Sepsis Flashcards by Lauren Cameron

define colonisation

the presence of a microbe in the human body without an inflammatory response

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Define infection

inflammation due to a microbe

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Define bacteraemia

The presence of viable bacteria in the blood

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Define sepsis

The dysregulated host response to infection

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what are the main signs of septic shock

Persistent hypotension
Lactate greater than 2mmol/l

(despite adequate volume resuscitation)

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Give some differentials of diffuse pain

Aortic aneurysm
Aortic dissection
gastroenteritis
Early appendicitis
Addisonian crisis
Bowel obstruction
DKA

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Give some differentials of left upper quadrant abdo pain?

Gastric ulcer
gastritis
herpes zoster
pulmonary embolism
Pancreatitis

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Give some differentials of right upper quadrant pain

appendicitis
biliary colic
cholecystitis
herpes zoster
hepatitis
PE

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Give some differentials of left lower quadrant pain

diverticulitis (sigmoid)
ectopic pregnancy
endometriosis
ovarian cyst
ovarian torsion
testicular torsion
PID

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Give some differentials of right lower quadrant pain

appendicitis
crohn's disease
aortic aneurysm
endometriosis
ectopic pregnancy
testicular/ovarian torsion
meckel's diverticulum 
PID

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what tests do you do to diagnose an infection

Microbiology - blood, stool, urine, wound/tissue culture, CSF, sputum
Serology
Antigen detection
PCR

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What is the sepsis 6

Blood culture
Urine output
Fluid resuscitation 
- also give vasopressors (norepinephrine, vasopressin etc)
Antibiotics IV
Lactate levels
Oxygen

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what test do you do to identify whether it is strep or staph

Catalase

\+ve = staph
-ve = strep

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What test can you do to work out whether is is S.aureus or S. epidermis

coagulase

\+ve = S.aureus
-ve = S.epidermis

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what are the most common sources of infection in sepsis

Respiratory
Abdominal
UTI
Soft tissue, bone, joints

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In what 3 ways can you classify a bacteria

Shape

spirilla
Bacilli
Cocci

Gram stain

Positive = purple
negative = pink

Oxygen demand

aerobic
anaerobic

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What is responsible for the gram staining dye remaining purple in positive organisms

Thick layer of peptidoglycan which traps the dye

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Give some examples of gram positive bacteria

Cocci
(aerobes)
- staphlococcus
- streptococcus
- enterococcus
(anaerobes)
- peptostreptococcus

Rods
(aerobes)
- corynebacterium
- listeria
- lactobacillus
- mycobacterium
- bacillus
(anaerobes)
- clostridium

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What type of bacteria are staph and strep classed as and how do you tell them apart?

Gram positive

Staph - clusters, wound infections
strep - chains, throat often

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Give some examples of gram negative bacteria

Cocci
(aerobes)
- Neisseria

Rods
(aerobes)
- pseudomonas
(anaerobes)
- salmonella
- shigella
- Klebsiella
- campylobacter

Spiral
(aerobes)
- leptospira
(anaerobes)
- borrelia
- treponema

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what are coliforms

E.coli and similar

Gram negative rods

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What organism is most associated with UTI

E.coli

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what organisms are most associated with diarrhoea

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salmonella
shigella
E.coli

What organisms are most associated with lower resp. tract infections

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klebsiella

enterobacter

What kind of antibiotics can be active towards gram negatives

Beta lactams - amoxicillin aminoglycosides - gentamicin macrolides - erythromycin, clarithromycin tetracycline - doxycycline

what kind of bacteria is H.influenzae

gram negative coccobacillus

what are some atypical organisms causing of pneumonia and what antibiotic works against them

Mycoplasma pneumoniae coxiella burnetti Legionella, chlamydophila psettaci Doxycycline (main one) (legionella doesn't respond great to this) macrolides

Main causes of gram negative sepsis

E.coli, klebsiella, enterobacter Pseudomonas aeruginosa neisseria gonorrhoea

what is the main concern when giving gentamicin

nephrotoxicity

In streptococcus what can be used to differentiate S. viridans, S.pneumoniae, group A?

A - haemolytic - S. viridans, S. pneumoniae | B - haemolytic (green) - group A

what is mean inhibitory concentration

concentration of the drug required to kill 99.9% of organisms in 18 - 24hrs

what class of drugs are penicillin, flucloxacillin, amoxicillin, piperacillin etc in?

Beta lactams

classification of streptococci on agar?

``` Beta haemolytic strep - complete lysis next to growth, clear zone 1. Group A beta - strep. pyogenes 2. Group B beta - strep agalactaiae Alpha haemolytic strep - partial haemolysis, greenish colour to blood agar Gamma haemolytic strep - non haemolytic ```

Pathology of community acquired pneumonia

Organism reaches lungs Immune activation and infiltration Fluid and cellular build up in alveoli leads to impaired gas exchange

What are the clinical signs of community acquired pneumonia

``` cough increased sputum chest pain dyspnoea fever chest xray with infiltrates ```

what are the most likely organism to cause community acquired pneumonia

strep pneumoniae H. influenzae Atypicals (legionella, psitacci etc.) and virus staph aureus

what are the investigations for pneumonia

sputum culture viral PCR Antigen tests biomarkers

what are some clinical signs of TB

Haemoptysis night sweats weight loss

what are some clinical signs of CMV?

visual changes esophagitis enteritis encephalitis

what are some ways that a pathogen can evade being destroyed by immune responding cells

multiple mechanisms camouflage the surface Dampen the response

what is aspergillus

A lung infection caused by aspergillus, which is a type of mould that grows indoors and outdoors

what antibiotics target folate synthesis

sulfonamides | trimethoprim

what kind of antibiotic is gentamicin

gram negative

Antibiotics can be bactericidal or bacteriostatic, what does this mean?

Bactericidal - kill the bacteria directly | Bacteriostatic - supress the growth of bacteria

what is bioavailability

the proportion of a drug that enters the circulation when introduced to the body (i.e. the amount of the drug that has an active effect

A NEWS score of what should make you consider sepsis

> 5

what happens physilogically in septic shock

Capillary leakage cytokine release vasodilation

risk factors in sepsis

very young/very old immunosuppressed pregnancy neonates

what is the empirical treatment for sepsis

Amoxicillin (vancomycin if penicillin allergic) Gentamicin metronizadole

what antibiotic would you give if C.diff was found on blood culture

Vancomycin

what does high lactate levels indicate?

Signs of hypoperfusion (low BP) >4 = bad, repeat at 4 - 6 hrs

what is minimum inhibitory concentration (MIC)?

the lowest concentration at which the antibiotic inhibits growth of the organism

If a patient is taking antibiotics what is the bacteria that they are at risk from?

C. difficile

what is flucloxacillin often used for

Staphylococcus skin infections | streptococcus skin infections

when should you not use urinalysis?

in those over 65 those with urinary catheters will likely show bacteria that is not actually causing an infection

Sepsis Flashcards

(55 cards)