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sepsis Flashcards

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1
Q

what is infection?

A

inflammation due to microbe

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2
Q

what is sepsis?

A

Life-threatening organ dysfunction caused by dysregulated host response to infection

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3
Q

what is septic shock?

A

Sepsis along with both:
Persistent hypotension (vasopressors needed to maintain MAP at >/= 65)
High lactate (>/= 2)
(with adequate fluids)

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4
Q

most common infection that leads to sepsis?

A

Lung-lower respmost common
Abdominal
UTI
Skin infection (soft tissue, bone, joint)
Other
Indwelling devices

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5
Q

Best scoring system to identify sepsis?

A

NEWS>5

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6
Q

What is measured in NEWS?

A

Respiration rate
Oxygen saturation
Systolic blood pressure
Pulse rate
Level of consciousness
Temperature

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7
Q

timeframe to do sepsis 6?

A

1 hour

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8
Q

What is sepsis 6?

A

BUFFALO
BLOOD CULTURES (and Us and Es) + all relevant sites – before antibiotics
URINE OUTPUT (HOURLY!)
FLUID RESUSCITATION
ANTIBIOTICS IV
LACTATE MEASUREMENT
OXYGEN – TO CORRECT HYPOXIA

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9
Q

How many blood cultures in endocarditis to diagnose

A

3 within an hour before antibiotics

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10
Q

Criteria to assess for likelihood of endocarditis

A

Dukes criteria

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11
Q

What investigations can be done to diagnose sepsis?

A

Cultures: blood, urine, stool, wound, tissue cultures
Microscopy: stool, urine, CSF, sputum
Serology – detects antibodies in the blood
Antigen detection
PCR/molecular studies

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12
Q

When the infectious cause is identified sensitivity for antibiotics can be done.
what tests are they

A

E test- determines the lowest concentration at which the antibiotics inhibit the growth of the organsism.

Vitek machine- gives MICs (minimum inhibitory concentrations for each)

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13
Q

What is MIC?

A

Mean inhibitory concentration
The concentration of a drug required to kill 99.9% of organisms in 18-24 hours.
Useful to guide antibiotic choice

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14
Q

What inflammatory markers can be measured in the lab?

A

White cell count
CRP
Procalcitonin (PCT)
Lactate - main one in sepsis

All rise in infection

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15
Q

What drug causes wcc to raise commonly?

A

Steroids
Lithium

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16
Q

Difference between gram negative and gram positive bacteria?

A

Gram neg- two layers in cell wall and periplasmic space causing pink staining

Gram-positive- single layer, no space causing purple staining

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17
Q

ways of identifying bacteria

A

Gram stain
Shape
MALDI-TOF
Anaerobic vs aerobic

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18
Q

What is the MALDI-TOF machine?

A

Used to identify organisms on a positive culture.
Uses mass spectrometry to identify peaks associated with particular micro-organsims

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19
Q

Common causes of gram negative sepsis?

A

E. coli
Pseudomonas aeruginosa
H. Influenza
Neisseria meningitidis
Neisseria gonorrhoea

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20
Q

Good antibiotics for gram negative?

A

Gentamicin (IV only)
Amoxicillin

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21
Q

common side effects of gentamicin

A

Nephrotoxicity
Ototoxicity

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22
Q

What drug for h. influenza

A

Amoxicillin
(doxycycline also works)

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23
Q

Does h. influenza grow on blood agar?

A

No
Chocolate agar only

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24
Q

Causes of atypical pneumonia?

