Sepsis Pedia Flashcards
criteria for sirs
2/4 of:
- core temp >38.5 or <36
- tachycardia (mean hr >2 sd above normal in absence of stimuli or drugs)
- tachypnea (rr >2 sd above normal or acute need for mechanical ventilation)
- leukocyte count elevated or depressed for age or >10% immature neutrophils
criteria for sepsis
fulfillment of criteria for sirs in the presence of suspected or proven infection
criteria for severe sepsis
fulfillment of sepsis plus 1 of:
- cardiovascular organ dysfunction
- ards
- > /= 2 organ dysfunctions
criteria for septic shock
severe sepsis + cardiovascular organ dysfunction depsire fluid resuscitation
criteria for multi-organ dysfunction syndrome
altered organ function such that homeostasis cannot be maintained without medical intervention (late stages of septic shock)
most common pathogens in previously healthy children
s aureus
strep sp
n meningitides
most common pathogens in children with chronic diseases
s aureus
candida
pseudomonas
transmission of s aureus
autoinoculation or direct contact
most significant risk factors for developing s aureus infections
- disruption of intact skin and breaches from wounds
- skin disease (eczema, burns)
- catheters or shunts
different mechanisms for invasion by s aureus
- coagulase that escapes phagocytosis
- antigen masking by protein a
- clumping factors
- toxic shock syndrome toxin 1
- pneumonia: panton valentine leukocidin, protein a, alpha hemolysin
t/f s aureus infections are more common following influenza virus infection in those with cerebral palsy
false, those with cystic fibrosis
most important groups of streptococcus species
s pneumoniae: alpha hemolytic (partial)
gas and gbs: beta (complete)
s pneumoniae or pneumococcus is the most common cause of
bacteremia bacterial pneumonia meningitis osteomyelitis septic arthritis
gas: ___
gbs: ___
gas: streptococcal toxic shock syndrome and necrotizing fascitiis
gbs: early and late onset sepsis
pneumococcus is an important cause of secondary pneumonia in pts with __
influenzae infection
body defenses that limit strep infection
- aspiration of secretions containing strep is hindered by epiglottic reflex
- respiratory epithelial cilia move infected mucus towards the pharynx and away from the lungs
- normal ciliary flow from middle ear to eustachian tube and sinuses to nasopharynx
== interference of these can lead to infection
the spread of infection by streptococus is facilitated by ___
antiphagocytic properties of its capsule (avoids immune clearance)
the pyrogenic toxin of gas is responsible for ___
rash of scarlet fever and streptococcal toxic shock syndrome
clinical syndromes of pneumococcal infections
otitis media sinusitis pneumonia sepsis bacteremia primary peritonitis
clinical syndromes of gas
pharyngitis
pneumonia (CONSOLIDATION)
scarlet fever (pale zone around the mouth, pharynx and tongue beefy red)
rheumatic fever
gas-tss (shock and multi-organ system failure early)
necrotizing fasciitis (extensive local necrosis)
clinical syndromes of gbs
early onset sepsis: within first 6 days of life, associated with maternal ob complications; usually sepsis, pneumonia, and meningitis, GROUND GLASS ON CXR
late onset sepsis: after day 7, bacteremia and meningitis
gas infections can be diagnosed retrospectively on the basis of ____
an elevated streptococcal antibody titer
cxr findings in strep infections
s pneumonia: pneumatoceles
pneumococcal/gas: consolidation
gbs in neonates: ground glass appearance
substances that can increase during inflammatory response to infection
elevated crp
elevated procalcitonin
elevated tnf
elevated il6, il8, il10
gold standard of diagnosing strep infection
isolation and identification of organism (blood, urine, csf)
enzyme secreted by invasive n meningitidis that degrades secretory igA from muucosal surfaces
immunoglobulin a1 protease
