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Flashcards in Sepsis Deck (21):
1

What is sepsis?

systemic inflammatory response syndrome + confirmed or suspect infection process

2

What is the definition of systemic inflammatory response syndrome?

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

3

What is severe sepsis?

Acute organ dysfunction secondary to sepsis

4

What is evidence of organ dysfunction?

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

5

What action is taken to manage a patient with sepsis?

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

Give
Fluids
Antibiotics
Oxygen

6

What are community acquired causes of bacteraemia?

Escherichia coli (and other coliforms)
Staphylococcus aureus
Streptococcus pygoenes

7

What are hospital acquired causes of bacteraemia?

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

8

What are coliforms?
Give examples

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

9

What is the definition of strict aerobes?

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

10

What is the definition of aerobic organisms?

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)

11

What are normal bacteria found in the mouth?

Strep. “viridans”, Neisseria sp., anaerobes
Candida sp. (few), Staphylococci

12

What are normal bacteria found in the stomach and duodenum?

Usually sterile
Few Candida sp. & Staphylococci may survive

13

What are normal bacteria found in the bile ducts?

These are usually sterile

14

What are normal bacteria found in the jejunum?

Small numbers of coliforms and anaerobes

15

What are normal bacteria found in the colon?

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

16

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

Amoxicillin

17

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

Gentamicin

18

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

Metronidazole

19

What type of antibiotics is gentamicin?

aminoglycoside antibiotic

20

How long should the time on gentamicin be minimised to?

72 hours
Then review the patients condition and microbiology results

21

What is septic shock?

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

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