Sepsis and Septic Shock (Bolesta) (Exam 2)

what are the SIRS criteria? (4) how many do you need to have to be considered to have sepsis?

temp >38 C or <36C

HR > 90 bpm

RR > 20 bpm

WBC > 12,000 or <4,000 or >10% bands

what are the common infection sites for sepsis? (3)

pulmonary

intra-abdominal

urinary

what are the complications of sepsis? (4)

disseminated intravascular coagulation (DIC)

acute kidney injury (AKI)

acute respiratory distress syndrome

hemodynamic instability

what indicated AKI?

increase in SCr of >= 0.3 mg/dL in 48 hours

what do all complications of sepsis lead to?

septic shock

what is the TIME acronym stand for when it comes to sepsis?

temperature

infection

mental decline

extremely ill

what are the qSOFA criteria? what score suggests a greater risk of a poor outcome?

hypotension systolic HP <100 mmHg

altered mental status

tachypnea RR >22/min

score of >= 2

guidelines recommend againt using __________ as a single screening tool

qSOFA

what is the volume of fluid initially recommended for sepsis patients? of what?

30 mL/kg of IV balanced crystalloids fluid within 3 hours

what is the target MAP for resuscitation?

65 mm Hg

what does the acronym ROSE stand for?

resuscitation --> optimization --> stabilization --> evacuation

what two balanced crystalloids should you use for resuscitation? why?

lactated ringers

plasma-lyte 148

more similar to human plasma

what is empiric therapy for community-acquired urinary tract sepsis?

ceftriaxone OR cipro/levo

what is empiric therapy for community-acquired respiratory tract sepsis?

levo/moxi OR ceftriaxone + clarithromycin/azithromycin

what is empiric therapy for community-acquired intra-abdominal sepsis?

ertapenem OR cipro/levo + metro OR ceftriaxone + metro

what is empiric therapy for community-acquired SSTI sepsis?

vanco or linezolid or dapto

what is empiric therapy for community-acquired unknown sepsis?

zosyn or carbapenem

what is empiric therapy for hospital-acquired urinary tract sepsis?

ceftriaxone/ceftazidime OR cipro/levo

what is empiric therapy for hospital-acquired respiratory tract sepsis?

zosyn or ceeftazidime or cefepime or carbapenem PLUS levo/cipro or aminoglycoside

+ vanco or linezolid

what is empiric therapy for hospital-acquired intra-abdominal sepsis?

carbapenem OR zosyn OR ceftazidime/cefepime + metro

what is empiric therapy for hospital-acquired SSTI sepsis?

vanco + zosyn

what is empiric therapy for hospital-acquired catheter-related sepsis?

vanco

what is empiric therapy for hospital-acquired unknown sepsis?

carbapenem

what is recommended in nonneutropenic ICU patients, recent exposure to antifungals or suspected C. glabrata or C. krusei?

echinocandins

what is recommended in hemodynamically stable patients without prior exposure to triazoles and not known to be colonized with triazole-resistant Candida species?

triazoles

what is an alternative to echinocandins in patients with echinocandin intolerance or toxicity?

liposomal amphotericin B

may assist in duration of therapy

may improve survival

most studies done in patients with pneumonia or bacteremia

procalcitonin

what is duration of treatment if there is source control? without source control or fungal infections?

7-10 days

10-14 days

what is the duration of treatment for hospital- and ventilator-associated pneumonia?

7 days

what is the duration of treatment for intra-abdominal infections with source control? without source control?

no more than 4 days

5-7 days without

used to achieve and maintain MAP = 65 mm Hg in fluid resuscitation refractory septic shock

vasopressors

what is preferred for fluid-refractory septic shock? what is an alternative if not available

norepinephrine

dopamine

preferred in patients with bradycardia and low arrhythmia risk

dopamine

what is added to norepinephrine to maintain adequate MAP?

vasopressin

what is added to NE and vasopresson to maintain MAP?

epinephrine

what should be started for patients with septic shock and ongoing vasopressor therapy?

IV hydrocortisone 200mg per day

all patients need to be screened for what?

hyperglycemia

hyperglycemia and insulin resistance are common with sepsis. what is recommended to be initiated?

insulin therapy at a glucose level of >= 180 mg/dL

what should be started to lower risk of VTE?

heparin

caution using LMWH (heparin) in patients with what?

reduced kidney function

what should be given to sepsis patients who have GI bleeding risk factors? stress ulcer prophylaxis