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
- 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:
- 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.
In a previously healthy adult, suspect Skin, Urinary, Respiratory, Bowel or Pelvic infection sites:
|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.|
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
Give three, take three:
- Fluids 20ml/kg
- Blood Lactate
- Infection screen
- Urine output measurement