sepsis etc... (4) Flashcards
infection
inflammatory response to the presence of microorganisms or invasion of normally sterile site or host tissue by those organisms
bacteremia
presence of viable bacteria in the blood
what is SIRS
systemic inflammatory response syndrome
widespread inflammatory response
presence of 2 or more of:
- temp >38.5 or 90 bpm
- RR > 20 or PaCO2
what is sepsis
SIRS + clinical/definitive EVIDENCE OF INFECTION (presumed or confirmed)
severe sepsis is when its associated with organ dysfunction or hypoperfusion
what is septic shock
sepsis with HYPOTENSION despite adequate fluid resuscitation along with PERFUSION ABNORMALITIES (i.e lactic acidosis, oliguria or acute alteration of mental status)
patients requiring inotropic or vasopressor therapy despite adequate fluid resuscitation are in septic shock
“refractory hypotension”
etiologic agents of septicemia/sepsis
E. coli = most common organism causing septic shock (22%)
second most common is S. aureus
gram +s = more cause of sepsis than gram -s
E. coli, S. aureus, S. pneumo, Klebsiella
clinical presentation of sepsis
look for:
- confusion
- leukocytosis
- tachycardia
- tachypnea
- hypotension
- organ dysfunction
management of sepsis
- fluid rescusitation
- appropriate cultures
- source control
- vasopressors/inotropes when fluid fixed
- early institution of appropriate Ab therapy–> HIT HARD AND HIT EARLY
clinical presentation of septic shock
- hemodynamic alterations–> hyper or hypodynamic
- myocardial depression
- altered vasculature
- altered organ perfusion
- imbalance O2 delivery
- lactic acidosis
what is “warm shock”
assoc w severe sepsis/septic shock
hyperdynamic state–> elevated cardia output, tachycardia, decreased systemic vascular resistance
what is “cold shock”
assoc with severe sepsis/septic shock
hypodyamic state–> decreased cardiac output
what is infective endocarditis
infection of the endocardial surface of the heart
usually heart valves but may occur on septal defects or mural endocardium
what are the 4 types of infective endocarditis
- native valve
- prosthetic
- IV drug abuse
- nosocomial
what percent of infective endocarditis is native valve?
55-75% (underlying abnormality)
what is the median age of infective endocarditis
47-69
who is given infective endocarditis prophylaxis
given to high risk patients (i.e with prosthetic heart valves, previous IE, cardiac transplant, congenital heart defect, and high risk procedures)
what causes acute infective endocarditis
S. aureus
S. pyogenes (GAS)
S. pneumoniae
(strep more likely than staph in native valve endocarditis)
(in prosthetic valve coagulase - staph is more likely than strep is more likely than staph)
what causes chronic/subacute infective endocarditis
viridans group strep
how does infective endocarditis occur
turbulent blood flow makes the endocardium “sticky”–> bacteremia delivers organism to the endocardial surface–> adherence of organism–> eventual invasion of valvular leaflets
how does infective endocarditis present clinically
- febrile illness (85%)
- persistent bacteremia
- lesions on heart
- vegetation (variable in size)
- heart murmur (85%)
- peripheral signs–> Osler’s nodes, splinter hemorrhage, Janeway lesions, subconjunctival lesions
- Roth spots (embolic lesions)
- spenomegaly (30%)
Tx for native valve endocarditis
acute: vancomycin + ceftriaxone
subacute–await culture
Tx for prosthetic valve endocarditis
if its early onset (
risk factors for prosthetic joint infections
- primary–> rheumatoid arthritis, diabetes mellitus, poor nutritional status, obesity
- revision–> prior joint surgery, prolonged OR time, preoperation infection (skin, teeth, UTI)
uncommon infection–less than 2% of joint replacements
etiologic agents in prosthetic joint infections
S. aureus and coagulase - staph
what are some examples of coagulase negative staph species
Staph epidermis
Staph haemolyticus
Staph saprophyticus
Tx of prosthetic joint infections
empiric therapy is not recommended
treat based on culture and sensitivity and treat for at least 6 weeks
remove prosthesis if joint age is more than 30 days and symptoms persist for more than 3 weeks
what is febrile neutropenia
development of fever, often with other signs of infection, in a patients with neutropenia
what is neutropenia
an abnormally love number of neutrophil granulocytes in the blood
what type of patients get febrile neutropenia
immunocompromised people
what causes febrile neutropenia
gram -s like pseudomonas
can also be cause by gram +s, fungal superinfection if the neutropenia is prolonged
what is the clinical presentation of febrile neutropenia
fever for longer than 1 hour and ANC less than 0.5 but trending down
