Sepsis and Septic Shock

Sepsis definition

infection + acute increase of ≥2 SOFA points (Sepsis-3/4)

Septic shock criteria

need vasopressors to maintain MAP ≥65 AND lactate >2 mmol/L after adequate fluids

Best early marker of tissue hypoperfusion

lactate

First step before antibiotics in sepsis

obtain blood cultures

Antibiotic timing goal

within 1 hour for shock, within 3 hours for sepsis

Initial fluid bolus dose

30 mL/kg crystalloid

Preferred crystalloid for sepsis

lactated ringer's (balanced solutions)

When to repeat lactate

within 2-4 hours if initially elevated

First-line vasopressor

norepinephrine

Role of vasopressin

add-on to reduce norepinephrine requirements (not first-line)

When to add corticosteroids

shock refractory to fluids + vasopressors

Corticosteroid regimen

hydrocortisone 200 mg/day (typically 50 mg q6h)

Definition of "adequate fluid resuscitation"

received initial 30 mL/kg or clinical euvolemia achieved

Preferred therapy for ESBL E. coli

carbapenems (e.g., meropenem)

Most important early intervention in sepsis

rapid broad-spectrum antibiotics

Two components of septic shock classification

vasopressors required + lactate >2

Why balanced crystalloids preferred over NS

less risk of hyperchloremic metabolic acidosis

Purpose of SOFA score

measures degree of organ dysfunction

qSOFA recommendation in Sepsis-4

not recommended as sole screening tool

Key pharmacist role in sepsis management

ensure timely, appropriate antimicrobial therapy and dose optimization