Sepsis

Question 1

What is sepsis?

Answer 1

systemic inflammatory response syndrome + confirmed or suspect infection process

Question 2

What is the definition of systemic inflammatory response syndrome?

Answer 2

SIRS Definition
A non-specific clinical response including >2 of the following:
Temperature >38oC or 90 beats/minute
Respiratory rate >20/minute
White blood cell count >12,000/mm3 or 10% immature neutrophils

Question 3

What is severe sepsis?

Answer 3

Acute organ dysfunction secondary to sepsis

Question 4

What is evidence of organ dysfunction?

Answer 4

Brain - confusion
Lungs – Adult respiratory distress syndrome/acute lung injury
Heart - hypotension
Liver – dysfunction/acute liver injury
Kidney – acute kidney injury
Clotting cascade – disseminated intravascular coagulpathy
Acid base balance – metabolic acidosis

Question 5

What action is taken to manage a patient with sepsis?

Answer 5

Sepsis 6
Take
Blood cultures
Full blood count and lactate
Measure urine output

Give
Fluids
Antibiotics
Oxygen

Question 6

What are community acquired causes of bacteraemia?

Answer 6

Escherichia coli (and other coliforms)
Staphylococcus aureus
Streptococcus pygoenes

Question 7

What are hospital acquired causes of bacteraemia?

Answer 7

E. Coli (and other coliforms)
Staph. aureus
Coagulase negative Staph.
Enterococcus spp.
Pseudomonas aeuriginosa
Candida spp.

Question 8

What are coliforms?

Give examples

Answer 8

E. coli and similar organisms that inhabit the large bowel, 
Klebsiella sp.
Proteus sp.
Enterobacter sp.
Serratia sp. etc.

Question 9

What is the definition of strict aerobes?

Answer 9

organisms that require oxygen for growth, such as Pseudomonas sp.

Question 10

What is the definition of aerobic organisms?

Answer 10

Organisms that grow better with oxygen, but can also grow without it, e.g. Staphylococci, Streptococci, Enterococci and Coliforms (i.e.the majority of human pathogens)

Question 11

What are normal bacteria found in the mouth?

Answer 11

Strep. “viridans”, Neisseria sp., anaerobes

Candida sp. (few), Staphylococci

Question 12

What are normal bacteria found in the stomach and duodenum?

Answer 12

Usually sterile

Few Candida sp. & Staphylococci may survive

Question 13

What are normal bacteria found in the bile ducts?

Answer 13

These are usually sterile

Question 14

What are normal bacteria found in the jejunum?

Answer 14

Small numbers of coliforms and anaerobes

Question 15

What are normal bacteria found in the colon?

Answer 15

Large numbers of coliforms (106 per gram), anaerobes (109 per gram) and Enterococcus faecalis

Question 16

What antibiotics are used for intra-abdominal infection with gram positive aerobes e.g. streptococci and enterococci?

Answer 16

Amoxicillin

Question 17

What antibiotics are used for intra-abdominal infection with coliforms e.g. E coli?

Answer 17

Gentamicin

Question 18

What antibiotics are used for intra abdominal infection with anaerobes e.g. bacteroides?

Answer 18

Metronidazole

Question 19

What type of antibiotics is gentamicin?

Answer 19

aminoglycoside antibiotic

Question 20

How long should the time on gentamicin be minimised to?

Answer 20

72 hours

Then review the patients condition and microbiology results

Question 21

What is septic shock?

Answer 21

Severe sepsis with hypotension refractory to adequate volume resuscitation or requiring vasopressors or inotropes