II. Epidemiology: United States

  1. Incidence: 750,000/year
  2. Prevalence: 3 cases per 1000
  3. In-Hospital Mortality: 200,000/year (20%)

III. Pathophysiology

  1. Inflammatory response (and antagonizing anti-inflammatory response)
  2. Endothelial damage
  3. Increased vascular permeability
  4. Coagulation Pathway activation
  5. Impaired tissue oxygenation
  6. Decreased vasopressin, Thyroxine, cortisol and Growth Hormone

IV. Risk Factors

  1. Age over 65 years
    1. Sepsis risk >13 fold increased risk
    2. Sepsis mortality risk >2 fold increased risk
  2. Malnutrition
  3. Chronic illness
  4. Immunosuppression
  5. Recent surgery or hospitalization
  6. Indwelling catheter or other device

V. Signs: Sepsis

  1. Constitutional changes
    1. Body Temperature abnormality
      1. Fever
      2. Hypothermia (<36 C): Poor prognostic sign
    2. Diaphoresis
    3. Rigors
    4. Myalgias
    5. Malaise
  2. Cardiovascular changes
    1. Occurs with myocardial depression and intravascular fluid redistribution
    2. Hypotension
      1. Systolic Blood Pressure <90 mmHg or
      2. Mean arterial pressure <65 mmHg or
      3. Systolic Blood Pressure drop >40 mmgHg from baseline
      4. Hypotension at presentation confers a 2 fold increased mortality risk
    3. Cold and clammy skin
    4. Mottling of skin
    5. Decreased Capillary Refill 3 seconds or greater
    6. Tachycardia
    7. Decreased urine output (<0.5 ml/kg)
  3. Respiratory Findings
    1. Hypoxia, Dyspnea or Tachypnea
    2. Pharyngitis, Dysphagia or Stridor
    3. Cough, Pleuritic Chest Pain
    4. Abnormal lung auscultation (consolidation)
  4. Gastrointestinal findings
    1. Abdominal Pain, distention and rigidity
    2. Decreased Bowel Sounds
    3. Upper Gastrointestinal Bleeding (significant blood loss in Sepsis is rare)
    4. Vomiting
    5. Diarrhea
  5. Genitourinary Findings
    1. Dysuria, frequency, Hematuria, pyuria
    2. Costovertebral angle tenderness
    3. Pelvic Pain
    4. Vaginal Discharge or Vaginal Bleeding
  6. Neurologic changes
    1. Mental status changes
    2. Agitation may be only presenting neurologic change in elderly
    3. Headache
  7. Dermatologic changes
    1. Direct bacterial infection (responsible for Sepsis)
      1. Abscess
      2. Cellulitis
      3. Necrotizing Fasciitis
    2. Vasculitis, microembolic, or Disseminated Intravascular Coagulation (DIC) induced lesions
      1. Petechiae
      2. Purpura
      3. Ecchymosis

VI. Diagnosis: Criteria

  1. Sepsis
    1. Infection and
    2. Systemic Inflammatory Response Syndrome (SIRS) criteria positive (2 of 4 present)
  2. Severe Sepsis
    1. Infection and SIRS and
    2. Markers of poor organ perfusion
      1. Increased serum lactate (>2 mmol/L)
      2. Capillary Refill 3 seconds or greater
      3. Mottled skin
      4. Urine output <0.5 ml/kg for 1 hour or more (or renal replacement therapy)
      5. Abrupt onset of Altered Level of Consciousness or abnormal EEG
      6. Disseminated Intravascular Coagulation
      7. Acute Lung Injury or ARDS
      8. Platelet Count <100,000/ml
      9. Cardiac dysfunction (based on Echocardiogram)
  3. Septic Shock
    1. Infection and SIRS AND
    2. Full fluid Resuscitation trial (e.g. 40-60 ml/kg or 2 Liters in an adult patient or wedge pressure 12-20 mmHg) AND
    3. Hypotension despite what should be adequate fluid Resuscitation
      1. Mean arterial pressure <60 mmHg (<80 mmHg if prior Hypertension) or
      2. Vasopressor (Dopamine, Norepinephrine, Epinephrine) required for pressure support
  4. Refractory Septic Shock
    1. Septic Shock AND
    2. High Vasopressor dose required to maintain Mean arterial pressure <60 mmHg (<80 mmHg if prior Hypertension)
      1. Dopamine >15 mcg/kg/min OR
      2. Norepinephrine or Epinephrine >0.25 mcg/min
  5. Multiple Organ Dysfunction Syndrome (MODS)
    1. Most severe Sepsis with progressive organ dysfunction
    2. Parameters demonstrating progressive organ dysfunction
      1. Serum Creatinine
      2. Serum Bilirubin
      3. PO2 to FIO2 ratio
      4. GCS Score
      5. Platelet Count

