Spesis/meningitis Flashcards
What are the clinical features of sepsis?
Temperature instability Irritability Poor feeding V/D Respiratory distress
What is respiratory distress?
Tachypnea
Grunting
Nasal flaring
Retractions
What are neonatal RFs for spesis?
Male Premature Low birth wt Resuscitation required Infected sibling AA
What are maternal RFs for sepsis?
GBS + GBS bacteriuria during pregnancy Membrane rupture (>/= 18 h) Intrapartum temp (>/=38C) Chorioamnionitis Multiple gestations Previous infant w/GBS invasive dz = 20 yo Intrauterine monitoring
What do we use to evaluate if a neonate has sepsis?
CBC w/diff CRP Cultures - Micro: blood, CSF, urine - Virology: CSF, surface samples Chest xray
What is chorioamnionitis?
Maternal fever PLUS 2 below:
- Fetal tachycardia (HR >/= 160)
- Foul odorous amniotic fluid
- Maternal leukocytosis (WBC >/= 15,000)
- Maternal tachycardia (HR >/= 100)
- Uterine tenderness
What are the risk factors for sepsis at <37 week gestation?
Chorioamnionitis
Premature rupture of membranes (PROM)
Intrapartum antimicrobial prophylaxis (IAP)
What are the RFs for sepsis at >/=37 week gestations?
Chorioamnionitis
What do we do if the neonates are at <37 weeks gestation/ >/= 37 weeks gestation with corresponding RFs?
Birth: blood culture
6-12h old: CBC w/diff +/- CRP
All: broad spectrum abx
What do we do if a neonate has suspected sepsis and the culture comes back positive?
Continue abx
What do we do if the culture is negative and the neonate remains well?
Check the labs
Normal labs = dc abx
Abnormal labs = continue abx
What does an abnormal blood lab look like?
ANC < 1.75 CRP > 1 I:T > 0.2 Plt < 100,000 WBC < 5
What does an abnormal CSF look like?
Glucose < 10
Preterm protein > 250
Term protein > 100
WBC > 25
What are the neonatal sepsis classifications?
Early onset (EOS) Late onset (LOS) Congenital
What is EOS?
= 3 DOL
How is EOS transferred?
Perinatal transmission
Vertical transmission
What is LOS?
> 3 DOL
How is LOS transferred?
Community aquired
Nosocomial
Vertical transmission
What is congenital sepsis?
<10-14 DOL
How is congenital sepsis transferred?
Transplacental transmission
What are the common pathogens of EOS?
GBS
E. coli
(less common: listeria)
What are the common pathogens of LOS?
CONS
S aureus
What are the common pathogens for congenital sepsis?
Toxoplasma Trepenema Rubella CMV HSV VZV
What is the treatment of empiric EOS?
Amp + AG/cefotaxime
What is the treatment for GBS/Listeria?
Amp/Pen + AG
What is the treatment for E coli?
Cefotaxime/AG/meropenem
What is the treatment for enterococcus?
Amp/Vanc + AG
What is the duration of therapy for: Empiric EOS GBS/Listeria E coli Enterococcus
7 days (presumed sepsis) 10 days (sepsis) 14 days (GBS sepsis) 21 days (GNR/listeria meningitis)
What is the treatment for HSV?
Acyclovir
14 (mouth, eye skin)
21 (disseminated, CNS)
What is the treatment for empiric LOS?
Vanc + AG
What is the treatment for pseudomonas?
Pip/tazo or antipseudomonal ceph/carbapenem
+
AG
What is the duration of treatment for:
Empiric LOS
Pseudomonas
Presumed sepsis = 7 days
Sepsis = 10 days
GBS meningitis = 14 days
GNR meningitis = 21
What is the treatment for CONS/staph?
Vanc/oxacillin x 14 days
What is the treatment of candida?
Amphotericin B x 21 days
What is dosing for Amp?
50-100 mg/kg/dose
What is dosing for cefotaxime?
same as Amp
What is dosing for acyclovir?
10-20 mg/kg/dose
What is peak and trough levels for gent?
Peak: 6-12 mcg/mL
Trough: <1-2 mcg/mL
What is dosing for PCN?
50,000 - 100,000 units/kg
