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inflammatory response to the presence of microorganisms or invasion of normally sterile site or host tissue by those organisms



presence of viable bacteria in the blood


what is SIRS

systemic inflammatory response syndrome

widespread inflammatory response

presence of 2 or more of:
1. temp >38.5 or 90 bpm
3. RR > 20 or PaCO2


what is sepsis

SIRS + clinical/definitive EVIDENCE OF INFECTION (presumed or confirmed)

severe sepsis is when its associated with organ dysfunction or hypoperfusion


what is septic shock

sepsis with HYPOTENSION despite adequate fluid resuscitation along with PERFUSION ABNORMALITIES (i.e lactic acidosis, oliguria or acute alteration of mental status)

patients requiring inotropic or vasopressor therapy despite adequate fluid resuscitation are in septic shock

"refractory hypotension"


etiologic agents of septicemia/sepsis

E. coli = most common organism causing septic shock (22%)

second most common is S. aureus

gram +s = more cause of sepsis than gram -s

E. coli, S. aureus, S. pneumo, Klebsiella


clinical presentation of sepsis

look for:
1. confusion
2. leukocytosis
3. tachycardia
4. tachypnea
5. hypotension
6. organ dysfunction


management of sepsis

1. fluid rescusitation
2. appropriate cultures
3. source control
4. vasopressors/inotropes when fluid fixed
5. early institution of appropriate Ab therapy--> HIT HARD AND HIT EARLY


clinical presentation of septic shock

1. hemodynamic alterations--> hyper or hypodynamic
2. myocardial depression
3. altered vasculature
4. altered organ perfusion
5. imbalance O2 delivery
6. lactic acidosis


what is "warm shock"

assoc w severe sepsis/septic shock

hyperdynamic state--> elevated cardia output, tachycardia, decreased systemic vascular resistance


what is "cold shock"

assoc with severe sepsis/septic shock

hypodyamic state--> decreased cardiac output


what is infective endocarditis

infection of the endocardial surface of the heart

usually heart valves but may occur on septal defects or mural endocardium


what are the 4 types of infective endocarditis

1. native valve
2. prosthetic
3. IV drug abuse
4. nosocomial


what percent of infective endocarditis is native valve?

55-75% (underlying abnormality)


what is the median age of infective endocarditis



who is given infective endocarditis prophylaxis

given to high risk patients (i.e with prosthetic heart valves, previous IE, cardiac transplant, congenital heart defect, and high risk procedures)


what causes acute infective endocarditis

S. aureus
S. pyogenes (GAS)
S. pneumoniae

(strep more likely than staph in native valve endocarditis)
(in prosthetic valve coagulase - staph is more likely than strep is more likely than staph)


what causes chronic/subacute infective endocarditis

viridans group strep


how does infective endocarditis occur

turbulent blood flow makes the endocardium "sticky"--> bacteremia delivers organism to the endocardial surface--> adherence of organism--> eventual invasion of valvular leaflets


how does infective endocarditis present clinically

1. febrile illness (85%)
2. persistent bacteremia
3. lesions on heart
4. vegetation (variable in size)
5. heart murmur (85%)
6. peripheral signs--> Osler's nodes, splinter hemorrhage, Janeway lesions, subconjunctival lesions
7. Roth spots (embolic lesions)
8. spenomegaly (30%)


Tx for native valve endocarditis

acute: vancomycin + ceftriaxone

subacute--await culture


Tx for prosthetic valve endocarditis

if its early onset (


risk factors for prosthetic joint infections

1. primary--> rheumatoid arthritis, diabetes mellitus, poor nutritional status, obesity

2. revision--> prior joint surgery, prolonged OR time, preoperation infection (skin, teeth, UTI)

uncommon infection--less than 2% of joint replacements


etiologic agents in prosthetic joint infections

S. aureus and coagulase - staph


what are some examples of coagulase negative staph species

Staph epidermis
Staph haemolyticus
Staph saprophyticus


Tx of prosthetic joint infections

empiric therapy is not recommended

treat based on culture and sensitivity and treat for at least 6 weeks

remove prosthesis if joint age is more than 30 days and symptoms persist for more than 3 weeks


what is febrile neutropenia

development of fever, often with other signs of infection, in a patients with neutropenia


what is neutropenia

an abnormally love number of neutrophil granulocytes in the blood


what type of patients get febrile neutropenia

immunocompromised people


what causes febrile neutropenia

gram -s like pseudomonas

can also be cause by gram +s, fungal superinfection if the neutropenia is prolonged


what is the clinical presentation of febrile neutropenia

fever for longer than 1 hour and ANC less than 0.5 but trending down