Infectious Disease Book

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Bacteremia in AdultsAka: Sepsis, Septicemia in Adults

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  1. See Also
    1. Bacteremia in Children
  2. Signs: Sepsis
    1. Hypotension
      1. Systolic Blood Pressure <90 mmHg or
      2. Mean arterial pressure <65 mmHg or
      3. Systolic Blood Pressure drop >40 mmgHg from baseline
    2. Decreased urine output (<0.5 ml/kg)
    3. Hypoxia
    4. Body Temperature abnormality
      1. Fever
      2. Hypothermia (<36 C): Poor prognostic sign
    5. Tachypnea
    6. Tachycardia
    7. Mental status changes
    8. Mottling of skin
  3. Labs
    1. Blood Cultures
    2. Complete Blood Count
      1. Leukocytosis (>12,000) or Leukopenia (<4000)
      2. Thrombocytopenia
  4. Management: Antibiotics
    1. General
      1. Appropriate antibiotic choice
      2. Start as early as possible
      3. Consider source, but start broad spectrum antibiotic
      4. Source not identified in 20-30% of cases
    2. Pulmonary source suspected
      1. Beta-lactam/lactamase inhibitor or Cephalosporin and
      2. Macrolide or Fluoroquinolone and
      3. Consider Vancomycin
    3. Gastrointestinal source suspected
      1. Beta-lactam/lactamase inhibitor and
      2. Metronidazole
      3. Consider Fluoroquinolone
    4. Urinary tract source
      1. Beta-lactam/lactamase inhibitor and
      2. Fluoroquinolone
    5. Central nervous system source
      1. Cephalosporins and
      2. Consider Vancomycin and
      3. Consider Acyclovir
  5. Management: Stabilization
    1. Oxygenation
    2. Ventilation (BIPAP or mechanical Ventilators)
    3. Volume Resuscitation (2-10 liters NS or LR)
    4. Transfusion if Hemoglobin <7 g/dl
      1. Mortality increases for transfusion for mild Anemia
      2. Herbert (1999) N Engl J Med 340:409
    5. Vasopressors
      1. Target perfusion
        1. Central venous pressure 8-12 mmHg
        2. Mean arterial pressure >65 mmHg
        3. Urine output >0.5 ml/kg/h
        4. Mixed venous Oxygen Saturation >70%
      2. First-line
        1. Norepinephrine (preferred first line)
          1. Dosing range: 0.1 to 1 mcg/kg/min
        2. Dopamine
          1. Dosing range: 2-20 mcg/kg/min
          2. Do not use "renal dose" Dopamine - misnomer
      3. Other Vasopressors
        1. Phenylephrine
        2. Epinephrine
        3. Vasopressin
    6. Other agents
      1. Activated Protein C
      2. Drotecogin Alfa (Xigris)
      3. Corticosteroids
  6. Predictors of positive Blood Cultures (each doubles risk)
    1. Age over 30 years
    2. Heart Rate >90 bpm
    3. Temperature >37.8 C (>100 F)
    4. White Blood Cell count >12,000
    5. Central venous catheter
    6. Hospital stay >10 days
  7. Prognosis
    1. Positive Blood Culture
      1. Confers 150% increase in mortality risk
  8. References
    1. Jaimes (2004) Clin Infect Dis 38:357

Septicemia (C0036690)

Definition (CSP)systemic disease associated with presence and persistance of pathogenic microorganisms or their toxins in the blood.
Definition (NCI)Disease caused by the spread of bacteria and their toxins in the bloodstream. Also called blood poisoning.
Definition (NCI)(SEP-sis) The presence of bacteria or their toxins in the blood or tissues.
Definition (MSH)Systemic disease associated with the presence of pathogenic microorganisms or their toxins in the blood.
ConceptsDisease or Syndrome (T047)
ICD9038, 038.9
EnglishBLOOD POIS, BLOOD POISONING, POIS BLOOD, Sepsis, Septicaemia, Septicemia, Unspecified septicemia
Spanishsepticemia
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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