INFECTION II
For adults with suspected sepsis or septic shock, does SSC 2021 suggest using procalcitonin plus clinical evaluation to decide when to start antimicrobials?
No
What therapy is recommended for VTE prophylaxis?
LMWH
Under the Sepsis-3 definitions, which of the following terms has been eliminated: sepsis, severe sepsis, or septic shock?
Severe sepsis
How does URMC define sepsis?
Suspected or documented infection AND: two or more SIRS OR AMS not attributable to another cause OR other clinical findings consistent with severe response to infection
Appropriate routine microbiologic cultures always include what?
At least two sets of blood cultures (aerobic and anaerobic)
What are the most common gram-positive pathogens isolated in patients with sepsis? (Hint: there are two)
Staphylococcus aureus and Streptococcus pneumoniae
When should insulin therapy be initiated in patients with sepsis or septic shock?
Glucose >/= 180 mg/dL
What differentiates sepsis from infection?
An abnormal or dysregulated host response and the presence of organ dysfunction
How does URMC recommend managing sepsis in the FIRST HOUR?
1. Obtain blood cx’s (& others PRN)
2. Broad-spectrum abx
3. Measure lactate
What are the most common gram-negative pathogens isolated in patients with sepsis? (Hint: there are three)
Escherichia coli, Klebsiella spp., and Pseudomonas aeruginosa
How does SSC 2021 suggest infusing beta-lactam antibiotics?
Initial bolus followed by prolonged infusion for maintenance
According to SSC 2021, when should medication reconciliation be performed?
At both ICU and hospital discharge
How does Sepsis-3 define septic shock?
Sepsis + persisting hypotension requiring vasopressors to maintain MAP >/=65mmHg and having a serum lactate >2mmol/L despite adequate volume resuscitation
If a patient is hypotensive (SBP</=90 or MAP </=65) or has a lactate >/=4, what should be done ASAP (within 3 hours)?
30 ml/kg crystalloid IV bolus, repeat BP x2 within 1 hour of completion
What five things are recommended to be done within Hour-1 of the 2018 Surviving Sepsis Campaign Bundle of Care?
1. Measure lactate level
2. Obtain blood cultures
3. Administer broad-spectrum abx
4. Administer IVF
5. Apply vasopressors
What is SSC 2021’s stance on de-escalation of antimicrobials for adults with sepsis or septic shock?
Suggests daily assessment for de-escalation over using fixed durations of therapy
When should enteral nutrition be initiated in patients with sepsis or septic shock who can tolerate it?
Early (within 72 hours)
According to Sepsis-3, which laboratory measurement offered no meaningful change in the predictive validity beyond 2 or more qSOFA criteria in the identification of patients likely to be septic?
Lactate
If the patient is persistently hypotensive, has a persistently elevated lactate, or continued tissue hypoperfusion, what else should be done ASAP (within 6 hours)?
Repeat 30 ml/kg IV crystalloid bolus OR start vasopressors (norepi)
What is the approximate rate of mortality from sepsis? (in %)
20-30%
When does SSC 2021 suggest using procalcitonin (in combination with clinical evaluation)?
To decide WHEN TO DISCONTINUE ANTIMICROBIALS for adults with adequate source control and OPTIMAL DURATION OF THERAPY IS UNCLEAR
What are the qSOFA criteria?
RR >/= 22
AMS (GCS <15)
SBP </= 100 mm Hg
Name at least 3 of the SOFA variables.
Respiration: PaO2/FiO2 ratio
Central nervous system: Glasgow Coma Scale
Cardiovascular: Mean arterial pressure / administration of vasopressors
Renal: Serum creatinine or urine output
Liver: Bilirubin
Coagulation: Platelet count
What tool can be used as a faster alternative to SOFA score to detect clinical deterioration?
NEWS
What is the most common cause of (severe) sepsis?
Pneumonia