Infectious Disease Book

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Sepsis

Aka: Sepsis, Bacteremia in Adults, Septicemia in Adults
  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 Culture
    2. Urine Culture
    3. Complete Blood Count
      1. Leukocytosis (>12,000) or Leukopenia (<4000)
      2. Thrombocytopenia
    4. Chemistry panel
    5. Liver Function Tests
    6. Lactic Acid
  4. Management: Antibiotics
    1. General
      1. Appropriate antibiotic choice
      2. Start as early as possible (within 1 hour)
      3. Consider source, but start broad spectrum antibiotic
      4. Source not identified in 20-30% of cases
      5. Remove obvious source within 6 hours (e.g. infected lines, drain abscess)
    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 (Total of 2-10 liters NS or LR)
      1. Start with 1 liter of isotonic crystalloid (NS or LR) in first 30 minutes
      2. Goals
        1. Systolic Blood Pressure >90 mmHg
        2. Central Venous Pressure >8 (>12 if on mechanical Ventilator)
        3. Central venous oxygen level >70 mmHg
    4. Transfusion if Hemoglobin <7 g/dl (Hematocrit <30)
      1. More important after the initial stabilization
      2. Mortality increases for transfusion for mild Anemia
      3. Herbert (1999) N Engl J Med 340:409-17
    5. Blood sugar management
      1. Conventional therapy (non-intensive blood sugar management: 144-180) is safer in critically ill
        1. (2009) N Engl J Med 360:1283-97
    6. Corticosteroids
      1. Hydrocortisone at physiologic dose (200-300 mg) has short-term benefit in duration and severity
        1. Annand (2009) JAMA 301:2362
    7. 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
    8. 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 38:357-62

Septicemia (C0036690)

Definition (NCI) The presence of pathogenic microorganisms in the blood stream causing a rapidly progressing systemic reaction that may lead to shock. Symptoms include fever, chills, tachycardia, and increased respiratory rate. It is a medical emergency that requires urgent medical attention.
Definition (NCI) A disorder characterized by the presence of pathogenic microorganisms in the blood stream that cause a rapidly progressing systemic reaction that may lead to shock.
Definition (MEDLINEPLUS)

Sepsis is a life-threatening illness. Your body's response to a bacterial infection usually causes it. Your immune system goes into overdrive, overwhelming normal processes in your blood. The result is that small blood clots form, blocking blood flow to vital organs. This can lead to organ failure. Babies, old people and those with weakened immune systems are most likely to get sepsis. But even healthy people can become deathly ill from it. A quick diagnosis can be crucial, because one third of people who get sepsis die from it.

Sepsis is usually treated in a hospital intensive care unit (ICU). IV antibiotics and fluids may be given to try to knock out the infection and to keep blood pressure from dropping too low. Patients may also need respirators to help them breathe.

Definition (NCI) Disease caused by the spread of bacteria and their toxins in the bloodstream.
Definition (CSP) systemic disease associated with presence and persistance of pathogenic microorganisms or their toxins in the blood.
Definition (MSH) Systemic disease associated with the presence of pathogenic microorganisms or their toxins in the blood.
Concepts Disease or Syndrome (T047)
MSH D018805
ICD9 038.9, 038
ICD10 A41.9
SnomedCT 186392004, 154313001, 187333004, 40555009, 266089004, 105592009, 91302008
English Unspecified septicemia, BLOOD POISONING, SEPTICAEMIA, SEPTICEMIA, Blood poisoning, NOS, Septicemia, NOS, Septicaemia NOS, Septicaemia, unspecified, Septicemia NOS, Septicemia, unspecified, [X]Septicaemia, unspecified, [X]Septicemia, unspecified, sepsis, Septicaemia, NOS, Blood Poisoning, Poisoning, Blood, POIS BLOOD, BLOOD POIS, septicemia (diagnosis), septicemia, (Septicaemia NOS) or (sepsis) (disorder), Septicaemia (disorder), [X]Septicemia, unspecified (disorder), Poisonings, Blood, Blood Poisonings, Septicemias, Septicemia NOS (disorder), SEPSIS, Septicemia [Disease/Finding], Blood poisoning, poisoning blood, septicaemia, blood poisoning, toxemia, Unspecified septicaemia, Septicaemia, Septicemia (disorder), Septicemia, intoxication; septic, general, intoxication; septic, septic; intoxication, general, septic; intoxication, (Septicaemia NOS) or (sepsis), (Septicemia NOS) or (sepsis), Sepsis
French SEPTICEMIE, Septicémie SAI, Septicémie non précisée, Septicémie
Portuguese SEPTICEMIA, Septicemia NE, Septicémia NE, Septicemia não especificada, Septicemia
Spanish SEPTICEMIA, Septicemia NEOM, Septicemia por organismo indeterminado, Septicemia no especificada, (Septicemia NOS) or (sepsis), Septicaemia, Septicemia NOS, (Septicaemia NOS) or (sepsis), Septicaemia NOS, Septicemia, Sepsis, [X]septicemia, no especificada, [X]septicemia, no especificada (trastorno), septicemia (trastorno), septicemia, SAI (trastorno), septicemia, SAI, septicemia
German SEPTIKAEMIE, unspezifische Septikaemie, Septikaemie NNB, Septikaemie ohne weitere Angabe, Septikämie, Sepsis, nicht naeher bezeichnet, Septhämie, Septisches Fieber, Septikaemie, Septikhämie, Septikhaemie
Dutch septikemie, septikemie NAO, niet-gespecificeerde septikemie, intoxicatie; septisch, gegeneraliseerd, intoxicatie; septisch, septisch; intoxicatie, gegeneraliseerd, septisch; intoxicatie, Sepsis, niet gespecificeerd
Italian Setticemia NAS, Setticemia non specificata, Setticemia
Japanese 敗血症, 敗血症NOS, 詳細不明の敗血症, ハイケツショウ, ショウサイフメイノハイケツショウ, ハイケツショウNOS
Czech septikémie, Septikemie, Septikemie NOS, Blíže neurčená septikemie
Korean 상세불명의 패혈증
Croatian SEPTIKEMIJA
Hungarian septicaemia, nem meghatározott septicaemia, nem meghatározott szeptikémia, septicaemia k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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