discussing septicemia regarding site of infection and antibiotic therapy.

1. Septicemia And Septic ShockSepticemia And Septic Shock
OverviewOverview
Almataria Teaching Hospital, Nasser InstituteAlmataria Teaching Hospital, Nasser Institute
Cairo, EgyptCairo, Egypt
Dr. Mamdouh SabryDr. Mamdouh Sabry
MD. Ain Shams, PhD. FranceMD. Ain Shams, PhD. France
Consultant Ob. & Gyn.Consultant Ob. & Gyn.

2. 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.

3. 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.

4. 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
2015.
• Increased sepsis is a consequence of
advancing age, immunosuppression,
multidrug-resistant infection and awareness.

5. 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.

6. 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%.

7. 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.

8. 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

9. CLINICAL MANIFESTATIONS
- S/S related to site or source of infection.
- Temperature <38,3 or >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.

10. 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.

11. 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…

12. 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.

13. 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

14. Thank You
Best Wishes