You are on page 1of 30

Sepsis

Andree Kurniawan
Learning objectives

• To name what are the causes and risks of sepsis


• To discuss the signs and symptoms of the sepsis
• To appreciate the importance of early diagnosis of sepsis.
• To discuss the pathogenesis and management of sepsis
Vignette
Definition

• SIRS
• Sepsis  the presence (probable or documented) of infection
together with systemic manifestations of infection
• Severe sepsis  Sepsis + sepsis-induced organ dysfunction or
tissue hypo-perfusion
• Sepsis shock  Sepsis + shock
Causes

• Bacteria
– Gram negative
– Gram positive
• Fungal
• Virus
Risk

• Elderly population
• Child
• Neutropenia
• Immunocompromised (primary or secondary) patients
• Blood stream infections
• Chronic illness (diabetes, CKD, liver cirrhosis, cancer patients)
Signs and Symptoms

• Documented infections (pneumonia, UTI, abscess, blood stream)


• SIRS (pulse, RR, temp, white blood cell)

• Signs organ dysfunction


– Liver, kidney, hemodynamic, lung, coagulation, CNS
International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–6.
Pathogenesis Sepsis
Diagnosis

International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–6.


Diagnosis (2)

International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–6.


Diagnosis (3)
Diagnosis (4)

• Cultures as clinically appropriate before antimicrobial


therapy if no significant delay (> 45 min) in the start of
antimicrobial(s) (grade 1C).
– At least 2 sets of blood cultures (both aerobic and anaerobic
bottles) be obtained before antimicrobial therapy with at least 1
drawn percutaneously and 1 drawn through each vascular access
device, unless the device was recently (<48 hrs) inserted (grade
1C).
• Use of the 1,3 beta-D-glucan assay (grade 2B), mannan and
anti-mannan antibody assays (2C), if available and invasive
candidiasis is in differential diagnosis of cause of infection.
• Imaging studies performed promptly to confirm a potential
source of infection (UG).
Treatment

• Initial resuscitation (fluid therapy)


• Antimicrobial therapy
• Source control
• Prevention nosocomial infections
Initial resuscitation (fluid therapy)
Septic shock
EGDT

N Engl J Med 2001;345:1368-77


Empirical antimicrobial therapy

• Depend on
– Patient’s history,
– drug intolerances,
– recent antibiotic last 3 months,
– underlying disease, clinical syndrome,
– susceptibility patterns of pathogens,
– previous documented colonize or infection
• Virulence and growing resistant bacteria
• Empirical antifungal therapy (echinocandin, triazoles or
amphotericin B) candida score
Candida score
Supportive therapy

• Target hemoglobin 7.0 to 9.0 g/dl in adults


• Not using erythropoietin
• FFP not be used to correct laboratory clotting abnormalities in
absence of bleeding or planned procedures
• Not use anti-thrombin
• Not use IVIG
• Platelet transfusion
– <10.000 in absence apparent bleeding
– <20.000 had significant risk of bleeding
– Target 50.000  active bleeding, surgery, invasive
procedures
Supportive therapy (2)

• Glucose control 110-180 mg/dl (insulin preferred)


• Renal replacement therapy
• Not use bicarbonate if pH >7.15
• DVT prophylaxis (LMWH or graduated compression stockings)
• Stress ulcer prophylaxis (H2 blocker of PPI)
• Nutrition (oral enteral, low dose feeding)
Howell MD. JAMA Published online January 19, 2017
Conclusion
References
Thank You

You might also like