May 1, 2016
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Sepsis (cont.)

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How do health-care professionals diagnose sepsis?

Clinically, the patient needs to fit at least two of the diagnostic 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 criteria. However, other helpful tests depend on lab analysis such as white blood cell examinations, procalcitonin levels, and PaCO2. These tests, like blood cultures, are measured in clinical laboratories. Researchers are currently investigating other blood tests to diagnose early sepsis. In addition, other underlying causes for sepsis are often established by using CT imaging studies, MRI, ultrasound, and chest X-rays. Sometimes it's difficult to differentiate between underlying causes of sepsis and other emergency medical problems. Consequently, it is not unusual to run cardiac studies to rule out heart disease on patients that may also have sepsis since some of the symptoms are similar.

There are other diagnostic findings 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. Some of the commonly used antibiotics used are

  • ceftriaxone (Rocephin),
  • meropenem (Merrem),
  • ceftazidime (Fortaz),
  • cefotaxime (Claforan),
  • cefepime (Maxipime),
  • piperacillin and tazobactam (Zosyn),
  • ampicillin and sulbactam (Unasyn),
  • imipenem/cilastatin (Primaxin),
  • levofloxacin (Levaquin),
  • clindamycin (Cleocin).

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 [mechanical ventilation] to support lung function or dialysis to support kidney function) or a central venous catheter and fluid replacement with intravenous fluids and/or antihypotensive medication to raise blood pressure (norepinephrine [Levophed] or phenylephrine [Neo-Synephrine] administered by IV). Secondly, surgery may be needed to drain or remove the source of infection. Amputation of extremities has been done to save some patients' lives.

Medically Reviewed by a Doctor on 4/4/2016

Source: MedicineNet.com
http://www.medicinenet.com/sepsis/article.htm

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