resistance in n meningitidis to complement mediated lysis and phagocytosis is mediated by
polysaccharide capsule and lipopolysaccharide
manifestation of acute meningococcal septicemia
- non-specific early symptoms
- fine maculopapular rash
- cold extremities, abnormal skin color, prolonged crt, petechial rashes >/= 80% cases
manifestation of fulminant meningococcal septicemia
- progresses rapidly (hrs)
- septic shock: PURPURA FULMINANS, poor peripheral perfusion, tachytachy, hypotensive, coma, coagulopathy, renal/cardiac failure
diagnosis of n meningitidis
- child with unexplained rash
- signs of meningitis/septicemia
- PE + labs
- definitive: culture
indications for iv ceftriaxone for n meningitidis
- petechiae starts to spread
- rash becomes purpuric
- signs of meningitis or septicemia
- child appears ill
antibiotic prophylaxis for n meningitidis
ceftriaxone or ciprofloxacin
p aeruginosa is commonly isolated among neonates with __ and __
bacteremia and malignancy
risk factors for p aeruginosa infection
- prolonged hospitalization
- broad spectrum antibiotics
- chemotherapy
- mechanical ventilation
- urinary catheters
manifestations of pseudomonas infection
- ecthyma gangrenosum: characteristic skin lesion*
- colonization of burns and wounds
- conjunctivitis, nosocomial bacteremia, pseudomonas ulcer (eyes)
60% of ___ patients have chronic respiratory infection by pseudomonas
cystic fibrosis
- bacteria settle into thick mucus
- ground glass on cxr, bronchial thickening and consolidation
- respiratory failure cases death
- vap
3rd most common cause of bloodstream infection in premature infants
candida albicans
> 10% from vertical transmission
drugs that facilitate candida colonization and overgrowth
h2 blockers and broad spectrum antibiotics
routes by which candida reaches the bloodstream
- git mucosal barrier
- iv catheter
- localized infection
characteristics of oral candidiasis / thrush
- superficial mucous membrane infection
- pseudomembranous, erythematous, or chronic hypoplastic
characteristics of diaper candidiasis
- both immunocompetent and compromised
- rash with satellite lesions
- with systemic symptoms
characteristics of vulvovaginal candidiasis
- both immunocompetent and compromised
- common in pubertal and postpubertal females
- rash with satellite lesions
- pregnant, ocps, oral antibiotics
characteristics with ungual and periungual candidiasis
- both immunocompetent and compromised
- fingers > toes
when to suspect sepsis
initial localized infection -> develop systemic
initial systemic infection -> worsens (despite treatment)
PLUS fever, lethargy, increased sleepiness, general pain, discomfort or fussiness, nausea/vomiting, headache
PLUS sirs
surviving sepsis campaign reduced mortality rate by
25%
treatment for s aureus
mssa: penicillin or 1st gen cephalosporin (+ beta lactamase inhibitor [clavulanic acid, sulbactam, tazobactam])
penicillin allergic or suspected mrsa: vancomycin
treatment for strep
- > /=1 mo pneumococcal meningitis: vancomycin + cefotaxime OR ceftriaxone
- fully immunized uncomplicated cap: ampicillin or penicillin g
- hospitalized and not fully immunized: 3rd gen parenteral cephalosporin (ceftriaxone or cefotaxime iv)
- allergic to penicillin and cephalosporin: macrolides
- gas: penicillin, amoxicillin, cephalosporin
- gbs: penicillin g
- group b meningitis: high dose penicillin, ampicillin
treatment for n meningitidis
- initial 3rd gen cephalosporin
- confirmed beta lactam sensitive meningococcal: penicillin
treatment for p aeruginosa
- ceftazidime (effective for cystic fibrosis)
- piperacillin or piptazo + aminoglycoside
- outpatient: ciprofloxacin (not for <18 yo)
treatment for candida albicans
- not systemic, full term infant: topical antifungal
- preterm: systemic therapy
- remove central venous catheters
- 21 days of systemic fungal therapy
- systemic candidiasis: amphotericin b
