Académique Documents
Professionnel Documents
Culture Documents
rd
for 3 year MBBS
Dr. Ahmad Uzair Qureshi
FCPS ( SURGERY) /
MRCS ( ENGLAND) /
MCPS ( SURGERY)
Dip Med Edu (Cardiff)
SEPSIS
Is a systemic, harmful ( deleterious) host response to infection.
SEPSIS
Is a systemic, deleterious host response to infection.
leading to
Severe Sepsis
(acute organ dysfunction secondary to documented or suspected infection)
Severe Sepsis
(acute organ dysfunction secondary to documented or suspected infection)
Dysfunction of organ(s) distant from the site of infection
leading to
SEPTIC SHOCK
(severe sepsis plus hypoperfusion or hypotension not reversed
with fluid resuscitation).
INFECTION
INFECTION
Presence of microorganisms in a normally sterile site
INFECTION
Presence of microorganisms in a normally sterile site
Do Not confuse with colonization, which is the presence of
microorganisms on an epithelial surface
Bacteremia
Bacteremia
Cultivatable bacteria in the bloodstream
May be transient and inconsequential;
Systemic inflammatory
response syndrome (SIRS)
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Systemic inflammatory
response syndrome (SIRS)
Anti-infective
Antiinflammatory
Procoagulant
Metabolic
Thermoregulat
CONCEPTs
1.Microvascular
TWO Theories
derangement
2.Mitochondrial
dysfunction.
Septic Shock
Opportunistic commensal bacteria typically invade across
disrupted epithelia.
Hosts in whom immunosuppressive acute-phase responses are
already occurring because of illness, injury, or infection.
Host is unable to kill the bacteria because of mechanical failure
(obstructed drainage pathway), immunosuppression
(neutropenia, endogenous immunosuppression)
DIAGNOSTIC CRITERIA
B. Diagnosis
Cultures as clinically appropriate before antimicrobial therapy if no
significant delay (> 45 mins) in the start of antimicrobial(s)
At least 2 sets of blood cultures (both aerobic and anaerobic bottles) be
obtained before antimicrobial therapy
Imaging studies performed promptly to confirm a potential source of
infection (UG).
C. Antimicrobial Therapy
Administration of effective intravenous antimicrobials within the
first hour of recognition of septic shock and severe
sepsis without septic shock as the goal of therapy.
Initial empiric anti-infective therapy of one or more drugs that
have activity against all likely pathogens
Antimicrobial regimen should be reassessed daily for potential
deescalation.
Use of low procalcitonin levels in the discontinuation of empiric
antibiotics
Combination empirical therapy for neutropenic respiratory failure
and septic shock,
Vasopressors
Vasopressor therapy initially to target a mean arterial pressure (MAP) of 65 mm Hg
Norepinephrine as the first choice vasopressor.
Epinephrine (added to and potentially substituted for norepinephrine) when an additional
agent is needed to maintain adequate blood pressure (grade 2B).
Vasopressin 0.03 units/minute can be added to norepinephrine (NE) with intent of either
raising MAP or decreasing NE dosage .
Low dose vasopressin is not recommended as the single initial vasopressor for treatment of
sepsis-induced hypotension and vasopressin doses higher than 0.03-0.04 units/minute
should be reserved for salvage therapy (failure to achieve adequate MAP with other
vasopressor agents) .
Dopamine as an alternative vasopressor agent to norepinephrine only in highly selected
patients (eg. patients with low risk of tachyarrhythmias and absolute or relative
bradycardia).