VII. Differential Diagnosis

  1. Hypovolemia
  2. Acute blood loss
  3. Acute Myocardial Infarction
  4. Acute Pancreatitis
  5. Transfusion reaction
  6. Diabetic Ketoacidosis
  7. Adrenal Insufficiency
  8. Acute Pulmonary Embolism
    1. Consider evaluation early in course

VIII. Evaluation: 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

IX. Evaluation

  1. Most common organisms
    1. Bacteria are responsible for most Sepsis cases
    2. Gram-positive bacteria account for up to 50% of all Sepsis cases
  2. Most common sources (80% of cases)
    1. Respiratory infection
      1. Pneumonia is most common cause of Sepsis
    2. Genitourinary infection
      1. Urinary Tract Infection (Pyelonephritis)
      2. Consider Septic Abortion in pregnancy or Chorioamnionitis in postpartum patients
    3. Gastrointestinal infection
    4. Skin and Soft Tissue Infection
  3. Occult sources
    1. Meningitis
      1. Consider Lumbar Puncture
    2. Bacterial Endocarditis
      1. Consider Echocardiogram
    3. Acute Sinusitis
      1. Consider Sinus CT
    4. Cholecystitis
      1. Consider RUQ Ultrasound

X. Labs

  1. Cultures
    1. Obtain within 45 minutes of presentation
    2. Do not delay antibiotics if cultures cannot be obtained within 45 minutes
    3. If surgical source culture is required, percutaneous, minimally invasive approach is preferred
      1. Consult with local surgery or interventional radiology
    4. Sources
      1. Blood Culture
      2. Urine Culture
      3. CSF Culture (if indicated)
      4. Central Line or PICC Line (if present, draw a culture through the line prior to removal)
  2. Complete Blood Count
    1. Leukocytosis (>12,000) or Leukopenia (<4000)
      1. Neutrophil predominance is typical
      2. Neutropenia is uncommon (except for chronic Alcoholism and the elderly)
    2. Thrombocytopenia
      1. Typically precedes DIC
      2. Platelet Count drop >30% is associated with increased ICU-mortality
    3. Hemolytic Anemia (microangiopathic)
      1. Present in DIC
  3. Coagulation Studies (INR, PTT)
    1. Coagulopathy in DIC
  4. Chemistry panel
    1. Hyperglycemia (Sepsis-induced Insulin Resistance)
    2. Acute Renal Failure
  5. Liver Function Tests
  6. Thyroid Stimulating Hormone
    1. Consider in refractory cases
  7. Serum Lactate (Lactic Acid)
    1. Marker of poor organ perfusion (see definition of severe Sepsis above)
    2. Obtain on all septic patients, when obtaining Blood Cultures and for those admitted with infection
    3. Serum Lactate >4 mmol/L is associated with increased mortality
    4. Higher serum lactates should be met with more aggressive management
    5. Measurement of serial Lactic Acid levels should be performed on the same machine
      1. Most accurate methods are with Arterial Blood Gas machine (even for venous sample)
      2. Weingart and Orman in Majoewsky (2013) EM:Rap 13(10):5
  8. Urinalysis
    1. Urinary sediment (in association with anuria or oliguria)
      1. Acute Tubular Necrosis

