February 7, 2016
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Sepsis (cont.)

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How is sepsis diagnosed?

Clinically, the patient needs to fit at least two of the SIRS criteria listed above and have a suspected or proven infection. This is a screening tool to help physicians presumptively diagnose sepsis early in the disease process. Definitive diagnosis depends on a positive blood culture for an infectious agent and at least two of the SIRS criteria. However, two subsets of the four criteria depend on lab analysis: white blood cell examinations and PaCO2. These subset criteria, like blood cultures, are measured in clinical laboratories. Researchers are currently investigating other blood tests to diagnose early sepsis.

There are other diagnoses that indicate the severity of the patient's sepsis. Severe sepsis is diagnosed when the septic patient has organ dysfunction (for example, low or no urine flow, altered mental status). Severe sepsis can also include sepsis-induced hypotension (also termed septic shock) when the patient's blood pressure falls.

What is the treatment for sepsis?

In almost every case of sepsis, patients need to be hospitalized, treated with appropriate intravenous antibiotics, and given therapy to support any organ dysfunction. Sepsis can quickly cause organ damage and death; therapy should not be delayed as statistics suggest as high as a 7% mortality increase per hour if antibiotics are delayed in severe sepsis. Most cases of sepsis are treated in an intensive-care unit (ICU) of the hospital.

Appropriate antibiotics to treat sepsis are combinations of two or three antibiotics given at the same time; most combinations usually include vancomycin to treat many MRSA infections. However, once the infecting organism is isolated, labs can determine which antibiotics are most effective against the organisms, and those antibiotics should be used to treat the patient. In addition to antibiotics, two other major therapeutic interventions, organ-system support and surgery, may be needed. First, if an organ system needs support, the intensive-care unit can often provide it (for example, intubation to support lung function or dialysis to support kidney function). Secondly, surgery may be needed to drain or remove the source of infection. Amputation of extremities has been done to save some patients' lives.

A recent research report may alter a common treatment for septic shock. Because of the low blood pressure seen with septic shock, IV fluid boluses have been used to support the patient's blood pressure. However, a 2011 study in over 3,000 children in Africa with impaired perfusion (shock) showed that the fluid bolus treatments actually increased mortality (death rate) in the children. This surprising result has raised questions about how clinicians can best manage septic shock in the future. For example, in 2004, guidelines were published that "bundled" therapeutic methods (for example, blood cultures, antibiotic therapy, and fluid therapy) to treat sepsis in an initial six-hour period that included fluid boluses. This septic treatment bundle of techniques may need revision or reexamination.

Medically Reviewed by a Doctor on 2/9/2015

Source: MedicineNet.com

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