A

Mycoplasma pneumonia
Chlamydia psittaci
Legionella pneumophilia

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25
Antibiotics that work in atypical pneumonias
Doxicycline – not in legionella Clarithromycin Levofloxacin if penicillin allergic
26
UTI treatment guidelines
In a women: 3 days of nitrofurantoin or trimethoprim In a man: 7 days of nitrofurantoin or trimethoprim Complicated: IV amoxicillin and gentamicin step down to co-trimoxazole
27
drug for staph aureus
Flucloxacillin Vancomycin (if allergic or MRSA)
28
What route does strep pyogenes cause sepsis through
Skin and soft tissue infection
29
where does Strep viridans infect
Endocarditis Doesn’t cause gut infection- this where it lives
30
Strep antibiotics
Penicillins are still okay
31
Where do enterococci cause sepsis ?
Infective endocarditits UTI
32
Antibiotics for enterococci
Amoxicillin If resistant: vancomycin VRE- vacomycin resistant enterococcus use a weirdo antibiotic
33
Strep haemolysis test
Beta haemolysis Group A strep e.g. strep pyogenes Alpha haemolysis Strep viridans Strep pneumonia Gamma haemolysis Enterococci
34
List some gram positive bacilli
Listeria monocytogenes (atypical meningitis in alcoholics, diabetics, over 65 and immunosurpressed) Bacillus b. Anthracis (anthrax) b. Cereus (food poisoning after reheated rice) Clostridia c. Difficile (diarrhoea after antibiotics) c. Tetani (tetanus) c. Perfringes (soft tissue infection)
35
Do antibiotics work in abscesses?
No – they require drainage
36
Mechanism (really simplified) of antibiotic resistance?
Antibiotics are only able to kill certain strains of bacteria Bacteria with certain traits survive These bacteria are now able to multiply and colonise
37
4cs of c. diff
Co amox Cephalosporins (cef- drugs) Clindamycin Ciprofloxacin
38
How often should you review iv abx?
Daily
39
Whats source control in sepsis?
Eliminate the source of infection, control ongoing contamination, and restore premorbid anatomy and function Strategies used to achieve source control include drainage of purulent collections, open or percutaneously, removal of the infected and/or necrotic tissue (debridement), creation of diverting ‘ostomies’, and removing obstruction, among others.
40
Are people fixed after sepsis goes away?
No Many physical and mental symptoms persist
41
Clinical signs of community acquire pneumonia
Cough Increased sputum Chest pain Dyspnoea Fever CXR with infilitrates Needs to be acquired in the community (or first 24 hours in the hospital)
42
typical bug of CAP?
Strep. pneumonia
43
Atypical pneumonia bugs
Mycoplasma pneumonia Legionella pneumonia Chalmydophilia pneumonia Chlamydia psittacci Viruses
44
Pneumonia type common in the immunosurpressed
Pneumocystis jiroveci - HIV patients+CF Aspergillus sp. – after organ transplant! Endemic mycoses TB
45
Common in cf
Straph aureus H. influenza Strep pneumonia Main 2 Pseudomonas aeruginosa Burkholderia cepacia
46
Diagnosing CAP
Sputum culture Viral PCR Additional tests – antigen/biomarkers
47
Treating CAP
use curb65 CONFUSION UREA >7 RR >/ 30 BP- SBP < or =90 DBP< or =60 0-2 - Amoxicillin 1g tds IV/PO(5 days)- if penicillin allergic- Doxycycline 200mg PO on day one then 100mg od or IV Clarithromycin 3-5 - Co-amox IV 1.2g tds + Doxy PO 100mg bd- if pen allergic IV Levofloxacin
48
Neutropenic sepsis?
Sepsis + Neutrophil count <0.5 or <1 if on chemo in last 21 days
49
treatment for neutropenic sepsis
piperacillin and tazobactam (add gentamicin if high risk)
50
When would you suspect malaria?
Up to 1 year post travel to an affected area Fever Reduced GCS Seizures Respiratory distress Abnormal bleeding
51
What bug causes malaria
Plasmodium falciparum
52
How do you diagnose malaria?
3 x thick and thin films (over time) Can do a rapid antigen- not that helpful but fast
53
Whats enteric fever
Typhoid Paratyphoid
54
How can typhoid present
Travel to area plus Maybe asymptomatic Anaemia DIC Meningitis/encephalopathy Shock Myocarditis Bronchitis Pneumonia Hepatitis GI bleed
55
How does dengue fever present?
Within 14 days of returning from an endemic area With fever, arthralgia, leukopaenia Rash- blanches to your hand
56
how dengue fever managed
Supportive
57
most common root of meningitis
Ears- otitis media Nasopharynx Parameningeal e.g sinusitis, mastoiditis Haematogenous eg infective endocarditis
58
types of meningitis
Acute Pyogenic → bacterial Acute Aseptic → viral, non-infectious Acute Focal Suppurative → abscess, empyema Chronic Bacterial → TB Fungal
59
what is pyogenic meningitis
The pia-arachnoid layer is congested w/ a thick layer of suppurative exudate (pus) that covers the leptomeninges
60
Pathogen causes of pyogenic meningitis
Strep. Pneumoniae → extracellular *pneumococcal Neisseria meningitidis → intracellular *meningococcal Listeria monocytogenes → gram +ve H. influenzae
61
epidemiology of meningitis
