Sepsis

Sepsis and Septic Shock

Definitions Physiologically similar systemic inflammatory response syndrome  can be seen even in the absence of identifiable infection. Pathophysiology The sites of infections that most frequently led to sepsis were the respiratory tract (40%), urinary tract (18%), and intra-abdominal space (14%). Sepsis may be caused by gram-negative or gram-positive bacteria, as well as by fungi or other microorganisms. Escherichia coli is the common pathogen isolated in sepsis; other common gram-negative pathogens include Klebsiella spp., Serratia spp., Enterobacter spp., and Proteus spp. Pseudomonas aeruginosa is the most frequent cause of sepsis fatality. Common gram-positive pathogens include Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, coagulase-negative staphylococci, and enterococci. Candida species (particularly Candida albicans) are a …

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Management of Sepsis

Definition and prognosis Sepsis, sepsis syndrome, septic shock, and multiorgan dysfunction are all part of a continuum of infection-related systemic illness. Table Definitions for Sepsis, Sepsis Syndrome, Septic Shock and Multiorgan Dysfunction Syndrome gives definitions for each of these entities. The pathogenesis of sepsis is very complex, involving a large number of mediators. A cascade is started when endotoxin or other products of microorganisms enter the circulation, resulting in the release of a variety of mediators from mononuclear phagocytes, endothelial cells and other cells. Initially the proinflammatory cytokines (tumor necrosis factor, IL-1β, IL-6, and IL-8) are elevated, although there are large individual variations. The anti-inflammatory cytokines (IL-10) and soluble cytokine receptors …

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Sepsis

Description of Medical Condition The systemic response to infection; it encompasses a broad array of clinical manifestations and overlaps with inflammatory reactions to other clinical insults (e.g., severe trauma or burn) • Bacteremia: Bacteria in the blood; may have no accompanying symptoms • Systemic inflammatory response syndrome (SIRS) inflammatory reaction to different clinical insults manifest by two of the following: (1) temperature >38°C or90/min; (3) respiratory rate >20/min or PaC02 12,000/mm3, 10% immature forms (bands) • Sepsis: SIRS with documented infection (typically bacterial) • Septic shock: Sepsis induced hypotension (systolic BP 40 mmHg drop from baseline) despite adequate fluid resuscitation plus hypoperfusion abnormalities (oliguria, lactic acidosis, acute change in mental status) …

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