Septicaemia

UK sepsis burden – key numbers?

≈250,000 cases/year; ≥46,000 deaths/year. deaths from breast + bowel + prostate cancer combined. Untreated severe sepsis: mortality ↑ ~8% per hour.

Long‑term outcomes in sepsis survivors?

1 in 5 with chronic organ damage: kidneys, lungs, liver.

Bacteraemia vs sepsis vs severe sepsis vs septic shock?

Bacteraemia: bacteria transiently in blood (e.g. after tooth‑brushing), often harmless. Sepsis: life‑threatening organ dysfunction from infection of blood. Severe sepsis: sepsis with organ dysfunction. Septic shock: sepsis with persistent hypotension despite fluids.

Common primary infection sources leading to sepsis?

UTI. Pneumonia/RTI. GI infections. Post‑surgery, minor procedures, catheterisation, mechanical ventilation.

Gram‑positive bacteria commonly causing sepsis + key cell‑wall trigger?

Staph aureus, Strep pneumoniae, Strep pyogenes, Enterococcus. Trigger: lipoteichoic acid (LTA).

Gram‑negative bacteria commonly causing sepsis + key cell‑wall trigger?

E. coli, Pseudomonas aeruginosa, Salmonella spp. Trigger: lipopolysaccharide (LPS, endotoxin).

Main fungal cause of septicaemia?

Candida species.

Central immunological events in sepsis?

Over‑activation of immune system → ↑ pro‑inflammatory cytokines (TNF, IL‑1, IL‑6) → secondary mediators (prostaglandins, leukotrienes, platelet‑activating factor, nitric oxide).

Physiological effects of cytokines/mediators in sepsis?

Vasodilation → ↓ BP. Bronchoconstriction → breathlessness. ↑ vascular permeability → fluid pooling/oedema. DIC → microthrombi. Further cytokine release (vicious cycle).

Typical early symptoms and importance of “red flags” in sepsis?

Early: flu‑like symptoms. Need to spot red‑flag signs quickly to start urgent treatment and reduce mortality.

Key red‑flag clinical parameters for possible sepsis?

AVPU: responds only to voice/pain or unresponsive; acute confusion. SBP ≤ 90 mmHg or drop > 40. HR > 130/min. RR ≥ 25/min. Needs O₂ to keep SpO₂ ≥ 92%. Non‑blanching rash, mottled/ashen/cyanotic. No urine in 18 h or UO < 0.5 mL/kg/h. Lactate ≥ 2 mmol/L. Recent chemotherapy.

Examples of organ dysfunction/complications in sepsis (by system)?

CNS: confusion, delirium, ↓ consciousness, cognitive loss. Lungs: oedema, acute lung injury, ARDS. Liver: steatosis, cholestasis, necrosis. CVS: ischaemia, dilated failure. Pancreas: ischaemia, ↓ insulin, hyperglycaemia. Kidneys: oedema, acute tubular injury. Adrenals: haemorrhage.

Initial IV regimen used in the case?

IV fluids. IV gentamicin 5 mg/kg OD (for 60 kg). IV amoxicillin 500 mg TDS.

Key pharmacokinetic points for gentamicin – absorption and distribution?

Poor oral absorption → given IV. Highly hydrophilic, poor tissue penetration. Not distributed into body fat → dose based on body mass.

Gentamicin elimination and dosing implication?

Excreted unchanged by kidneys → must consider renal function and monitor levels.

Why were blood cultures, urine and gentamicin levels sent?

Cultures: identify causative organism and sensitivities. Drug levels: ensure gentamicin efficacy and avoid toxicity (esp. nephro/ototoxicity).

When might meropenem or piperacillin/tazobactam be used in sepsis?

Meropenem: multi‑resistant infection, guided by hospital guidelines. Piperacillin/tazobactam: often reserved for suspected/confirmed Pseudomonas.

Why must carbapenems be used cautiously?

Emergence of carbapenemase‑producing organisms → risk of losing last‑line options.

Additional renal investigations before discharge after septic episode?

Post‑infection monitoring of kidney function (e.g. U&E, eGFR). Renal ultrasound to assess structural damage if indicated.

Example of oral step‑down therapy after IV treatment in this case?

Oral norfloxacin 400 mg BD for 10 days (per local hospital guideline).