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Bacteremia & Systemic Inflammatory Response Syndrome - Coggle Diagram
Bacteremia & Systemic Inflammatory Response Syndrome
Definition
Bacteremia
-Presence viable bacteria in circulating blood
Sepsis
-SIRS + Infection
Severe sepsis
-Sepsis associated with organ dysfunction
Septic Shock
-SIRS + Infection + Organ dysfunction + Persistent hypotension
SIRS
-Patient presents with two or more following symptoms
Fever, shivering or feeling very cold.
Temperature >38°C or <36°C
High heart rate
. Heart rate >90 bpm
Shortness of breath
. Respiration >20/min
Leukocytes count
>12,000/ μL, <4,000/ μL or >10% immature (band) cells
Risk Factors
Age
Children <1 y/o
Adult ≥ 65 y/o
Individual Undergoing Surgery
Individuals Prior in Drug Therapy
Immunosuppressive Drugs
People With Weakened Immune System & Chronic Conditions
Diabetes
Lung Disease
Cancer
Kidney disease
Foreign Materials
Patient on IV Catheter
Patient With An Infection
Pneumonia
Cellulitis
Urinary Tract Infection
Ruptured Appendix
Dental or medical procedures
Role of endotoxins in gram negative sepsis
What is endotoxins??
part of outer portion of cell wall
are liberated when bacteria die or cell wall breaks apart
Mechanism
gram negative bacteria is ingested by macrophages
bacteria degraded in vacuole
releases endotoxins
induce macrophages to form cytokines IL-1 and TNF-a
cytokines enter bloodstream
enter hypothalamus of brain
induce hypothalamus to form prostaglandins
1 more item...
What it does?
endotoxins mediates production of proinflammatory cytokines
Ex: tumour necrosis factor
interlukin-1
interlukin-6
proinflammatory cytokines mediates adhesion of polymorphonuclear leukocytes to endothelium
causing:
capillary leak
coagulation
vasodilation
CAUSES OF BACTEREMIA
Dental or medical procedures
Certain bacterial infections - skin abscesses, bacteria may periodically enter the bloodstream
Certain ordinary activities - vigorous toothbrushing
Injection of recreational drugs – contaminated needles
Bacteria commonly isolated from blood culture
Staphylococcus aureus
Escherichia coli
Streptococcus pneumoniae
Klebsiella pneumoniae
Viridans streptococci
Management Of Sepsis
:check:
Respiratory stabilization
with supplemental oxygen
15L O2(94-98%)
Intravenous
fluid
500-1000mL intial fluid bolus
Blood
Take blood cultures
prior to administering antibiotics, along with
Routine bloods,
inc. lactate
Include FBC, U&E, LFTs, clotting, CRP, and glucose
IV antibiotics
Start empirical antibiotics (based on local guidelines), before
switching to targeted therapy when sensitivities are available
Monitor urine output
urine output; aim for at least >0.5mL/kg/hour
Outline Investigations
:warning:
Lumbar Puncture
When bacterial meningitis suspected strongly
Climical diagnosis for early sepsis in newborn
Lab Study
Complete Blood Count With Differential
Septic shock may either cause leukocytosis or luekopenia
Blood chemistries
Biomarkers such as serum lactate and procalcitonin
Blood Cultures
Clinical gold standard for diagnosis bacterial infections
Urinalysis and urine
culture
To identify whether the source of infection is urinary tract infection
Gram stain & culture of secretions & tissue
CSF analysis, including culture can be done if the patient are thought having infection to the brain
Imaging
Plain radiography
Best for determining acute respiratory distress syndrome
Ultrasonography
Suspected acute cholecystitis
Suspected cholangitis
CT scan
Excluding intra abdominal abscess
MRI
Subcutaneous and deep tissue inflammation
Sepsis steps
SIRS
T: >100.4F, <96.8 RR:>20
HR:>90
WBC: >12000, <4000, >10% bands
PCO2 <32mmHg
Sepsis
2 SIRS + confirmed/suspected infection
Severe Sepsis
Sepsis
+
Signs of End Organ Damage
Hypotension (SBP <90)
Lactate <4mmol
Septic Shock
Severe sepsis with persistent
Signs of End Organ Damage
Brain
altered conciousness
confusion
-psychosis
Heart
tachycardia
hypotension
altered CVP
altered PAOP
Lungs
tachypnoea
PaO2 <70mmHg
SaO2 <90%
PaO2 300%
Liver
jaundice
:arrow_up: enzymes, PT
:arrow_down: albumin
Kidney
oliguria
anuria
:arrow_up: creatinine
Blood vessels
:arrow_up:PT, D-dimer
:arrow_down: platlets, protein C
Hypotension (SBP <90)
Lactate <4mmol