M.Sc.

Microbiology Project
Bacteraemia - presence of bacteria in the blood, eg following dental procedures. If there is only a trivial amount then it is usually handled by a competent immune system with no systemic effects. However, if the patient has damaged heart valves they are at risk of infective endocarditis. A greater amount of bacteria can cause systemic signs and symptoms with a number of sequelae. For example, spontaneous resolution, development of focal infection, eg pneumonia or abscess formation with or without sepsis, or sepsis with no obvious focal infection. Septicaemia - there is presence of numerous bacteria in the blood, which are actively dividing. This results in a systemic response leading to organ dysfunction. Septicaemia is a serious illness and often fatal. It can be complicated by circulatory collapse, myocardial depression, increased metabolic rate and vasoregulatory perfusion abnormalities. Thus it must not be viewed as simply being an infection alone. The Surviving Sepsis Campaign (SSC) was established in the last decade to raise awareness of severe sepsis and to improve its management The Surviving Sepsis Campaign is a collaboration between several groups worldwide and its aim is to reduce the mortality from sepsis. The SSC defines sepsis as a disease continuum with 3 groups:

Systemic inflammatory response syndrome (SIRS): In adults this is a clinical response arising from a nonspecific insult, including 2 or more of the following: o Temperature (>38C or <36C). o Heart rate >90 beats per minute (bpm). o Respiratory rate >20 per minute or PCO2 <32 mm Hg. 9 9 o White cell count greater than 12 x 10 cells/L or less than 4 x 10 cells/L or >10% immature neutrophils. Sepsis: SIRS as above with presumed or confirmed infectious process. Severe sepsis: sepsis with one or more signs of organ dysfunction, hypoperfusion or hypotension (eg septic shock or respiratory failure).

Pathophysiology of sepsis
Sepsis involves a number of derangements; the following are a few:

Abnormal coagulation. Endothelial injury. Presence of excessive tumour necrosis factor. Cell apoptosis, eg lymphocytes and endothelial cells. Neutrophil hyperactivity. Poor glycaemic control. Lack of steroid hormones.