XI. Imaging

  1. Chest XRay
  2. CT Abdomen and Pelvis
    1. Indicated for intraabdominal or pelvic findings or suspected GI Source
  3. Echocardiogram
    1. Indicated for suspected endocarditis with septic emboli (e.g. IVDA)

XII. Management: Antibiotics

  1. General
    1. Appropriate antibiotic choice and delivery
      1. Establish Emergency Department first dose protocols based on local sensitivities and infectious disease recommendations
      2. Simultaneous antibiotics without delay is ideal (obtain additional IV sites if needed)
    2. Start antibiotics as early as possible (within 1 hour is goal)
      1. Early antibiotic delivery is most critical in severe Sepsis and Septic Shock
      2. Mortality increases with each hour in antibiotic delay
      3. Kumar (2006) Crit Care Med 34(6): 1589-96
      4. Gaieski (2010) Crit Care Med 38(4): 1045-53
    3. Consider source, but start broad spectrum antibiotic
      1. Source not identified in 20-30% of cases
      2. Re-evaluate antibiotic selection daily
    4. Empiric therapy without obvious source (broad spectrum coverage)
      1. Vancomycin 1 g every 12 hours AND
      2. Piperacillin-Tazobactam (Zosyn) or Imipenem (or Cefepime with Metronidazole)
    5. Remove obvious source within 6 hours (e.g. infected lines, drain abscess)
      1. Culture the tip of infected device
  2. Community acquired Pneumonia
    1. See Pneumonia Management
    2. Empiric Antibiotic Regimen
      1. Ceftriaxone 1 gram IV (consider 2 grams IV in younger patients) and
      2. Macrolide or Fluoroquinolone such as Ciprofloxacin or Levofloxacin (Legionella coverage) and
      3. Vancomycin (MRSA coverage) indicated in Pneumonia with severe Sepsis
    3. Evaluate Pleural Fluid
      1. Drain empyema if present
  3. Nosocomial Pneumonia (recent hospitalization)
    1. See Nosocomial Pneumonia
    2. Vancomycin (MRSA coverage) AND
    3. Cefepime or Meropenem or Piperacillin-Tazobactam (Zosyn) AND
    4. Consider adding Tobramycin or Levofloxacin or Ciprofloxacin (if dictated by local resistance)
  4. Urinary tract source
    1. Cover organisms associated with complicated Urinary Tract Infection
      1. Enterococcus
      2. Pseudomonas aeruginosa
      3. Staphylococcus aureus
    2. Empiric antibiotics
      1. Piperacillin/Tazobactam 4.5 g every 8 hours AND
      2. Gentamicin 7 mg/kg every 24 hours
        1. If Enterobacteriaceae (nitrate positive or by Gram Stain), may subsititue Ciprofloxacin or Third generation Cephalosporin
        2. Otherwise avoid fluouroquinolones in UTI with Sepsis due to growing resistance
    3. Imaging indications
      1. Evaluate for obstruction (Nephrolithiasis)
  5. Intra-abdominal or pelvic source suspected
    1. Empiric antibiotic coverage
      1. Piperacillin-Tazobactam (Zosyn) 4.5 g every 8 hours (or Imipenem/Cilastin or Meropenem) and
      2. Gentamicin 7 mg/kg every 24 hours (or Ciprofloxacin)
      3. Consider Metronidazole
    2. Early surgical Consultation
      1. Consider percutaneous or open drainage of infection source
  6. Meningitis Suspected
    1. See Bacterial Meningitis Management
    2. Vancomycin 1 g every 12 hours AND
    3. Ceftriaxone 2 g every 12 hours (or Cefotaxime)
    4. Consider Ampicillin 2 g every 4 hours (if immunocompromised or over age 50 years)
    5. Consider adding Dexamethasone 10 mg every 6 hours (for pneumococcal Meningitis)
    6. Consider adding Acyclovir 10 mg/kg every 8 hours (if herpes Encephalitis suspected)
    7. Consider adding Rifampin
  7. Skin and Soft Tissue Infection or Necrotizing Fasciitis
    1. See Cellulitis
    2. Empiric antibiotics
      1. Vancomycin 1 g every 12 hours AND
      2. Piperacillin/Tazobactam (Zosyn) 4.5 g every 8 hours AND
      3. Clindamycin 900 mg every 8 hours
    3. Surgical Consultation indications
      1. Necrotizing Fasciitis suspected
      2. Deep abscess

