micro 4- septic shock

sepsis is caused by a

dysregulated host response to infection

septic shock

sepsis

serum lactate > 2

vasopressor therapy MAP > 65

qSOFA score that is associated with poor outcomes due to sepsis

2+

qSOFA criteria

GCS < 14

SBP < 100

RR > 22

toxic shock syndrome is caused by

toxins released by certain strains of strep and staph

risk factors for sepsis

infants and elderly

hospital/ICU

recent surgery/hospitalization

immunocompromised

indwelling medical device

community acquired pneumonia

chronic disease

recent injury

clinical presentation of sepsis

fever

tachypnea

tachycardia

hypotension

altered mental status

rash

s/s specific to infection source

most common gram + bacteria causing sepsis

staph aureus

strep pneumo

most common gram - bacteria causing sepsis

E coli

klebsiella pneumo

pseudomonas

most common infection leading to sepsis

lung infection

fungal cause of sepsis

candida spp

hospital acquired infections tend to be

gram negative rods

antibiotic resistant

early onset sepsis in neonates

s agalactiae

E coli

H influenzae

listeria

late onset sepsis in neonates

Staph epi

staph aureus

E coli

klebsiella

pseudomonas

candida

sepsis in infants

strep pneumo

N meningitidis

H influenzae

sepsis in malaria endemic regions

P falciparum

risk factors for gram positive cocci

vascular cath

indwelling medical devices

burns

IV drug use

toxin mediated

risk factors for gram negative rods

diabetes

lymphoproliferative diseases

liver cirrhosis

burns

invasive procedures or devices

neutropenia

sickle cell increases risk for ___ sepsis

salmonella

how to gram negative rods cause sepsis

lipid A of endotoxin (LPS and LOS)

activates coagulation cascade (DIC)

activates complement cascade

what host immune components contribute to hyperinflammation

TNF-a

IL-1, 6, 17

complement

gram pos bacterial mediators of hyperinflammation

PAMPS- peptidoglycan, teichoic acid

superantigens (TSST-1, enterotoxin B)

gram neg bacterial mediators of hyperinflammation

LPS

LOS

Teichoic acid is recognized by

TLR-2

LPS is recognized by

TLR-4

long term effects of the immune response in pts during immune resolution

inc in lymphocyte and APC apoptosis

inc in neutrophil dysregulation

inc in immunosuppressive cells (Tregs, myeloid derived suppressor cells)

anti-inflammatory cytokine release (IL-10, TGF-B)

what are the APCs

macrophages, dendritic cells, B cells

treatment of sepsis

stabilize

broad spectrum antibiotics

staph aureus superantigens

staph enterotoxin B (SEB)

TSST-1

how do superantigens work

cross link MHC-II with TCR to produce a strong T cell activation/proliferation

cytokine storm (IL-1, TNF-a)