Sepsis

Question 1

Define sepsis and septic shock.

Answer 1

Sepsis: Body’s life-threatening host response to infection that can lead to tissue damage, organ failure, and death

Septic shock: a life-threatening form of sepsis (can be result of severe sepsis) usually due to presence of bacteria and their toxins in the bloodstream. Characterized especially by decreased blood flow to organs and tissues, hypotension, organ dysfunction, and often multiple organ failure

Question 2

List risk factors for sepsis.

Answer 2

• Elderly (>75 years) and very young (<1 year)
• Impaired immune system (e.g. chemo, HIV)
• Surgery in last 6 weeks
• Breach of skin integrity
• IV drug users
• Indwelling lines or catheters
• Pregnancy, given birth or had miscarriage / termination of pregnancy in last 6 weeks
• Diabetes
• Asplenic

Question 3

Name four key causative pathogens of sepsis.

Answer 3

• Neisseria meningitidis
• Streptococcus pneumoniae
• Streptococcus pyogenes
• Encapsulated organisms (for asplenics)

Question 4

Define colonisation.

Answer 4

• Colonisation - presence of a microbe in the human body that does not cause infection or a specific immune response

Question 5

Define infection.

Answer 5

• Infection - occurrence of inflammation due to the presence of a microbe

Question 6

Define septicaemia.

Answer 6

• Septicaemia - presence of viable microbes in the blood (can be bacteraemia, viraemia, parasitaemia)

Question 7

Describe the criteria for sepsis.

Answer 7

• Patients with 2 or more of the following criteria:
– Temperature ≥ 38oC or <36oC
– Heart rate > 100 beats per minute
– Respiration > 20/min
– Leukocyte count >16,000/mm3, <4,000/mm3 (normally 4-11)

PLUS

• A documented infection site (may be GI tract, skin etc. Blood cultures do not need to be positive, because may not be there yet)

Question 8

Briefly explain the pathophysiology of sepsis.

Answer 8

1. Infection
2. Host defense mechanism activation
3. Influx of Activated neutrophils & monocytes
4. Release of inflammatory mediators
5. Vasodilation and Activation of coagulation
6. Diffuse endothelial dysfunction (Driver of most symptoms of sepsis)
7. Increased endothelial permeability

Question 9

Describe the set of interventions/investigations necessary for management of sepsis.

Answer 9

BUFALO

1. Take Blood cultures
2. Measure accurate hourly Urine output
3. Give intravenous Fluid challenges
4. Give broad spectrum Antibiotics
5. Measure serum Lactate and haemoglobin
6. Administer high flow Oxygen.

Question 10

How much can you increase the patient’s chances of survival by performing BUFALO in the first hour ?

Answer 10

By carrying these out in the first hour, you can double your patient’s chance of survival!

Question 11

Identify the investigations appropriate to the diagnosis and management of sepsis.

Answer 11

• Blood tests: WCC (could be increased or decreased in sepsis), CRP (always present in infection), platelets, clotting
• Microbiology: Culture (blood, stool, urine, wound swab, tissue, CSF, sputum)
• Viral studies: e.g. NAAT / PCR
• Serology: for antibodies

Question 12

Describe the treatment options for sepsis.

Answer 12

Blood cultures before prescribing!! (so have baseline to compare with after giving IV antibiotics)
Review once microbiology results available!
• IV antibiotics within 60 minutes of recognition of sepsis (even if suspect viral infection)
• IV fluids
• Oxygen
• Vasopressors

Question 13

List a few conditions which may cause sepsis.

Answer 13

Meningitis
Pneumonia
UTIs
Septic arthritis