XIII. Monitoring: Serum Lactate

  1. Serial serum lactate levels can help guide Resuscitation and response to management
    1. Consider obtaining at presentation and again at 3 and 6 hours
    2. Lactate clearance can drive goal directed therapy
    3. Jones (2010) JAMA 303(8):739-46
  2. Indications for more aggressive Sepsis management and monitoring with serial serum lactate levels
    1. Serum lactate >4 mmol/L
    2. Hypotension despite 2 Liters of IV fluids
    3. Hypotension responsive to IV fluids (may be a harbinger of later more severe episodes)

XIV. Management: Stabilization

  1. Oxygenation
    1. Maintain Oxygen Saturation >90%
    2. Maintain superior vena cava Oxygen Saturation (Scvo2) >70%
    3. Maintain mixed venous Oxygen Saturation (Svo2) >65%
  2. Ventilation (BIPAP or Mechanical Ventilation)
    1. Indicated for septic patients with Oxygen Saturation <90% or significant Tachypnea despite High Flow Oxygen
    2. Use a low threshold for intubation of the elderly patient with severe Sepsis
    3. Tidal Volumes 6 cc/kg of ideal body weight (up to 8 cc/kg/IBW)
  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. Typical total initial crystalloid bolus of 30cc/kg (2-3L in 70-100 kg adult)
    3. Typical total crystalloid fluid over first 24-48 hours may approach 5-7 Liters
    4. Goals
      1. Inferior Vena Cava Ultrasound with <50% collapse on inspiration
      2. Serial serum lactate decrease (see above)
      3. Central Venous Pressure >8 (>12 if on mechanical Ventilator)
      4. Central venous oxygen level >70 mmHg
      5. Systolic Blood Pressure >90 mmHg or mean arterial pressure >65-70 mmHg
        1. Blood Pressure is an unreliable marker of Sepsis severity and response to therapy
        2. Blood Pressure can be normal or high immediately before decompensated shock
        3. Patient positioning is also an unreliable marker to predict fluid Resuscitation response
          1. Technique involves raising legs and observing for increase in Blood Pressure
    5. Precautions
      1. Consider Albumin 5% (500 ml bolus) or similar colloid
        1. Indicated for high volume crystalloid Resuscitation (e.g. >4-6 Liters)
        2. May help prevent fluid third spacing
      2. Avoid hyroxyethyl starch
        1. Initially promoted to correct Metabolic Acidosis from high volume crystalloid Resuscitation
        2. Hydroxyethyl starch is associated with increased risk of bleeding and Renal Failure
  4. Transfusion: pRBC
    1. Indications are controversial
      1. Most current guidelines suggest transfusion for Hemoglobin <7 g/dl (Hematocrit <21)
      2. Other studies suggest transfusion for Hemoglobin <10 g/dl (Hematocrit <30)
        1. Goal Hematocrit >30% if central venous Oxygen Saturation <70% after restoring mean arterial pressure
    2. More important after the initial stabilization
    3. Mortality increases for transfusion for mild Anemia
    4. Herbert (1999) N Engl J Med 340:409-17
    5. Rivers (2001) N Engl J Med 345(19): 1368-77
  5. Transfusion: Platelets
    1. Platelet Count <5,000/ul or
    2. Platelet Count 5,000 to 30,000/ul and significant bleeding risk or
  6. Nutrition
    1. Maintain adequate nutrition
      1. Consider oral Gastric Tube or nasal Gastric Tube
      2. Consider TPN
    2. Blood Glucose
      1. Conventional therapy (non-intensive Blood Sugar management: 144-180) is safer in critically ill
      2. Tight Glucose control is associated with Hypoglycemia and increased mortality
      3. Hyperglycemia is associated with apoptosis, ischemia and delayed healing
      4. Ideally mean Glucose of 150 mg/dl is preferred
      5. (2009) N Engl J Med 360:1283-97
  7. Corticosteroids
    1. Hydrocortisone at physiologic dose
      1. Hydrocortisone 50 mg IV every 6 hours
    2. Indicated for severe Sepsis refractory to aggressive fluid Resuscitation and Vasopressor therapy
      1. Consider if patient is requiring 2 pressors for support (e.g. Norepinephrine and Epinephrine or vasopressin)
    3. Efficacy (variable evidence)
      1. Surviving Sepsis Campaign downgraded Corticosteroid recommendation to weak evidence in 2012
      2. Marked mortality benefit from Corticosteroids in severe Sepsis
