Sepsis Cases Notes Flashcards
What is the Sepsis 6 mnemonic?
BUFALO
B - Blood Cultures
U - Urine Output
F - Fluids
A - Antibiotics
L - Lactate
O - Oxygen
What is the main treatment for C.Diff?
Oral Vancomycin
- IV is ineffective as it is an Intra-luminal disease of the bowel.
What tests would you do for an Infection with C.Diff?
Blood cultures and 2 more…
- Stool culture/Stool PCR
- Abdominal X-ray (Toxic Megacolon)
- Blood Cultures.
What type of Organism is C.Diff?
Gram +ve aetobic, Spore-forming, Toxin-producing Bacilli
What are risk factors for C.Diff infection?
- PPI’s
- Abx treatment
- Being in Hospital
How does hand hygiene differ in C.Diff?
Alcohol is ineffective against spores. So Soap and water must be used every time.
What are the differential causative organisms for Bloody diarrhoea?
- E.Coli 0157
- Campylobacter.
- Shigella
- Listeria
- Salmonella
Which pathogen can cause diarrhoea, bruising and confusion and also predisposes to HUS?
E.Coli 0157
What signs on FBC are looked for in a patient with E.Coli infection?
- Anaemia
- Thrombocytopenia
What Abx should be offered in a patient with Gastroenteritis Infection?
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.
What is the Triad of HUS?
Haemolytic Uraemic Syndrome.
Triad of Haemolytic Anaemia, Thrombocytopenia and AKI.
What is an ICED infection?
Infection of Implantable Cardiac Electronic Device.
What causes an ICED infection?
Lead (“leed”) infection.
Generator pocket infection.
Endocarditis.
- Staph Aureus
- Staph Epidermidis
- Strep Viridans
What is the most common cause of Prosthetic valve endocarditis?
Coagulase negative staph - Staphylococcus Epidermidis.
What is the most common cause of Native Valve Endocarditis?
Staphylococcus Aureus.
What is the most common cause of a Septic Arthritis?
Staphylococcus Aureus.
What medication would be used when treating an Endocarditis with unknown causative organism?
Vancomycin
- Covers both a Staph Epidermidis and Staph aureus until causative organism is determined.
What does “source control” refer too?
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)
How should blood cultures be taken when considering Endocarditis?
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.
What areas are Swabbed in an MRSA swab screen?
Nose, throat, Groin
What is the definition of SEPSIS?
A News score of 5 or above likely caused by infection.
What does the CURB-65 score tell us?
Predicts the chance of Mortality in patients with Pneumonia and assesses the need for intervention.
What is included in a CURB-65 and what is the score system?
C - Confusion? 1pt
U - Urea (BUN >7mmol/l) 1pt
R - Resp Rate (>30) 1pt
B - BP <90 1pt
≥65yrs - 1pt
Out of 5.
What is the treatment of Pneumonia with a CURB-65 score of ≥3?
Doxycycline + Co-Amoxiclav.
What are Clarithromycin, Levofloxacin and Doxycycline targeting in Pneumonia Tx?
Covers the Atypical causes (e.g. Mycoplasm Pneumonae, Legionella, Viruses)
What is the Tx for low severity Community acquired Pneumonia?
Amoxicillin.
Clarithromycin or Doxycycline if Allergic.
What can be tested for in the urine of patients with Pneumonia?
Urinary antigen - Specific to L.Pneumophilia serotype 1.
L.Pneumophilia is a cause of Atypical Pneumonia
What pathogen can cause Bacteraemia with the potential to infect the Heart, Bones, Joints and create abscesses in large muscles (E.g. Psoas Abscess)?
Staph Aureus Bacteraemia (SAB) - Has the potential to cause metastatic infections.
What is the first line Tx of Staph Aureus Bacteraemia?
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.
What may cause Staph Aureus Bacteraemia to persist?
Persistance indicates a deep seated infection in other areas as well.
“source control” may be required (e.g. Drain abscess, Irrigation of Joint)
How would you treat a Lady with fever, R Loin pain and fever. Whose urine culture grew E.coli?
Trimethoprime
(Narrow spectrum)
If Pyelonephritis, Include Gentamicin.
- Examination => Red hot leg
- Excruciatingly painful with blisters.
- Collateral Hx => Shivery (rigors)
What are you worried about?
Necrotising Fasciitis!
(best case it’s just sepsis)
Tx - ACT FAST!
- Surgical Debridement AND Broad Abx (IV Fluclox + Clindamycin + Gentamicin)
What is the empirical treatment for Sepsis of unknown source?
- All Clinical examinations are clear.
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)
What is the drug of choice for Anaerobic cover?
Metronidazole
(co-amoiclav also will, Clindamycin too)
