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Sepsis

From Mediwikis

Sepsis is when a patient shows Systemic Inflammatory Response Syndrome (SIRS), in the presence of an infection- a microbe in a usually sterile site.

For information on Neutropenic Sepsis, click here

Definitions

  • Bacteraemia- The presence of bacteria in the blood- this does not equate to infection, as it can occur in healthy individuals.
  • SIRS- Describes a chain of events resulting from systemic activation of the innate immune system. Signs include[1]:
    • 36° > Temperature > 38°
    • Heart Rate > 90
    • Respiratory Rate > 20 OR pCO2 < 4.3kPa
    • 4,000 > White Cell Count > 12,000
  • Shock- State of inadequate organ perfusion
  • Severe Sepsis- Sepsis + Organ Hypoperfusion (dysfunction)
  • Septic Shock- Severe Sepsis + Hypotension unresponsive to fluid replacement.

Causes

In a previously healthy adult, suspect Skin, Urinary, Respiratory, Bowel or Pelvic infection sites:

Situation Pathogens
Urinary Catheter E. coli, Pseudomonas spp., Klebsiella spp.
IV Cannular S. aureus, S. epidermidis, Pseudomonas spp., Candida albicans
Surgical S. aureus, E. coli, various anaerobes
Burns Various G +ve cocci, Candida albicans, Pseumonas spp.

Management

Individual trusts have their own guidelines, but essentially, remember ABCDE of emergency management, then:

  • Find source of infection, and treat empirically, before sending away samples for culture and sensitivity testing
  • If source is unclear, broad spectrum antibiotics should be started, e.g. Piperacillin/Tazobactam, Gentamycin, Cefotaxime.
  • Refer to ITU team
  • Give fluids- Crystalloids, colloids
  • Consider inotropes

Sepsis Six

Give three, take three:

Give:

  • Oxygen
  • Fluids 20ml/kg
  • Antibiotics

Take:

  • Blood Lactate
  • Infection screen
  • Urine output measurement

References

  1. http://www.ncbi.nlm.nih.gov/pubmed/1597042