Pendahuluan

Sepsis is one of the most important problems for

children to deal with in terms of their high mortality
rates, especially in developing countries such as
Indonesia

Unsaved sepsis can fall into a state of septic shock that

can eventually lead to death. Early treatment of septic
shock can reduce morbidity and mortality.
 Definition
Sepsis is a suspicion or evidence of an infection
coupled with two or more symptoms of SIRS (Systemic
Inflammatory Response Syndrome), such as:
Increased temperatures above 38oC or less than 36oC,
Tachycardia (heart rate more than 90 times per minute)
Takipneu (breathing more than 20 times per minute or
PACO2 less than 32 mmHg), and
Leucocytosis (white blood cell count more than 12,000
/ mm3) or leukopenia (white blood cell count less than
4,000 / mm3).
 Epidemiologi

In 750,000 cases of sepsis and increasing

Immune system disorders
America Patients undergoing high-risk surgery

In 19,32% dari 502 pasien anak yang

dirawat mengalami sepsis dengan
RSCM angka mortalitas sebanyak 54%
 Etiologi

E.coli, S.aureus, Streptokokus grup

Neonates B and L.monositogenes

S.pneumoniae, H.influenzae tipe

Child B, N.meningitis, Salmonella sp.,
S.aureus and Streptokokus grup A.
Faktor Resiko
Manifestasi Klinis
 Diagnosis
The diagnosis of sepsis should be established if the
infectious disease is found toxic states that may include
hypothermia, hyperthermia, tachycardia,
hyperventilation, lethargy, agitation and perfusion
disorders.
 Diagnosis
Pemeriksaan Laboratorium
Biakan darah berulang untuk
mencari kemungkinan
bacteremia,

Biakan dari fokus infeksi

Tes kepekaan kuman

Jumlah leukosit dengan apus

darah tepi, kadar hemoglobin,
jumlah trombosit , urinalisis
tambahan pengukuran

Foto Thorax
 Diagnosis Banding
Infection Non-Infection

Leptospirosis Intoksikasi

Tuberculosis Sindrom Kawasaki

Malaria Syok Anafilaktik

Kriptokokus

Penyakit Lyme dan Rocky

Mountain Spotted Fever
 Pengobatan Sepsis
Infection Control
Ampicillin (200mg / kgBB / day / i.v in 4 doses)
combined with aminoglycosides (5-7mg / kgBB /
day / i.v or 5mg / kgBB / day / i.v or 5 mg / day /
i.v in 5-
Other combinations: ampicillin with cefotaxime
100mg / kgBW / day / i.v in 3 doses.
Metronidazole or clindamycin may be administered
along with other antibiotics for enteric germs:
Gram-Negative.
Improves tissue perfusion through fluid resuscitation,
acid-base correction and administration of
cardiovascular pharmacotherapy such as dopamine
and dobutamine in septic shock.

Maintain the function of respiration efficiently, such

as by giving oxygen and trying to keep the airway
open. In the usual state of lung shock: within 2 days
of the onset of shock, specialist equipment such as the
ventilator is required.

Renal support to prevent acute kidney failure.

 Kortikosteroid
The benefits of corticosteroids in septic shock are still
controversial. The differences in the results of the
study may be due to the uniformity of the terminology
used.
The given corticosteroid may be methyl prednisolone
30 mg / kgBB / dose / i.v or dexamethasone 3 mg /
kgBW / dose / i.v
In some health centers, corticosteroids are given in
septic shock 15-20 minutes after the diagnosis is
established and can be repeated 4 hours later. If no
response is stopped.
 Non-Conventional Drugs
Recently, in keeping with the development of
knowledge about the pathophysiology of sepsis and
septic shock, various drugs such as pentoxifylline,
monoclonal antibody to endotoxin, antibody to certain
mediators such as anti TNF and others have been tried.
 Complications
Disseminated intravascular coagulation (DIC):
DIC is a complication of septic shock. DIC needs to be
suspected if there are peteches and purpura
accompanied by bleeding elsewhere.
Inpatients with early signs of DIC include blood loss
from places where intravenous catheters are installed.
Confirmation of DIC diagnosis is done by examining
platelet levels, fibrinogen concentration, PT, and APTT
Acute respiratory distress syndrome (ARDS):
ARDS results from increased permeability of the
pulmonary vessels causing severe capillary leakage.
Intravascular fluid will enter the pulmonary
parenchyma resulting in pulmonary edema.
The diagnosis of ARDS is confirmed by examination of
the thoracic image where the opaque image is presented
in the majority of both hemithoraks. Another name for
ARDS is shock lung
Acute renal failure:
Complications of acute renal failure occur in 20-25% of
septic patients and in over 50% of patients with septic
shock.
Decreased perfusion to the kidneys is the cause of acute
renal failure
 Prognosis
The mortality rate in patients with sepsis is about 10% depending
on the location of the focus of infection, the pathogen of
infection, the presence of MODS or not, and the host's immune
response to infection.

Patients with low birth weight and chronic illness have a higher
risk for severe sepsis which is one of the leading causes of death in
children.

The mortality rate in septic shock ranges between 40-70% and in

the MODS state increases 90-100%.

The median duration of care for patients with a sepsis diagnosis

was 31 days for children and 53 days for neonates and toddlers
 Prevention
The things that can be done to prevent sepsis in children are
as follows:
Haemophilus inluenzae type B and S. pneumonia
immunization for all infants
Penicillin prophylaxis to prevent pneumococcal infections in
patients with spleen dysfunction (sickle cell disease and
asplenik children)
Antibiotic prophylaxis in patients who are in contact with N.
meningitides invasive or H. influenza type B
Prevention of nosocomial infection in hospitalized patients
Prevention of infection in immunocompromised patients