Septicemia And Septic Shock Overview Almataria Teaching Hospital, Nasser Institute Cairo, Egypt Dr. Mamdouh Sabry MD. Ain Shams, PhD. France Consultant Ob. & Gyn.

The Value Of Sepsis Understanding A leading condition of morbidity and mortality. Holds increased mortality rate, ( 30 – 50% ) in sepsis and ( 50 – 60% ) in septic shock. Risk factors are increasing with time due to increase in ICU admissions, bacteremia following surgery, in cancer patients in age extreme, immunosuppressed patients, immunosuppression, misuse of antibiotics and advanced age.

The Third international Consensus 2016 Definition for Sepsis ( Sepsis 3 ) SEPSIS Is a life threatening condition with organ dysfunction which is caused by dysregulated host response to infection. SEPTIC SHOCK A subset of sepsis, in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.

EPIDEMOLOGY The rate of sepsis and septic shock increased from 13 to 78 cases per 100,000 between 1998 and 2009 The global incidence of 437 per 100,000 person-years for sepsis between 1995 and Increased sepsis is a consequence of advancing age, immunosuppression, multidrug-resistant infection and awareness.

Epidemiology, cont. Circulatory failure, acute RDS, acute renal failure and DIC are the presentations of severe organ dysfunction. In the U.K. sepsis is considered the commonest direct cause of death more than VTE.

Site Of Infection Respiratory tract 44.4 – 60%. Abdomen 26%. Urinary system 12 – 21%. Blood stream 20%. Skin 14%. Indefinite source of infection 20-30%.

ORGANISMS Gram positive mainly, st aureus, coagulase –ve staph, enterococci, streptococci and MRSA. Gram negative second, E coli, kleb. pneumoniae and pseudomonas aeruginosa. Fungal sepsis, mainly candida albicans. Some viral infections. Culture –ve in considerable percentage of patients.

Sequential (sepsis-related) Organ Failure Assessment ( SOFA ) Based upon measurement of organ function & Determine individual treatment and outcome -Respiratory system -Cardiovascular system -Hepatic system -Coagulation system -Neurologic system -Renal system

CLINICAL MANIFESTATIONS -S/S related to site or source of infection. -Temperature 36 degree. -Arterial hypotension [ MAP >70mm Hg ]… -Heart rate <90/minute or more. -Tachypnea, respiratory rate <20/minute. -Skin, mental state….. -Younger pts go into sudden decompensation after persistence for some time.

Laboratory Findings Nonspecific, may be due to underlying cause, helpful in follow up. CBC, CRP, INR, ALT, AST…….. Creatinine, bilirubin, urine, blood gases,.. Plasma procalcitonin. Lactate elevation holds poor prognosis, serum level < 4 mmol/L is consistent with, but not diagnostic of, septic shock.

Management Of Sepsis Diagnosis, clinical and laboratory, bedside, or retrospective after ttt and lab results. Team work, emergency room or ICU. Antibiotic therapy, as soon as possible. Fluid therapy Vasopressors Corticosteroids Blood products Blood sugar control….??? Surgery…

ANTIBIOTIC THERAPY Culture first, gram stain, timing of adm., shifting after culture and duration of therapy. Broad spectrum combinations, not from same family, MRSA, may add antifungal. Imipenem, meropenem, vancomycin, linezolid daptomycin, ceftaroline, ampicillin/sulbactam, piperacillin/tazobactam, cefepime, cefoxitin, ceftazidime, cefoperazone/sulbactam, tigacycline, or (clindamycin or metronidazol) plus aztreonam, levofloxacin or aminoglycoside.

conclusion Sepsis is an emergency state with higher morbidity and mortality, even in best prepared centers. Early diagnosis and ttt holds better outcome. Prevention and prediction of risky patients is much better. A teamwork is needed from admission up to ICU with a specific emergency code

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