        1. Annane (2002) JAMA 288(7):862-71
      3. Has short-term benefit in duration and severity
        1. Annand (2009) JAMA 301:2362
      4. CORTICUS trial found no benefit to Corticosteroids overall
        1. However of those who did respond to shock reversal, those on Corticosteroids improved faster
        2. Sprung (2008) NEJM 358(2): 111-24
  8. Central venous access indications (e.g. internal jugular venous catheterization)
    1. Vasopressor delivery (Norepinephrine, Epinephrine)
    2. Monitoring
      1. Sepsis catheters (e.g. Vigileo) can monitor central venous Oxygen Saturation (ScvO2)
      2. Monitoring may be done instead non-invasively (e.g. follow IVC Ultrasound)
  9. Vasopressors
    1. Precaution
      1. Intravenous fluids should be maximized prior to starting first pressor (>2 L) and second pressor (4 L)
    2. Target perfusion
      1. Central venous pressure (CVP) 8-12 mmHg
      2. Mean arterial pressure (MAP) >65 mmHg
      3. Urine output >0.5 ml/kg/h
      4. See venous oxygenation goals (Scvo2 or Svo2) above
    3. First agent
      1. Norepinephrine (preferred first line)
        1. Start at 0.2 mcg/kg/min (range 0.1 to 1 mcg/kg/min)
        2. Titrate to adequate perfusion parameters including MAP (doses as high 1 mcg/kg/min may be required)
      2. Phenylephrine
        1. Indicated if pressors needed prior to securing central venous access
        2. Can bridge with less peripheral vein complications than Norepinephrine until central access is obtained
    4. Second agent (added to first)
      1. Indicated for Hypotension despite fluid bolus and other additional measures listed below
      2. Epinephrine
        1. Indicated for combined Vasopressor and inotropic support
        2. Indicated when bedside Echocardiogram demonstrates poor cardiac contractility (Cardiomyopathy)
      3. Vasopressin 0.03 units/minute (previously 0.04 units/min was recommended)
        1. Indicated for additional Vasopressor support
        2. Indicated when bedside Echocardiogram demonstrates good cardiac contractility with adequate inotropy
    5. Avoid Dopamine in Sepsis
      1. Dosing range: 2-20 mcg/kg/min
      2. Do not use "renal dose" Dopamine - misnomer
      3. No longer recommended in Sepsis due to less effective than Norepinephrine and arrhythmogenic
      4. De Backer (2010) N Engl J Med 362(9): 779-89
  10. Additional measures when poor response to Resuscitation efforts
    1. Consider Hypothyroidism
    2. Consider additional intravenous fluids (if suspect still volume down)
      1. Give additional 1-2 Liters on top of already administered 2 liters
    3. Manage Hypocalcemia (based on Ionized Calcium or Corrected Serum Calcium for albumin)
      1. Replace with Calcium Gluconate or Calcium Chloride if hypocalcemic
    4. Stress Ulcer or peptic ulcer prophylaxis
      1. Indications
        1. Thrombocytopenia
        2. Multiorgan failure
        3. Mechanical Ventilation
      2. Agents (either are equivalent)
        1. H2 Blocker (e.g. Ranitidine) or
        2. Proton Pump Inhibitor (e.g. Protonix)
    5. Occult Hemorrhage (e.g. Gastrointestinal Bleeding)
      1. Stop bleeding and Consider pRBC transfusion if actively bleeding or Hemoglobin <7.0 mg/dl
    6. DVT Prophylaxis
      1. Low molecular-weight Heparin (preferred) or
      2. Low dose Unfractionated Heparin or
      3. Mechanical compression devices if Heparin contraindicated
    7. Inotropes (e.g. Dobutamine)
      1. Consider for inotropic support when inadequate tissue perfusion/oxygenation where myocardial dysfunction is suspected
      2. Consider when perfusion markers fail to improve despite mean arterial pressure (MAP) >65 mmHg and Oxygen Saturation >90%
        1. SvcO2 <70% or
        2. Lactic Acid fails to improve or
        3. Serum Creatinine fails to improve
      3. Approach
        1. Dobutamine 2.5 mcg/kg/min
        2. Obtain beside Echocardiogram if available
  11. Other agents
    1. Activated Protein C
    2. Drotecogin Alfa (Xigris)
      1. No survival benefit
      2. Removed from the U.S. market in october 2011 (as well as surviving Sepsis guidelines)
    3. Bicarbonate
      1. Not generally recommended
      2. Acidosis improves with improved perfusion

