Septicemia

1. SEPTICEMIA
BY – AKHILESH KUMAR
ROLL NO. - 06
Guided by
Dr . MUKESH RANA Sir
Dr . BRIJESH Sir
Dr . ASIF AKHTAR Sir
Dr . JAVED Sir
Dr . RAJESH Sir

2. • 1.INFECTION - invasion of normally sterile host tissue by microorganisms
• 2.BACTEREMIA - 1. presence of bacteria in blood
2.evidenced by positive blood culture
• 3.SEPTICEMIA – presence of microbes or toxins in blood .
• Yet sepsis arose in response to many pathogens , and septicaemia was neither a
necessary condition nor a helpful term
• 4. SIRS ( SYSTEMIC INFLAMMATORY RESPONSE SYNDROME)
WHICH ENTAILS TWO OF – a. TEMPERATURE OVER 38⁰C OR UNDER 36⁰C
b. pulse rate >90 beats/minute
c. RR >20 BREATHS/MINUTE OR PCO₂ < 4.3kPa (32.5 mmHg)
d. WBC >12 or 4 × 109 /L
• 5.SEPSIS – sepsis is a dysregulated host response to infection that leads to acute organ
dysfunction
• 6. SEPTIC SHOCK - SEPSIS + HYPOTENSION ( SBP < 90 mmHg or a fall of more than 40
mmHg from baseline that is not responsive to fluid challenge or due to another cause)

3. CRITERIA IN 2016 FOR SEPSIS AND SEPTIC SHOCK
sepsis Septic shock
Suspected (or documented)
infection and an acute
increase in >2sepsis related
organ failure assessment (
SOFA) points
Suspected or documented
infection + vasopressor
therapy needed to maintain
MAP at >65 mmHg and serum
lactate >2.0 mmol/L despite
adequate fluid resuscitation

4. CAUSES OF SEPSIS
• Sepsis largely results from host response to microbial
lipopolysaccharide , peptidoglycans , lipoproteins or superantigens
• It may be community acquired and hospital acquired infection
BACTERIAL FUNGAL PARASITIC
Staph. Aureus Candida spp. Falciparum malaria
Coagulase negative staphylococci Histoplasma capsulatum Babesia microti
Streptococcus pneumoniae Other dimorphic fungi Strongyloides stercoralis
Neisseria meningitidis Hyperinfection syndrome
E.coli , other gram negative
bacteria
C. difficile
Mycobacterium tuberculosis
Etc.

5. PATHOGENESIS
• The specific reaction of each patient depends on pathogen ( load and
virulence ) and host (genetic composition and comorbidity)
Pro-inflammatory
reactions cause
tissue damage
Anti-inflammatory
reactions
Enhanced
susceptibility for
secondary infection
sepsis

7. • Septicemia is a potentially life threatening infection in which large
amount of bacteria are present in the blood . It is commonly referred to
as blood poisoning ………..
• It may be due to a primary infection (e.g. pneumonia) or it may be the result of clinical
interventions for other conditions (e.g. immunosuppressive drugs , chemotherapy ,
invasive lines)
people who are most susceptible are
1. very young , older people
2. weakened immune system(HIV , cancer , cancer therapy)
3. chronic illness – diabetes , lung disease and kidney disease
4. recent surgery and transplant
5. severe burns or other physical trauma
6. INVASIVE LINES : INTRAVENOUS OR ARTERIAL , NASOGASTRIC TUBES

8. CLINICAL FEATURE
Early signs of sepsis include
• Fever , shivering , or feeling cold
• Fast heart rate
• FAST BREATHING AND SHORTNESS OF BREATH
• SWEATY OR CLAMMY SKIN
• CHANGES IN MENTAL STATE , FEELING SLEEPY , CONFUSED , OR LOSING
INTEREST

10. IF MEDICAL ATTENTION IS NOT ACCESSED AT
ONCE , SEPTICK SHOCK MAY OCCUR
SYMPTOMS ARE
a. FEELING DIZZY OR FAINT
b. BEING CONFUSED OR LOSING ALERTNESS
c. UNUSUAL MENTAL CHANGES , INCLUDING A FEELING OF DOOM OR A FEAR OF DEATH
d. SLURRIED SPEECH
e. DIARRHEA , NAUSEA, OR VOMITING
f. SEVERE MUSCLE PAIN AND EXTREME OVERALL DISCOMFORT
g. DIFFICULTY BREATHING
h. PASSING VERY LITTLE URINE
i. COLD CLAMMY AND PALE OR MOTTLED SKIN
j. COLD AND PALE R UNUSUALLYWARM EXTREMITIES
k. LOSS OF CONSCIOUSNESS

