Response to foreign body Inflammatory reaction –Localized –Generalized Generalized inflammatory reaction –Infective –Noninfective Sepsis: Generalized inflammatory, having systemic signs

Systemic Inflammatory Response Syndrome (SIRS) Patient presents with two or more of the following criteria. –temperature > 38°C or 38°C or < 36°C –heart rate > 90 beats/minute –respiration > 20/min or PaCO2 20/min or PaCO2 < 32mm Hg –leukocyte count > 12,000/mm3, 10% immature (band) cells

Definition Sepsis: SIRS plus a documented infection site (documented by positive culture for organisms from that site). Blood cultures do NOT need to be positive. While SIRS, sepsis, and septic shock are associated commonly with bacterial infection, bacteremia may not be present. Septic Shock: Sepsis-induced hypotension despite fluid resuscitation PLUS hypoperfusion abnormalities

The infection site helps in determining the most likely cause of a patient's sepsis Suspected Source of Sepsis LungAbdomen Skin/Soft Tissue Urinary Tract CNS Major Community Acquired Pathogens Streptococcus pneumoniae Haemophilus influenzae Legionella sp. Chlamydia pneumoniae Escherichia coli Bacteroides fragilis Streptococcus pyogenes Staphylococcus aureus Clostridium sp. Polymicrobial infections Aerobic gram negative bacilli Pseudomonas aeruginosa Anaerobes Staphylococcus sp. Escherichia coli Klebsiella sp. Enterobacter sp. Proteus sp. Streptococcus pneumoniae Neiserria meningitidis Listeria monocytogenes Escherichia coli Haemophilus influenzae Major Nosocomial pathogens Aerobic gram negative bacilli Aerobic gram negative bacilli Anaerobes Candida sp. Staphylococcus aureus Aerobic gram negative bacilli Aerobic gram negative bacilli Enterococcus sp. Pseudomonas aeruginosa Escherichia coli Klebsiella sp. Staphylococcus sp.

Mechanism

Organ Dysfunctions associated with Severe Sepsis and Septic Shock: Lungs Lungs: early fall in arterial PO2, capillary-leakage into alveoli; tachypnea, hyperpnea (ARDS). Kidneys Kidneys :(acute renal failure): oliguria, anuria, azotemia, proteinuria Liver Liver: elevated levels of serum bilirubin, alkaline phosphatase,cholestatic jaundice Heart Heart: cardiac output is initially normal or elevated, Brain Brain : confusion

Organ Dysfunctions contd: Digestive tract: nausea, vomiting, diarrhea and ileus Skin: ecthyma gangrenosum (think Pseudomonas aeruginosa in neutropenic patients), ecthyma gangrenosumecthyma gangrenosum Petechia or purpura: (think Neisseria meningitidis or Rickettsia rickettsia: (if evidence of tick bite)), Hemorrhage or bullous lesions Toxic Shock Syndrome: Staphylococcus aureus or Streptococcus pyogenes

Adult respiratory distress syndrome (ARDS) Disseminated Intravascular Coagulation (DIC) Acute Renal failure (ARF) Intestinal bleeding Liver failure Central Nervous system dysfunction Heart failure Death Complications:

When to suspect Fever or unexplained signs with malignancy or instrumentation Hypotension Oliguria or anuria Tachypnea or hyperpnea Hypothermia without obvious cause Bleeding High fever and bounding pulse, rigor, purpuric rash, tachypnoea

THERAPY Immediate Stabilization of the Patient. The blood must be rapidly cleared of microorganisms The original focus of infection must be treated.