SEPSIS

Prof. Dr. dr. Djoni Djunaedi, SpPD, KPTI

Etiology
Microorganism and condition that may predispose to infection
Microorganism

Condition

Gram-negative bacteria:

Diabetes mellitus
Lymphoproliferative diseases
Cirrhosis of the lever
Burns
Invassive procedures or devices
Neutropenia
Indwelling urinary catheter
Diverticulitis, perforated viscus

Enterobacteriaceae, pseudomonads, Haemophillus spp.,

other gram-negative bacteria

Gram-positive bacteria:
Staphylococcus aureus, coagulase-negative
staphylococcus, enterococci, Streptococcus pneumoniae,
other streptococci, other gram-positive bacteria

Fungi
Polymicrobial
Classic pathogens:
Neisseria meningitidis, S. pneumoniae, H. influenzae,
Streptococcus pyogenes

Intravascular catheter
Indwelling mechanical devices
Burns
Neutropenia
Intravenous drug use
Infection with superantigen-producing S. pyogenes
Neutropenia
Broad-spectrum antimicrobial therapy

Epidemiology

Incidence of sepsis and septic shock over the past 20 years

Annual number of cases: > 300.000

2/3 of cases occur in pts hospitalized for other illnesses

The increasing incidence of severe sepsis is attributable to:

The aging of the population

The increasing longevity of pts with chronic diseases

The relatively high frequency with which sepsis develops in pts with AIDS

The wide spread use of antimicrobial agents, glucocorticoids, indwelling

catheter and mechanical devices and mechanical ventilation

Peran neutrofil pada sepsis

Pisau bermata dua
Eradikasi mikroba patogen
Sekresi protease dan oksidan

Merusak organ
(e.g. ARDS)

Temuan penelitian:
G-CSF

produksi nuetrofil

survival

Upaya menekan / menstimulasi neutrofil: hasil tak memuaskan

(Hotchkiss, 2003)

Otopsi

Limfosit, epitel sel usus: menghilang (apoptosis)

Sel imun adaptif turun secara progresif dan dalam

jumlah besar

Penyebab kematian (gagal organ), secara

histologis: tidak sesuai

?
cell hibernation
(cell stunning)

Potential therapies for sepsis

IL-12 (TH-1 inducer)

Ab terhdap aktivasi komplemen C 5a

Bakteri

Apoptosis

Survival

Ab terhadap MMIF peritonitis

Inhibisi produk mikroba toll like receptor (TLR)

PARP - inhibotor

Kesimpulan

Terjadi pergeseran besar dalam sikap peneliti mengenai

masalah sepsis

Sepsis tidak sekedar immune system gone haywire

melainkan kemungkinan severely compromised immune
system (mikroba patogen )

Hasil otopsi menunjukkan focal necrosis

Evidence-based recommendation: initial resuscitation

stress ulcer prophylaxis

Future therapy: enhance / inhibit the patients immune

response, depending on genetic polymorphisms, duration of
disease, characteristic of particular pathogen