Tutorial 3

Definitions used to describe the condition of septic patients

Bacteriemia
Presence of bacteria in blood (positive blood cultures)
Septicemia
Presence of microbes or their toxins in blood
SIRS
2 of these conditions: fever (oral temp. >38
0
C) or hypothermia (<36
0
C); tachypnea (>24 breath/min);
tachycardia (heart rate > 90 beats/min); leukocytosis (> 12.000/L); leukopenia (< 4.000/L) or > 10% bands; may
have a noninfectious etiology
Sepsis
SIRS that has a proven or suspected microbial etiology
Severe sepsis
= sepsis syndrome: sepsis with 0ne or more signs of organ dysfunction, e.g:
1. Cadiovascular: arterial systolic blood pressure 90mmHg or mean arterial pressure 70mmHg that respons
to administration of intravenous fluid
2. Renal: urine output < 0,5mL/kg per hour for 1 h despite adequate fluid resuscitation
3. Respiratory: Pa
O2
/FI
O2
250 or, if the lung is the only dysfunction organ, 200
4. Hematologic: platelet count < 80.000/L or 50% decrease in platelet count from highest value ercorded over
previous 3 days
5. Unexplained metabolic acidosis: a pH 7,30 or a base deficit 5,0mEq/L and a plasma lactate level > 1,5
times upper limit of normal for reporting lab
6. Adequate fluid resuscitation: pulmonary artery wedge pressure 12mmHg or CVP 8mmHg
Septic shock
Sepsis with hypotention (arterial blood pressure < 90mmHg systolic, or 40mmHg less than patients normal blood
pressure) for at least 1 h despite adequate fluid resuscitation; or need for vasopressors to maintain systolic blood
pressure 90mmHg or mean arterial pressure 70mmHg
Refractory
septic shock
Septic shock that last for > 1 h and does not respond to fluid or pressor administration
MODS
Dysfunction of mor than one organ, requiring intervention to maintain homeostasis
Sepsis: A Complex Disease
This Venn diagram
provides a conceptual
framework to view
the relationships
between various
components of
sepsis.
The inflammatory
changes of sepsis are
tightly linked to disturbed
hemostasis.
(Bone RC et al. Chest. 1992;101:1644-55.
Opal SM et al. Crit Care Med. 2000;28:S81-2).

Microorganism and condition that may predispose to infection
Microorganism Condition
Gram-negative bacteria:
Enterobacteriaceae, pseudomonads, Haemophillus spp., other
gram-negative bacteria
Diabetes mellitus
Lymphoproliferative diseases
Cirrhosis of the lever
Burns
Invassive procedures or devices
Neutropenia
Indwelling urinary catheter
Diverticulitis, perforated viscus
Gram-positive bacteria:
Staphylococcus aureus, coagulase-negative staphylococcus,
enterococci, Streptococcus pneumoniae, other streptococci,
other gram-positive bacteria
Intravascular catheter
Indwelling mechanical devices
Burns
Neutropenia
Intravenous drug use
Infection with superantigen-producing S. pyogenes
Fungi Neutropenia
Broad-spectrum antimicrobial therapy
Polymicrobial
Classic pathogens:
Neisseria meningitidis, S. pneumoniae, H. influenzae,
Streptococcus pyogenes
Trigger (organism-derived, e.g. endotoxin)
Release of tumor necrosis factor / other proinflammatory cytokines
Inflammatory cascade
Hypothalamus Capillary endothelial cell Vessel wall
Fever
Tachycardia
Tachypnea
Neutrophil migration
Platelet adherence
DIC
Depletion of intravascular vol
Nitric oxide synthesis
Vasodilatation
Cellular hypoxia
Organ dysfunction/hypoperfusion Hypotension
Death
(Rosario, 2011)
Septic shock

Greenberg.2005. Kedokteran Kedaruratan. Erlangga : Jakarta
Buku Ajar Ilmu Penyakit Dalam
Jurnal Severe Sepsis: Pathophysiology, Diagnosis, and Treatment -
Loyola University Medical Center 2013


References