Neonates → Listeria, Group B Strep. Unvaccinated kids → H. influenzae Age 10-21 → Neisseria meningitidis , Strep. Pneumoniae Age 21-65 → Strep. Pneumoniae Age 65+ → Strep. Pneumoniae Immunocompromised →Listeria Head Trauma → Staph. Aureus Cribriform plate fracture → Strep. Pneumoniae
62
complications of meningitis
SNHL- most common Limb loss Blindness Cerebral palsy
63
what is aseptic meningitis
meningitis that comes back negative on culture
64
most common cause of aseptic meningitis
Viral- entero, coxsackie, mumps, HSV, VZV
65
Diagnostic tools for viral meningitis
stool PCR + culture, throat swab, LP PCR, HIV
66
treatment for viral meningitis
supportive
67
Lumbar puncture appearance for bacterial ,viral and fungal Gross appearance difference
Bacterial- cloudy or frankly plurpent Viral- Clear/ slightly turbid Fungal- clear
68
Lumbar puncture appearance for bacterial ,viral and fungal Csf pressure
Bacterial- slightly high Viral- high Fungal- very high
69
Lumbar puncture appearance for bacterial ,viral and fungal Cell present
Bacterial- Neutrophils Viral- Lymphocytes Fungal- Lymphocytes
70
Lumbar puncture appearance for bacterial ,viral and fungal Protein
Bacterial- very high Viral- slightly high Fungal- high
71
Lumbar puncture appearance for bacterial ,viral and fungal Glucose
Bacterial- low Viral- normal Fungal- low
72
Lumbar puncture appearance for bacterial ,viral and fungal Bacteriology
Bacterial- causitive organism Viral- sterile Fungal- fungi
73
when to CT before LP
Papilloedema GCS <13 Hx of CNS disease Seizure /focal neuro deficit Stroke Immunocompromised
73
when is LP condraindicated
Raised ICP
74
Meningitis Treatment
Bacterial- ABX + steroid steroid- dexamethasone ABX- 1st line -IV ceftriaxone pen allergic- IV chloramphenicol+ vancomycin
75
what comes up on stain for fungal Fungal treatment for Meningitis
Indian pink stain IV amphotericin B or flucytosine
76
Suspect meningitis in GP- what do you give
IM Benzylpenicillin
77
what is encephalitis+ investigation+ treatment
infection of the brain parenchyma MRI- bright white in temporal lobes IV aciclovir
78
Causes of encephalitis
VZV- chicken pox virus HSV- older patients
79
symptoms of encephalitis
Mainly neurological psychosis seizure fever meningism speech disturbance
80
Pathology of guillain barr
B cells secrete Ab that attack pathogens, however the Ag on pathogens matches those on the myelin sheath
81
diagnostic test for GB
LP- rule out other causes
82
whats botulism pathology
exotoxin acts on motor neuron terminals to block vesicle docking in presynaptic membrane, irreversibly inhibiting Ach release.
83
signs of botulism
Rapid onset weakness w/out sensory loss Ascending paralysis
84
a person with multiple brain abscesses will get it through which mechanism of infection
Haematogenous spread
85
what is neutropenic sepsis
Temp >38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 10^9/L or lower.
86
causes of neutropenic sepsis
chemotherapy is the main reason immunosuppression, medications e.g. clozapine, methotrexate, sulphasalazine, carbimazole
87
most common infective pathogen in neutropenic sepsis
gm -ve, pseudomonas, aspergillus passmed says gram + due to lines in chemo but leactures say otherwise
88
treatment for neutropenic sepsis
piperacillin+tazobactam in septic shock add gentamicin
89
what is a commensal
organism present in body that doesn’t produce inflam response
90
what is definition of infection
presence of an organism w/ inflam response
91
what is definition of bacteraemia
presence of bacteria in the blood
92
what is definition of SIRS
dysregulated host response in response to stimuli (infective or non)
93
what is definition of severe sepsis
intermediate between sepsis and full septic shock
94
sepsis antibiotics
amox, metronidazole, gent all IV if allergy- Vanc, met, gent all IV
95
sepsis scoring
NEWS and qSOFA
96
qSOFA- what's in it
GCS reduction RR = OR >22 Systolic BP < or = 100 score >2 means concern
97
antibiotics in sepsis of unknown cause
Amox, met and gent If P.a- vanc, met and gent
98
antibiotics in sepsis of meningitis
IV ceftriaxone + dexamethasone if P.a- IV chloramphenicol + vanc
99
antibiotics in sepsis of severe CAP
Co-amox + doxy
100
antibiotics in sepsis of severe HAP
amox + gent
101
antibiotics in sepsis of C.Diff
oral vanc
102
antibiotics in sepsis of UTI
amox + gent if P.A- co-trimoxazole
103
endocarditis for Native valve indolent
Amoxicillin IV 2g 4 hourly + Gentamicin
104
confirmed endocarditis sepsis in native valve
flucloxacillin 2g IV 4-6 hrs
105
endocarditis sepsis which is mrsa in native valve
vanc + gent + rifam (3-5 after starting other antibiotics)
106
endocarditis sepsis with risk factors for resistant pathogens
vanc + meropenem
107
prosthetic valve endocarditis
vanc + gent + rifam (3-5 after starting other antibiotics)

year 3 clasp (3 decks)

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