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Sepsis and bacteremia
- 1. Bacteremia And Sepsis Under Observation: Sp. Jami By: Dr. Somaya Banaei January 20 20
- 2. Bacteremia Bacteremia is the presence of bacteria in the bloodstream. It can occur spontaneously, during certain tissue infections, with use of indwelling GU or IV catheters, or after dental, GI, GU, wound-care, or other procedures
- 3. Bacteremia Bacteremia may cause METASTATIC INFECTIONS including endocarditis, especially in patients with valvular heart abnormalities. Transient bacteremia is often asymptomatic but may cause fever.
- 4. Bacteremia has many possible causes Catheterization of an infected lower urinary tract Surgical treatment of an abscess or infected wound Colonization of indwelling devices, especially IV and intra cardiac catheters, urethral catheters, and ostomy devices and tubes
- 5. Suggests Sepsis Or Septic Shock.
- 6. Septic Shock Develops In 25 To 40% Of Patients With Significant Bacteremia. Sustained Bacteremia May Cause Metastatic Focal Infection Or Sepsis.
- 7. Development of Bacteremia symptoms usually suggests more serious infection, such as sepsis or septic shock
- 8. Bacteremia vs Septicemia Septicemia is a serious bloodstream infection. It’s also known as blood poisoning. Septicemia occurs when a bacterial infection elsewhere in the body, such as the lungs or skin, enters the bloodstream.
- 9. Sepsis Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. Septicemia Can Progress To Sepsis and Sepsis Is A Serious Complication Of Septicemia.
- 12. Sepsis Is One Of Top Killers In U.S. Hospital And World Wide
- 13. Sepsis Is One Of Top Killers In U.S. Hospital And World Wide
- 14. Etiology Hospital-acquired Gram- Bacilli Or Gram+ Cocci Rarely, It Is Caused By Candida Or Other Fungi Immunocompromised Patients Patients With Chronic And Debilitating Diseases. A SSI Should Be Suspected As The Cause Of Sepsis And Septic Shock In Patients Who Have Recently Had Surgery
- 17. Fever Oliguria Tachycardia Hyperglycemia Leukocytosis Vasodilatation High cardiac out put Sings includes
- 20. Risk Factors
- 21. • Diabetes mellitus • Cirrhosis • Leukopenia • Invasive devices • Prior treatment with antibiotics or corticosteroids Common causative sites of infection include the Lungs , The Urinary, Biliary, And GI Tracts. Predisposing factors include
- 22. Inflammatory Stimulus Proinflammatory Mediators TNF And IL-1 Neutrophil– endothelial Cell Adhesion Activate The Clotting Mechanism Generate Microthrombi Other Mediators Pathophysiology Negative Feedback Mechanism
- 23. Diagnosis Clinical manifestations BP, heart rate, and oxygen monitoring CBC with differential, electrolyte panel and creatinine, lactate CVP, PaO2, and ScvO2 readings Cultures of blood, urine, and other potential sites of infection, including wounds in surgical patients
- 24. S O F A The Sequential Organ Failure Assessment (SOFA) Score criteria identify patients who should have further clinical and laboratory investigation (all 3 criteria must be present): Respiratory rate ≥ 22/min Altered mentation Systolic BP ≤ 100 mm Hg
- 25. Perfusion restored with IV fluids and sometimes vasopressors Oxygen support Broad-spectrum antibiotics Source control Sometimes other supportive measures (eg, corticosteroids, insulin) Treatment
- 26. Patients with septic shock should be treated in an ICU. The following should be monitored hourly: CVP, PaO2 , or ScvO2 Pulse oximetry Blood glucose, lactate, and electrolyte levels Renal function Treatment
- 27. Perfusion Restoration ISOTONIC CRYSTALLOID (0.9% SALINE) ALBUMIN 1 L of crystalloid is given rapidly. Most patients require a minimum of 30 mL/kg in the first 4 to 6 h. However, the goal of therapy is not to administer a specific volume of fluid but to achieve tissue reperfusion without causing pulmonary edema due to fluid overload.
- 28. Antibiotics Suspected Sources Antibiograms Broad-spectrum Gram + And Gram - Bacterial Empiric Antifungal Drug In Immunocompromised Patients
- 29. Gram Positive
- 30. Gram Negative
- 32. IV And Urinary Catheters Endotracheal Tubes Abscesses Necrotic And Devitalized Tissues Source control