XV. Management: End Stage Renal Disease (ESRD) and Sepsis

  1. Precautions
    1. Septic Shock in ESRD is of the highest risk
  2. Fluid management
    1. All septic patients with Hypotension or Lactic Acidosis will typically need upwards of 30 cc/kg replacement
      1. If monitoring (e.g. Ultrasound, CVP) is unreliable or unavailable, aim for 3-4 Liter IV fluid Resuscitation (in 500 cc increments)
      2. Early intubation may be preferred
    2. Emergency Dialysis may be required to manage Fluid Overload with the paramount aggressive fluid Resuscitation needed in Sepsis
    3. Use Inferior Vena Cava Ultrasound to drive fluid Resuscitation
      1. See Inferior Vena Cava Ultrasound for Volume Status
      2. Hypotension or Lactic Acidosis
        1. Vena cava collapses with inspiration: Give 500 cc IV bolus of fluid
        2. Vena cava does not collapse: Start Vasopressors (e.g. Norepinephrine)
      3. Repeat cycle of fluid bolus or pressors followed by Ultrasound until Hypotension and Lactic Acidosis resolve
        1. Once IVC does not collapse with inspiration, move to Vasopressors
        2. Consider starting Vasopressors earlier to help increase preload
        3. Consider monitoring Central Venous Pressure (CVP) to confirm that it remains low following fluid bolus
  3. Airway management
    1. Early intubation is preferred over crash airway management
    2. BIPAP or intubation may be needed with fluid Resuscitation related to fluid shifts and pulmonary edema (expected)
  4. Labs
    1. Serum lactate is an accurate reflection of Sepsis status in ESRD (lactate undergoes hepatic clearance)
  5. References
    1. Weingart and Orman in Majoewsky (2013) EM:Rap 13(10): 6

XVI. Prognosis

  1. Positive Blood Culture
    1. Confers 150% increase in mortality risk
  2. Mortality
    1. Severe Sepsis: 25-30%
    2. Septic Shock: 40-70%

