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This presentation was prepared by me during my placement under medicine department in 2012.

Published in: Health & Medicine
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  1. 1. SepticemiaDr. Mashfiqul HasanResident (Phase A)Endocrinology & metabolism
  2. 2. Terminology to describe septicpatient2
  3. 3. Infection• Invasion of normally sterile host tissue bymicroorganisms3
  4. 4. Bacteremia• Presence of bacteria in blood• Evidenced by positive blood culture4
  5. 5. Septicemia• Presence of microbes or toxins in blood5
  6. 6. SIRS• Two or more of the following conditions:– Fever or hypothermia– Tachypnea– Tachycardia– Leukocytosis or leukopenia or >10% bands• Infectious / Noninfectious6
  7. 7. Sepsis• SIRS with proven or suspected microbialetiology7
  8. 8. Severe sepsis• Sepsis with signs of one or more organ dysfunction– Cardiovascular: hypotension that responds toadministration of IV fluids– Renal– Respiratory– Hematologic– Unexplained metabolic acidosis8
  9. 9. Septic shock• Sepsis with– Hypotension, for at least 1 h, despite adequate fluidresuscitation– Need for vesopressor9
  10. 10. Refractory septic shock• Last for >1 hour• Does not respond to fluid or pressor administration10
  11. 11. MODS• Dysfunction of >1 organ• Requiring intervention to maintain homeostasis11
  12. 12. 12
  13. 13. Inflammatory response to sepsis13
  14. 14. 14
  15. 15. 15
  17. 17. 17
  18. 18. 18
  19. 19. 19
  20. 20. Treatment: Severe Sepsis &Septic Shock
  21. 21. Antimicrobial agents• Without delay• Appropriate• IV• Maximal recommended dose• Local microbial susceptibility 21
  22. 22. Immunocompetent patient• Any of the following– Piperacillin-tazobactam– Imipenem-cilastin or meropenem– Cefepime• If allergic to ß lactam agents– Ciprofloxacin or levofloxacin plus clindamycin• Vancomycin should be added to each ofthe above regimen 22
  23. 23. Neutropenic patient• Imipenem-cilastin or meropenem or cefepime• Piperacillin-tazobactam plus tobramycin• Vancomycin should be added if indicated• Empirical antifungal therapy if hypotensive orhas been receiving broad spectrum antibiotic23
  24. 24. Other special situations• Splenectomy– Cefotaxime or Ceftriaxone– Vancomycin plus either moxifloxacin orlevofloxacin or aztreonam• IV drug user– Vancomycin24
  25. 25. Other special situations: cont• AIDS– Cefepime or peperacillin-tazobactamplus tobramycin– Ciprofloxacin or levofloxacinplus vancomycinplus tobramycin25
  26. 26. Source Control• Evaluation for a focused infection• Abscess drainage or tissue debridement
  27. 27. Management of hypotension• Fluid challenge over 30 min• 500–1000 ml crystalloid• 300–500 ml colloid• Repeat based on response and tolerance27
  28. 28. Management of hypotension• Vasopressor therapy– Titrating dose of norepinephrine or dopamine– Dobutamine if myocardial dysfunction28
  29. 29. Steroid• CIRCI: inadequate corticosteroid activity for theseverity of the illness• Hypotension that does not respond to fluidreplacement therapy• Hydrocortisone, 50 mg IV q6h• If clinical improvement, continue for 5-7 days,slowly taper• Hastens recovery from septic shock• No increase in long term survival29
  30. 30. Activated protein C• Approved by USFDA• Indicated for– Very sick patient (APACHE II)– Low risk of hemorrhage• Complex anti-inflammatory, anti-apoptotic,anticoagulant effect• Trials going on 30
  31. 31. Glucose control– Insulin to lower blood glucose to 100-120mg/dl is potentially harmful– Needed only to maintain blood glucose below150 mg/dl31
  32. 32. Other measures• Nutritional supplementation• Prophylactic heparinization• Erythrocyte transfusion– When Hb <7 g/dl– Target level 9 g/dl32
  33. 33. Other measures: cont…• Bicarbonate• Fresh frozen plasma and platelets• Ventilator support• Hemodialysis or hemofiltration33
  34. 34. Ongoing trials• IV Ig• Endotoxin antagonist (eritoran)• GM CSF34
  35. 35. 35
  36. 36. 36
  37. 37. 37