Pathophysiology and Treatment of Sepsis

Question 1

What is the definition of sepsis?

Answer 1

life-threatening organ dysfunction caused by a dysregulated host response to infection

Question 2

What is the definition of septic shock?

Answer 2

a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone

Question 3

What types of individuals are more at risk of sepsis?

Answer 3

• very young and elderly
• those with impaired immune system (HIV/chemo/infection)
• pregnancy/recent birth
• recent invasive procedures
• IV drug abusers

Question 4

What factors affect the level of infection of sepsis?

Answer 4

• virulence of the pathogen
• bioburden (how much of bug is there)
• portal of entry
• host susceptibility
• temporal evolution (when it is caught)

Question 5

Host innate responses to sepsis

Answer 5

• first line of defence
• comprises of many immune molecules such as TLRs, LPS, and NLRs
• can initiate the production of inflammatory molecules such as ILs, TNFa and ROS

Question 6

Outcomes of the immune and inflammatory pathways of sepsis

Answer 6

Increased:

• intravascular coagulation: good only if controlled, as it clots blood and plugs the hole caused by damage
• blood glucose levels: little bit is good
• dysoxia: ROS react with other molecules causing fever, reduced blood flow and can cause organ failure

Decreased:

• fibrinolysis: good, prevents uncontrolled clotting maintaining balance
• circulatory control: losing control over blood vessels
• endothelial integrity: breaks causing blood that cannot be contained anymore which helps bugs travel

Question 7

Effect of TNFa and IL1 on the body (inflammatory markers)

Answer 7

Acute phase response:

• fever
• hypotension
• increased HR
• corticosteroid and ACTH release
• release of neutrophils

Question 8

Effect of TNFa and IL1 on the CVS

Answer 8

• generalised vasodilation (NO)
• increased vascular permeability
• intravascular fluid loss
• myocardial depression due to decreased perfusion
• circulatory shock

Question 9

When should you screen a patient for sepsis?

Answer 9

if they have a NEWS score of 3 or more

Question 10

Describe the sepsis 6

Answer 10

BUFALO

• take blood cultures
• urine output: take hourly measures
• fluid resuscitation: if hypotensive
• give broad spectrum antibiotics
• serum Hb and lactate measured
• high flow oxygen administered

Question 11

What are the key questions to ask yourself as a clinician when prescribing for sepsis?

Answer 11

• wheres the infection?
• whats the likely microorganism?
• what effect is it having on the organs?

Question 12

What things need to be considered depending on the location of the infection?

Answer 12

• respiratory: pseudomonas and MRSA
• urine: gram negative bacteria and pseudomonas
• abdo: gram positive/negative bacteria and anaerobes
• soft tissue/joint: gram positive/negative bacteria and anaerobes
• CNS: meningitis

Question 13

What is the firstline treatment for sepsis?

Answer 13

• amoxicillin

- gentamicin

Question 14

What treatment is given for severe sepsis/MRSA suspected?

Answer 14

• piperacillin-tazobactam

- vancomycin

Question 15

What treatment is given for sepsis for patient’s with a penicillin allergy?

Answer 15

• vancomycin
• ciprofloxacin
• metronidazole

Question 16

How can you check that the anti-microbial therapy is working against sepsis?

Answer 16

• frequent observations

- repeat cultures

Question 17

What are the short term complications of sepsis?

Answer 17

• organ dysfunction

- coagulation disorders

Question 18

What are the long term complications of sepsis?

Answer 18

• neurological dysfunction

- increased mortality rate for a year minimum