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Micro - Overview of Sepsis (ii) (How to choose an antimicrobial (start…
Micro - Overview of Sepsis (ii)
Most common infective sources of sepsis
non-pregnant
resp (esp in winter)
UTI
intra-ab
IV line BSI
device-associated
CNS
pregnant
being pregnant is a risk factor -> immunosuppression
esp if...
35+ y/o
premature membrane rupture
previous group B strep infection
previous pelvic infection
exposed to group A strep infection
amniocentesis (invasive screening)
chorioamnionitis (bacterial infection before/during labour)
endometritis
post C-section wound infection
perineal infection
lactational mastitis
infections exacerbated by pregnancy
UTI
listeria
influenza
VZV
parvovirus
CMV (in herpes fam)
Sepsis 6
take 3
blood cultures (also others such as CSF, sputum, urine)
urine (to assess urinary output)
appropriate investigations
FBC
U+E
lactate
coag profile
LFTs
give 3
IV antibiotic
IV fluids
O2
Principles of Sepsis Management
optimise organ perfusion
eradicate infection
identify source
control source (e.g. abscess drainage/device removal)
choose appropriate antibiotic based on source
support dysfunctional organs
How to choose an antimicrobial
find site
assess if infection is community or hospital acquired (likelihood of resistance)
consult records for previous prescribed antibiotics + previous micro results
ask about allergies
start smart then focus
broad empiric Tx
then direct after lab pathogen confirmation