Term
|
Definition
- Fever (over 38.3) or hypothermia (<36)
- RR > 20 or PaCO2 < 32
- HR > 90 BPM
- WBC - over 12,000, under 4,000. >10% bands |
|
|
Term
| What are the different types of sepsis? |
|
Definition
- Sepsis - infection + 2 SIRS criteria
- Severe sepsis - Sepsis + organ dysfunction/hypoperfusion
- septic shock - severe sepsis + hypotension DESPITE fluids |
|
|
Term
| What are signs of organ dysfunction caused by sepsis? |
|
Definition
- hypotension
- Hypoxemia: PaO2 < 250 (200 w/ pneumonia)
- Oliguria
- SCr > 2
- Platelets < 100,000
- Bilirubin > 2
- Lactate > 4
- INR > 1.5 |
|
|
Term
| What is sepsis-induced hypotension? |
|
Definition
- Systolic < 90 OR
- MAP < 70 |
|
|
Term
| Is it possible to have SIRS and not have an infection? |
|
Definition
|
|
Term
| What increases %mortality for sepsis? |
|
Definition
# of failing organs
**Also: ADVANCED AGE, COPD, malignancy, HIV, ICU, MODS |
|
|
Term
| How does the immune system affect sepsis? |
|
Definition
- Innate - quick response by TLR/pattern receptors. Increase in cytokines -- neutrophils release NO, worsen edema
- Adaptive - B cells release Ig, T cells. |
|
|
Term
| How does coagulation change in sepsis? |
|
Definition
- Increase in procoagulation
- LPS upregulates tissue factor
- LOWER levels of anticoags: C/S, AT3, TFPI
**Injury leads to a thrombus --> organ dysfunction |
|
|
Term
| What are the leading sites of infection for sepsis? |
|
Definition
- Respiratory
- Bloodstream
- Urinary tract
- Intra-abdominal space
**Most pathogens: gram(+)!! BUT - gram(-) = higher mortality |
|
|
Term
|
Definition
- 2 sets of blood cultures before starting antibiotics
- Also culture other sites of suspected infection |
|
|
Term
| What is early goal directed therapy? |
|
Definition
EARLY rescuscitation in patients w/ sepsis-induced hypoperfusion: Within the first 6 hours -
- Target CVP between 8-12
- MAP >/ 65
- Urine output > 0.5 mL/kg/hr |
|
|
Term
| How is EGDT achieved in sepsis patients? |
|
Definition
- CVP < 8? Give CRYSTALLIODS - normal saline
- MAP < 65? Give a vasopressor - Norepi is first choice
- ScvO2 < 70%? Transfusion until hematocrit 30% |
|
|
Term
| What is source control for sepsis? |
|
Definition
- Drainage of: abdominal abcess, septic arthritis, pyelonephritis
- Debridement
- Device removal |
|
|
Term
| What is the key to sepsis antibiotic therapy? |
|
Definition
IV antibiotics within the FIRST HOUR of recognition
- Empiric therapy w/ activity and penetration. Reassess daily for de-escalation |
|
|
Term
| What should be considered for sepsis empiric therapy? |
|
Definition
Immunocompromised status:
- normal - likely pathogen
- Compromised - Tx for fungal, viral, parasite, opportunists IN ADDITION to bacteria |
|
|
Term
| What are common causes of gram(+) sepsis? |
|
Definition
- S. aureus
- S. pneumoniae
- CoNS
- Enterococci
**50% of all cases |
|
|
Term
| What are likely causes of gram(-) sepsis? |
|
Definition
- E. coli
- P. aerug
**Less common, more likely to cause septic shock |
|
|
Term
| What are other causes of sepsis? |
|
Definition
- Low risk anaerobes: Bacteroides, Clostridium
- Polymicrobial infections
- Fungal - Candida (albicans) - high mortality |
|
|
Term
| How is community acquired sepsis treated? |
|
Definition
**Single regimen
- Catheter - Vanc
- CNS - 3rd gen cef + vanc/ampicillin
- Abdominal - ampi/sul, Ticar/clav, 2nd gen cef, carbapenem
- Skin - Nafcillin or 1st gen cef
- Respiratory - beta lactam + macrolide
- Urinary - 3rd gen cef
- Unknown: Consider P. aerug/MRSA. Zosyn or 3rd gen cef or penem + Vanc |
|
|
Term
| What are indications for combo therapy in sepsis? |
|
Definition
- Neutropenia
- MDR bacteria - Acinetobacter, Pseudomonas
- Septic shock, respiratory failure
- Septic shock from S. pneumo
** 3rd gen cef + vanc |
|
|
Term
| How is empiric therapy de-escalated for sepsis? |
|
Definition
- Select appropriate antibiotic upon culture
- Prevent resistance
- Only use combo therapy for 3-5 days |
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