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Sepsis/systemic inflammatory response syndrome (SIRS)
Terms in this set (17)
How is sepsis defined per the latest Sepsis-3 definition?
Sepsis is now defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection
How is septic shock defined?
Septic shock is defined as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality. Previously, septic shock was identified by the presence of hypotension. It is now recognized that hypotension can be a late manifestation, and tissue hypoperfusion proceeds hypotension
What is the Quick SOFA (qSOFA) and SOFA?
Quick SOFA (qSOFA) and SOFA are a new guideline for predicting mortality that has replaced SIRS ⇒ qSOFA is used outside ICU, while the full SOFA is used in the ICU. Use to predict mortality, NOT to diagnose sepsis, per 2017 Surviving Sepsis Guidelines.
What are the qSOFA criteria?
Sepsis should be suspected in patients meeting at least two of the following three qSOFA criteria
- New or worsened mentation
- Respiratory rate greater than or equal to 22/min
- Systolic blood pressure less than or equal to 100 mmHg
What is SIRS?
The systemic response to a wide range of stresses
What are the criteria for SIRS?
The systemic inflammatory response syndrome (SIRS) criteria for sepsis are no longer part of the new sepsis guidelines (Sepsis-3). However, still have a role in the identification of acute infections. SIRS requires at least 2 of the 4 following criteria be met
- temperature > 38°C or <36°C
- pulse > 90 bpm
- respiratory rate > 20 or PaCO2 < 32 mm Hg
- WBC > 12,000/mm3 or <4,000/mm3 (or >10% bands)
What is sepsis syndrome or severe sepsis?
Sepsis with an evidence of altered organ perfusion including at least 1 of the following: hypoxemia, elevated lactic acid, oliguria, or altered mentation
What are the noninfectious causes of SIRS?
Burns, cardiopulmonary bypass, and pancreatitis
What are the leading bacterial causes of blood stream infection (BSI)?
Infection with staphylococci and streptococci, followed by infection with E. coli, Enterobacter sp., and Pseudomonas aeruginosa
List the common symptoms and signs of sepsis by bacterial infection.
Fevers, chills, hyperventilation, hyperthermia or hypothermia, changes in mental status, hypotension, bleeding, leukopenia, thrombocytopenia, and organ failure
What are the predisposing factors for sepsis?
Surgery, chemotherapy, trauma, transplantation, and splenectomy
What is the workup for sepsis?
1. Meticulous history and physical examination for clues to the source and extent of an infectious process
2. Microbiologic studies including blood cultures and culture of any potential source of systemic infection (draw blood cultures before initiating antibiotics)
3. If CNS signs are present, lumbar puncture
Name the two sepsis biomarkers
The two sepsis biomarkers are lactate and procalcitonin
- Procalcitonin levels rise within four hours after onset of infection and peak at 12-48 hours
- Lactate levels rise secondary to tissue hypoxia ⇒ levels > 18 are diagnostic of septic shock
What is the antibiotic treatment for sepsis?
Empiric antimicrobial regimens (modified based on culture results) should include broad gram-negative and gram-positive coverage. For nosocomial and neutropenic sepsis, coverage should include activity against Pseudomonas. If an indwelling vascular catheter infection is suspected, vancomycin should be considered.
What supportive therapies should be considered?
Fluid and electrolyte management and sympathomimetic agents (dopamine, dobutamine, and norepinephrine) as needed to maintain adequate blood pressure
Is there a role for empiric steroids in sepsis?
No, controlled clinical trials have failed to confirm any beneficial effects of corticosteroids in septic shock except in patients with adrenal insufficiency.
List the organisms associated with postsplenectomy sepsis
Encapsulated organisms including S. pneumoniae, H. influenzae, and N. meningitides
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