2. History
• Infection has always been a major complication related to
surgery.
• Both Egyptians and Greeks independently described
about the knowledge of infection.
• The Hippocratic teachings described the use of wine and
vinegar to irrigate open or infected wound.
• A belief common to all civilizations was that whenever
pus is localized it needs to be drained.
3. • Hungarian obstetrician Ignaz Semmelweiss
was the first to introduce the importance of
antisepsis in Vienna in early 1850.
• He drastically reduced the mortality rate by
introducing hand sanitization during child
birth process.
• But medical community rejected his claims
and accused him for high mortality rate.
• He was admitted to an insane asylum at 47
years age and he died two weeks later.
4. Koch’s postulate
• A specific organism can always be
found in association with a given
disease.
• The organism can be isolated and
grown in pure culture in the laboratory.
• Pure culture will produce the disease
when inoculated in susceptible animal.
• It is possible to recover the organism in
pure culture in experimental animal.
CONT…
5. Professor Sir Alexander Fleming
a Scottish-born microbiologist
discovered first antibiotic
Penicillin in 1928
Penicillium notatum, the
source of penicillin, the
first antibiotic
CONT…
6. • Bacteramia: Presence of bacteria in blood which is
evident by positive blood culture.
• Septicaemia: Bacteramia with presence of sign &
symptom (of bacterial proliferation & toxin) is called
septicaemia.
• Systemic inflammatory response syndrome (SIRS) is a
systemic manifestation sepsis which may also be
caused by trauma, burn or pancreatitis.
7. • Sepsis: SIRS with documented infection is called
sepsis.
• Severe sepsis or sepsis syndrome is sepsis with
evidence of failure of one or more organs: respiratory
(acute respiratory distress syndrome), cardiovascular
(septic shock follows compromise of cardiac function
and fall in peripheral vascular resistance), renal
(usually acute tubular necrosis), hepatic, blood
coagulation systems or central nervous system
8. • Multiple organ dysfunction syndrome (MODS): when
sepsis causes two or more organ dysfunction it is
called MODS.
• Multiple system organ failure (MSOF): it is the end
stage of uncontrolled MODS.
9. Systemic inflammatory response
syndrome (SIRS)
Presence of two out of three of the following:
• Hyperthermia (>38°C) or hypothermia (<36°C)
• Tachycardia (>90/min, no β-blockers) or tachypnoea
(>20/min)
• White cell count >12 × 109/LITRE or <4 × 109/litre
10. • The Sepsis Six is the name given to a bundle
of medical therapies designed to reduce
mortality in patients with sepsis. Drawn from
international guidelines that emerged from the
Surviving Sepsis Campaign, the Sepsis Six
was developed by the UK’s Sepsis Trust. The
components of the
11. Sepsis Six are:
Give three to patients:
(1)Intravenous fluid
challenge,
(2)Intravenous antibiotics,
(3)Oxygen and monitor
urine output
Take three from patients:
(4) blood cultures,
(5) full blood count,
(6) lactate.
12. Cause
From any sorts of septic foci when microorganism
enters into blood stream and causes systemic
manifestation.
Microorganism- almost any germ can cause septicaemia
but most commonly
Staphyllococcus aureus
Strepcoccus neumoniae
E coli
13. Sepsis if not treated promptly may cause
septic shock and MODS
15. Diagnosis
• Blood culture (confirmatory)
Others
• Complete blood count
• C reactive protein
• Specific organ function test for detection of MODS (s
creatinine, FDP, D dimer, CXR etc)
16. Management
• According to European Society of Intensive Care
Medicine (ESICM) and Society of Critical Care
Medicine (SCCM) start sepsis bundle (sepsis six)
within 6 hours for patient presenting with
• Severe sepsis
• Septic shock
• S lactate > 4mmol/L
17. Last but not the least
• Removal of source of infection either by drainage or
by debridement is the main concern
• Prevention of infection by prophylactic use of
antibiotics
• If organ failure develops treat accordingly.
18. Antibiotic prophylaxis
• Not required in clean surgery unless a prosthesis is implanted
• Use antibiotics that are effective against expected pathogens
• Plan for single-shot intravenous administration at induction of
anaesthesia
• Repeat only during long operations or if there is excessive
blood loss
• Patients with heart valve disease or a prosthesis should be
protected from bacteraemia
