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Sepsis and SSTIs
Fichas del conjunto (23)
- 1Define sepsis and septic shockSIRS + documented site (positive cultures for organisms)
Blood culture do not need to be +
Septic shock;
Sepsis induced hypotension despite fluid resuscitation + hypoperfusion abnormalities
Mortality increase with increase number of SIRS symptoms and severity of disease, complications include: Disseminated intravascular coagulation, cardiac failure, death - 2causes and risk factors for sepsisrisk factors:
Diabetes, cancer, severe wounds, asplenic patients, prosthetic devices- catheters, heart valves, extreme age
causes:
Staphylococcus aureus (MRSA), Neisseria meningitidis, Streptococcus (Group A Strep), strep pneumonia, gram – bacilli, candida species - 3management of sepsisSEPSIS 6:
Administer high flow of O2
Take blood cultures
Give broad spectrum antibiotics
Give IV fluid challenges
Measure serum lactate and hemoglobin
Measure accurate hourly urine output - 4Diagnosing infection:Blood test: WCC, CRP, platelets, clotting
Microbiology: Blood culture, stool, urine, sputum
Serological blood test for antibodies, viral studies- PCR - 5Sepsis clinical handling:ABC, Sepsis 6, blood culture before antibiotics given- amoxicillin, imaging, surgery reviewed/ infection control- public health/ ICU-severe cases
- 6Example: Anthrax outbreakB. antracis soft tissue infection- contamination of heroin/ cutting agent
- 7Patient Not improving?Check antibiotic/ dose/ route/ abscess/ deep/ new infection
- 8SIRS [Systemic Inflammatory Response Syndrome] Patients with 2/ more symptomsTemperature more than 38 or less than 36 degrees
-Heart rate more than 100 beats per minute
-Respiration more than 20 per minute
-Leukocyte count more than 16000/ mm3, less than 6000/mm3/ more than 10% immature cells - 9Colonization:Presence of microbe in human body that does not cause infection/ specific immune response
- 10Infection:Occurrence of inflammation due to presence of microbe
- 11Bacteraemia:Presence of viable bacteria in blood
- 12common SSTIs location:
- 13Pasteurella multocidaGram negative coccobacillus, penicillin sensitive
Zoonosis- Common in animal bites ie. dog, septic arthritis, meningitis, osteomyelitis - 14Common SSTIs: Rare SSTIs:S.aures, group A beta- hemolytic strap
Coagulase - staphylococci - 15Animal bites:Dogs 80-90% > cat> human
Children> adults
Children- facial/ cervical, adults- extremities - 16Infection risk:Species: Cat 80%> dog 36%> human 18%
Host factors: immune status, site of injury, wound management
Iron overdose- alcoholic liver disease, breast cancer patients - 17Cat bites: Dog bites: Human bites:Deep puncture, little superficial damage
Extensive superficial injury, crush injury
Clenched fist, deep infection common, adults> children, BBV- hep b/c/ HIV - 18Most common microbes:Anaerobes- fusobacterium, bacteroids, porphyromonas, prevotella
- 19Microbiology:Human- 60% anaerobes, Eikenella corrodens quarter hand bites, group A strep (S. pyogenes)
Viral aetiology- rabies, simian herpes virus, Hep B/C/HIV - 20Rare:Pigs- Flavobacterium type 2, Streptococcus suis, Pateurella spp., E.coli
Seals- fisherman’s thumb- chronic meningeal meningitis - 21Management:Full history- immunodeficiency, country of exposure
Radiology- clenched fist, scalp bites children
Wound exploration
-Irrigate/ debride- source contro
l
-Delayed exposure
Antibiotic therapy- prophylaxis, treatment
Prophylaxis- after primary closure, puncture wounds, cat bites to hand/ wrist, crush wounds, host risk factors- prosthetic joint, asplenia, mastectomy, diabetes mellitus,
duration- 7 days - 22AntibioticsNEVER USE erythromycin/ clindamycin monotherapy for bites
Mild to moderate- co-amoxyclav, doxycycline and metronidazole, clindamycin and ciprofloxacin
Severe- ben pen and ciprofloxacin and mtz, meropenem and clindamycin - 23DurationCellulitis 7-10 days,
Tenosynovitis 21 days,
Septic arthritis 28 days,
osteomyelitis 42 days
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- Descripción
- md2001 cells, drugs and genes Fichas sobre Sepsis and SSTIs, creado por denise tan1844 el 28/04/2015.
- Creado por
- denise tan1844
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