1. Sepsis Douglas Stahura D.O. Grandview Hospital March 21, 2001

2. Definitions Infection – microbial phenomenon characterized by inflammatory response to the presence of micro- organisms or the invasion of normally sterile host tissue Bacteremia – presence of viable bacteria in the blood

3. Definitions SIRS – Systemic inflammatory response to a variety of severe clinical insults, including infection, pancreatitis, ischemia, multiple trauma and tissue injury, hemorrhagic shock, immune- mediated organ injury, and exogenous administration of inflammatory mediators such as tumor necrosis factor and other cytokines

4. Definitions Sepsis – Systemic response to infection. This response is identical to SIRS, except that it must result from infection

5. Definitions Septic shock – Sepsis with hypotension (SBP<90 mm Hg or a reduction of 40mm Hg from baseline) despite adequate fluid resuscitation, in conjunction with organ dysfunction and perfusion abnormalities

7. SIRS Criteria 2 or more must be present –Temp >38 or < 36 –Heart Rate >90 bpm –Resp Rate > 20 bpm or PaCO2 < 32 mm Hg –WBC’s >12,000 or 10% bands

11. Clinical Considerations Diagnosis of sepsis considered when patient meets numerical criteria for SIRS Thorough H+P may reveal clues to the source of sepsis Sepsis caused by GN organisms is hemodynamically indistinguishable from sepsis caused by GP organisms

13. Clinical Considerations Multiple cultures from multiple sites Blood Cultures –Drawn from two different sites –Set= aerobic and anaerobic bottle –Each bottles requires 7-10 ml Candida –Isolation from sputum, urine, stool is not necessarily synonymous with infection –Isolation from blood always significant

15. Clinical Considerations Antibiotics are the cornerstone of tx Supportive care is essential –Fluids –Pressors –Ventilation –Nutrition –Monitoring – PA line, Lytes

16. Summary Appreciate the mortality associated with sepsis Appreciate the Pathophysiology and complexity of the bodies immune system in fighting infection Review clinical considerations in diagnosis and treatment of septic patient

17. References