XVIII. References

  1. Swadron and Goldberg in Majoewsky (2013) EM:RAP 13(6): 2-4
  2. Orman and Weingart in Majoewsky (2012) EM:RAP 12(10): 4-7
  3. Khoujah (2013) Crit Dec Emerg Med 27(4):12-21
  4. Marik (2011) Annals of Intensive Care 1:17
  5. Annane (2005) Lancet 365(9453): 63-78
  6. Cunha (2008) Crit Care Clin 24(2): 313-34
  7. Dellinger (2013) Crit Care Med 41(2):580-637
  8. Gauer (2013) Am Fam Physician 88(1): 44-53
  9. Jaimes (2004) Clin Infect Dis 38:357-62
  10. Lever (2007) BMJ 335(7625): 879-83

Images: Related links to external sites (from Google)

Ontology: 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.

Ontology: Septic Shock (C0036983)

Definition (CSP) shock caused by infection; frequently caused by gram negative bacteria, although some cases have been caused by other bacteria, viruses, fungi, and protozoa; characterized by fever, chills, tachycardia, tachypnea, and hypotension.
Definition (MSH) Sepsis associated with HYPOTENSION or hypoperfusion despite adequate fluid resuscitation. Perfusion abnormalities may include, but are not limited to LACTIC ACIDOSIS; OLIGURIA; or acute alteration in mental status.
Concepts Pathologic Function (T046)
MSH D012772
ICD9 785.52
SnomedCT 207031008, 158359009, 76571007
English Shock, Septic, [D]Septic shock, [D]Septicaemic shock, [D]Septicemic shock, [D]Septic shock (context-dependent category), SHOCK SEPTIC, [D]Septic shock (situation), septic shock (diagnosis), septic shock, Shock septic, SHOCK, SEPTIC, SEPTIC SHOCK, Shock, Septic [Disease/Finding], septicemic shock, Septic shock, Septicaemic shock, Septicemic shock, Sepsis-associated hypotension, Septic shock (disorder), Septic Shock, septic; shock, shock; septic
Dutch shock septisch, septisch; shock, shock; septisch, septische shock, Septische shock, Shock, septische
German Schock septisch, Septischer Schock, Schock, septischer
Swedish Chock, septisk
Spanish [D]choque séptico (categoría dependiente del contexto), choque septicémico, [D]Septic shock, [D]shock séptico, [D]choque séptico, [D]choque séptico (situación), Shock Séptico, Síndrome de Choque Tóxico, Síndrome del Shock Tóxico, Shock Tóxico, Shock Endotóxico, Sindrome de Choque Toxico, Choque Septico, Sindrome del Shock Toxico, Choque Séptico, Sindrome de Shock Toxico, Shock Toxico, Shock Septico, Síndrome de Shock Tóxico, Shock Endotoxico, Shock séptico, choque septicémico (trastorno), shock septicémico, choque séptico (trastorno), choque séptico, shock séptico
Japanese ハイケツショウセイショック, ショック-中毒性, 中毒性ショック, 内毒素ショック, 中毒性ショック症候群, ショック-内毒素, 敗血症性ショック, 敗血性ショック, ショック-エンドトキシン, 細菌性ショック, 感染性ショック, エンドトキシンショック, ショック-敗血症性
Czech šok septický, Septický šok
Finnish Septinen sokki
Russian TOKSICHESKII SHOK, SHOK SEPTICHESKII, SHOK TOKSICHESKII, SHOK ENDOTOKSICHESKII, TOKSICHESKOGO SHOKA SINDROM, ТОКСИЧЕСКИЙ ШОК, ТОКСИЧЕСКОГО ШОКА СИНДРОМ, ШОК СЕПТИЧЕСКИЙ, ШОК ТОКСИЧЕСКИЙ, ШОК ЭНДОТОКСИЧЕСКИЙ
Croatian ŠOK, SEPTIČKI
Polish Wstrząs septyczny, Wstrząs endotoksyczny
Hungarian septicus shock, Septicus shock
Portuguese Choque séptico, Choque Séptico
French Choc septique
Italian Shock settico