11. DIAGNOSIS
• LABORATORY AND PHYSIOLOGICAL FINDINGS
tachycardia (heart rate > 90 beats/min.)
tachypnea ( RR >20 breaths / min.)
hypotension (SBP < 100 mmHg)
hypoxia
leucocytosis ( WBC count > 12,000 / ꙡL)
leukopenia ( WBC count <4000 / ꙡL)
many features of acute organ dysfunction such as
platelet count
total bilirubin or serum lactate
hypoalbuminemia
troponin elevation
hypoglycaemia
hypofibrinogenemia

12. Diagnostic criteria
• Once infection is suspected clinicians consider SOFA score for organ dysfunction
SOFA score - widely studied in the ICU among patients with infection , sepsis,
shock
range from 0 to 24
Because SOFA score requires multiple laboratory tests and may be costly to
measure repeatedly the quick SOFA score is proposed
Quick SOFA score - for outside the ICU patients , ward , and emergency
department
range from o to 3
> 2 indicate sepsis

13. SOFAvariables
SBP
SERUM CREATININE
Pa0₂
platelets
Glasgow coma scale
bilirubin
Mechanical
ventilation
Vasopressor present
/absent
Vasopressors
>1
SIRSvariables
Heart rate
RR
temperature
WBC

14. ELEMENTS OF CARE IN SEPSIS AND SEPTIC
SHOCK (international consensus guidelines)
• -- RESUSCITATION INFECTIVE CONTROL RESPIRATORY SUPPORT
Iv crystalloid (30 ml/ kg) Microbiologic culture before
antibiotics
Target tidal volume 6ml/kg
Haemodynamic assessments Iv antibiotics within 1 hr In severe sepsis prone
position is recommended
Norepinephrine (DOC) for
vasopressor
Narrowed once pathogen
identified
Conservative fluid strategy in
sepsis induced ARDS
Dobutamine in persistent
hypoperfusion
Routine use of pulmonary
artery catheter not
recommended
RBC transfusion if Hb
concentration <7.0 gm/dl
Spontaneous breathing trials

15. EMPIRICAL THERAPY
• SEPSIS WITHOUT A CLEAR FOCUS
1. SEPTIC SHOCK - vancomycin (15 mg/kg )+ gentamicin( 5 mg/kg /day) either
piperacillin / tazobactem or cefepime
2. Post splenectomy sepsis - ceftriaxone + vancomycin
3. Babesiosis - clindamycin + quinine
 Sepsis with skin findings
1. Meningococcemia – penicillin (4 mU q4h) or ceftriaxone (2 g q12h)
2. RMSF – doxycycline 100 mg bid
3. Erythroderma :toxic shock syndrome – vancomycin (15 mg/kg) + clindamycin
(600 mg q8h)

16. • Sepsis with soft tissue findings
1.Necrotizing fasciitis – vancomycin (15mg/kg) + clindamycin (600 mg q8h) +
gentamicin (5 mg/kg/day)
2.Clostridial mynecrosis – penicillin (2 mU q4h) + clindamycin (600mg q8h)
 Neurologic infection
1. Bacterial meningitis – ceftriaxone (2 g q12h) + vancomycin (15 mg/kg q12h)
2. Brain abscess – vancomycin (15 mg/kg q12h) + metronidazole (500 mg q8h) +
ceftriaxone (2g q12h)
3. Cerebral malaria – artesunate (2.4 mg/kg iv at 0 , 12, and 24 h : then once
daily) or quinine (Iv 20 mg salt/kg then 10 mg/kg q8h)
4. Spinal epidural abscess – vancomycin (15 mg/kg q12h) +
piperacillin/tazobactem or cefepime
 Acute bacterial endocarditis – (ceftriaxone 2 g q12h) + vancomycin (15 mg/kg
q12h)