood cultures and 2 more…

Answer 3

• Stool culture/Stool PCR
• Abdominal X-ray (Toxic Megacolon)
• Blood Cultures.

Question 4

What type of Organism is C.Diff?

Answer 4

Gram +ve aetobic, Spore-forming, Toxin-producing Bacilli

Question 5

What are risk factors for C.Diff infection?

Answer 5

• PPI’s
• Abx treatment
• Being in Hospital

Question 6

How does hand hygiene differ in C.Diff?

Answer 6

Alcohol is ineffective against spores. So Soap and water must be used every time.

Question 7

What are the differential causative organisms for Bloody diarrhoea?

Answer 7

• E.Coli 0157
• Campylobacter.
• Shigella
• Listeria
• Salmonella

Question 8

Which pathogen can cause diarrhoea, bruising and confusion and also predisposes to HUS?

Answer 8

E.Coli 0157

Question 9

What signs on FBC are looked for in a patient with E.Coli infection?

Answer 9

• Anaemia
• Thrombocytopenia

Question 10

What Abx should be offered in a patient with Gastroenteritis Infection?

Answer 10

Abx should be WITHHELD!
- Campylobacter (No Abx usually required)
- Salmonella or shigella (Need confirmation)
- E.Coli 0157 (Tx w Abx can cause HUS!)

Management should be supportive with IV fluids, Renal replacement theory if necessary.

Question 11

What is the Triad of HUS?

Answer 11

Haemolytic Uraemic Syndrome.
Triad of Haemolytic Anaemia, Thrombocytopenia and AKI.

Question 12

What is an ICED infection?

Answer 12

Infection of Implantable Cardiac Electronic Device.

Question 13

What causes an ICED infection?

Answer 13

Lead (“leed”) infection.
Generator pocket infection.
Endocarditis.

• Staph Aureus
• Staph Epidermidis
• Strep Viridans

Question 14

What is the most common cause of Prosthetic valve endocarditis?

Answer 14

Coagulase negative staph - Staphylococcus Epidermidis.

Question 15

What is the most common cause of Native Valve Endocarditis?

Answer 15

Staphylococcus Aureus.

Question 16

What is the most common cause of a Septic Arthritis?

Answer 16

Staphylococcus Aureus.

Question 17

What medication would be used when treating an Endocarditis with unknown causative organism?

Answer 17

Vancomycin
- Covers both a Staph Epidermidis and Staph aureus until causative organism is determined.

Question 18

What does “source control” refer too?

Answer 18

Physical methods to reduce the burden of infection and aid Abx treatment.
(e.g. Irrigation in Septic Arthritis.) or (Removal of ICED in Endocarditis or Lead infection)

Question 19

How should blood cultures be taken when considering Endocarditis?

Answer 19

Ideally 3 sets of blood cultures 6 hours apart if considering Endocarditis.

In the context of sepsis however, Minimum of 2 sets over the first hour.

Question 20

What areas are Swabbed in an MRSA swab screen?

Answer 20

Nose, throat, Groin

Question 21

What is the definition of SEPSIS?

Answer 21

A News score of 5 or above likely caused by infection.

Question 22

What does the CURB-65 score tell us?

Answer 22

Predicts the chance of Mortality in patients with Pneumonia and assesses the need for intervention.

Question 23

What is included in a CURB-65 and what is the score system?

Answer 23

C - Confusion? 1pt
U - Urea (BUN >7mmol/l) 1pt
R - Resp Rate (>30) 1pt
B - BP <90 1pt
≥65yrs - 1pt

Out of 5.

Question 24

What is the treatment of Pneumonia with a CURB-65 score of ≥3?

Answer 24

Doxycycline + Co-Amoxiclav.

Question 25

What are Clarithromycin, Levofloxacin and Doxycycline targeting in Pneumonia Tx?

Answer 25

Covers the Atypical causes (e.g. Mycoplasm Pneumonae, Legionella, Viruses)

Question 26

What is the Tx for low severity Community acquired Pneumonia?

Answer 26

Amoxicillin.

Clarithromycin or Doxycycline if Allergic.

Question 27

What can be tested for in the urine of patients with Pneumonia?

Answer 27

Urinary antigen - Specific to L.Pneumophilia serotype 1.

L.Pneumophilia is a cause of Atypical Pneumonia

Question 28

What pathogen can cause Bacteraemia with the potential to infect the Heart, Bones, Joints and create abscesses in large muscles (E.g. Psoas Abscess)?

Answer 28

Staph Aureus Bacteraemia (SAB) - Has the potential to cause metastatic infections.

Question 29

What is the first line Tx of Staph Aureus Bacteraemia?

Answer 29

High dose IV Flucloxacillin.

Vancomycin if allergic (not as effective)

For both Tx must last a minimum of 2 Weeks.
- then 48 hourly cultures until negative.

Question 30

What may cause Staph Aureus Bacteraemia to persist?

Answer 30

Persistance indicates a deep seated infection in other areas as well.
“source control” may be required (e.g. Drain abscess, Irrigation of Joint)

Question 31

How would you treat a Lady with fever, R Loin pain and fever. Whose urine culture grew E.coli?

Answer 31

Trimethoprime
(Narrow spectrum)

If Pyelonephritis, Include Gentamicin.

Question 32

• Examination => Red hot leg
• Excruciatingly painful with blisters.
• Collateral Hx => Shivery (rigors)
  What are you worried about?

Answer 32

Necrotising Fasciitis!
(best case it’s just sepsis)

Tx - ACT FAST!
- Surgical Debridement AND Broad Abx (IV Fluclox + Clindamycin + Gentamicin)

Question 33

What is the empirical treatment for Sepsis of unknown source?
- All Clinical examinations are clear.

Answer 33

A fever with no cause found but is still being investigated through Blood cultures or Urine cultures etc..

IV Amoxicillin + Metronidazole + Gentamicin.
(Won’t cover S.Aureus so if IV drug user may need to add this)

Question 34

What is the drug of choice for Anaerobic cover?

Answer 34

Metronidazole

(co-amoiclav also will, Clindamycin too)