Sepsis - etiologyVarious bacteria of E. coli can be used as sepsis pathogens, antimicrobial agents, the widespread use of immunosuppressive drugs, the pathogen has also changed, to the hemolytic streptococcus, pneumococcus is more common before the 1950s.
Lead to sepsis pathogens Staphylococcus aureus and Escherichia coli, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus epidermidis, anaerobic and fungal sepsis are also increasing.
Virulence and its toxins and enzymes produced by bacteria such as Staphylococcus aureus, coagulase, alpha-hemolysin, leukocidin, a common cause of severe sepsis or sepsis; E. coli and other gram-negative endotoxin of Bacillus damage blood vessels and heart, which could easily cause a disseminated intravascular coagulation, microcirculatory disorders, septic shock; Streptococcus pneumoniae with the capsule can be antagonistic human phagocytic role.
Sepsis - CategoriesStaphylococcus aureus sepsis caused by different pathogens of its clinical manifestations can be divided into the following categories:
1, S. aureus sepsis, the primary lesion often for skin abscess or wound infection, a few weak immune hospital infection, the bacteria in their blood come from the respiratory tract.
GPB septicemia seen in hospital infection. Patients receiving broad-spectrum antibiotic treatment, the bacteria is easy to form bacteria increased significantly in the number of drug-resistant strains, respiratory and intestinal tract, can cause systemic infection.
, Enterococcus sepsis, Enterococcus spp opportunity sexy contamination, usually parasites in the intestinal and urinary system.
4, gram-negative bacilli sepsis pathogens by various means into the blood, can cause complex and diverse performance. Sometimes the performance of these to cover up the signs and symptoms of primary disease. Disease and poor health, most accompanied by the host defense function of the primary disease, is a hospital-acquired infections were more.
5, anaerobic sepsis pathogens in 80% to 90% of Bacteroides fragilis, in addition there are anaerobic streptococci, Peptococcus and Clostridium perfringens bacillus. Invasion of the way to the gastrointestinal tract and female reproductive tract, bedsores, ulcers, followed by
Fungal sepsis generally occurs in the late course of severe primary disease.
Sepsis - SymptomsSalmonella sepsis primary inflammation: primary inflammation caused by various pathogens and their distribution site in the human body. Primary inflammation is characterized by localized redness, swelling, heat, pain and dysfunction.Toxemia symptoms: more abrupt onset. Often have chills, fever, fever remittent fever, and intermittent fever, but also was missed heat, irregular fever, and bimodal heat, the latter mostly the Gram-negative bacilli sepsis caused. Fever accompanied by symptoms of varying degrees of toxemia, such as headache, nausea, vomiting, abdominal distension, abdominal pain, aches and discomfort, muscle and joint pain.
Rash: found in some patients, blood spots, the most common, and more distributed in the trunk, limbs, conjunctival, oral mucosa, etc., one of the few.Joint symptoms: large joints red, swollen, hot, pain and activity is limited, and even concurrent joint effusion and empyema in the course of the disease prevalent in gram-positive, meningococcus, Alcaligenes sepsis.
Met with septic shock: 1/5 ~ 1/3 of patients with sepsis, manifested as restlessness, pulse rate, cold limbs, piebald skin, decreased urine output and decreased blood pressure, and the occurrence of DIC, Department of serious side hyperlipidemia due.
Hepatosplenomegaly: only slightly enlarged.
Except for injury, post-operative sepsis after squeezing boils incubation period, the large frequently occurring abrupt, the patient has repeated chills, persistent high fever, general malaise, headache, rapid heart rate, shortness of breath, nausea, vomiting, In severe cases, there may be irritability, seizures, convulsions, coma, pale and skin pale or grow dim, lips and nail bed cyanosis, clammy extremities, thready pulse speed, blood pressure, decreased urine output or no urine, and some also occurred in the skin and mucous membranes or visceral extensive bleeding, multiple organ failure and sepsis symptoms. Some patients with joint swelling, pain, limited mobility, joint effusion or empyema, hepatosplenomegaly, subcutaneous abscess, lung abscess, liver abscess, pericarditis, and osteomyelitis migration lesions.
Pseudomonas aeruginosa. Newborns and elderly patients have different physiological characteristics, its sepsis also have their own characteristics. Newborn's skin and mucosal barrier function, lymphoid and mononuclear phagocytic cell system functions are not perfect, is still a lack of complement, the low level of humoral immunity, cellular immunity is not perfect; umbilical cord stump has created favorable conditions for bacterial invasion, maternal genitourinary tract infection or systemic infection and so can the incidence of neonatal sepsis high performance complex, more complications. The clinical manifestation of the lack of "typical" symptoms, body temperature did not rise, weight gain, listlessness, lethargy, irritability, convulsions, pale mouth Zhou Faqing, shortness of breath, fast heart rate, skin blur, jaundice, increase, refusing milk, vomiting, abdominal distension, diarrhea, liver and spleen enlargement. Elderly the incidence of sepsis increased, due to poor reactivity of the body, early clinical manifestations are more subtle, heat and often irregular; because of immune dysfunction, the condition is often more severe, progress rapidly and difficult to control; elderly organ much diminished or existing chronic diseases, vulnerable to sepsis-induced organ failure. Therefore, newborns and the elderly sepsis and poor prognosis, the mortality rate is also high. Timely detection of newborns and the elderly sepsis, mainly based on age characteristics and vigilance.
Sepsis - CheckBlood: WBC count was mostly significantly higher.Pathologic examination.Bacterial culture.Direct smear examination of bacterial smears: pus, cerebrospinal fluid, pleural effusion, petechia, and pathogens were detected, a certain reference value for the rapid diagnosis of sepsis.
Detailed history and a detailed physical examination is extremely important. Where acute fever, white blood cells and neutrophils increased significantly, but not limited to certain infections, tendency, or local lesions, ducts and equipment operating history should consider the possibility of sepsis; blood or bone marrow culture positive the basis of diagnosis. Should identify with typhoid fever, miliary tuberculosis, connective tissue disease, and lymphoma and other diseases.
Sepsis - diagnostic criteriaA history of focal infection.
2, acute onset, chills, high fever, body temperature fluctuations, sweating more general failure, may have a large joint pain. The symptoms of poisoning a serious delirium, coma and shock.
3, the liver, splenomegaly, skin and mucous membrane petechiae, may have jaundice, anemia.
4, migratory lesions.
5, the increase in leukocytes and medium-sized myeloid acidic granulocyte reduction or disappearance of a serious infection or some Gram-negative bacteria infection can reduce the total number of leukocytes.
6, blood spots, petechiae picture to find bacteria.
, Blood or bone marrow culture was positive, eliminate the polluter can be diagnosed
Sepsis - treatment principleGeneral and symptomatic treatment: bed rest, better nutrition, add the right amount of vitamins. Maintain water, electrolyte and acid-base balance. Necessary to give blood transfusions, plasma, albumin and gamma globulin. Physical cooling may be given high fever, and irritability were given tranquilizers.
Pathogen treatment. The timely selection of appropriate antimicrobial agents is the key to treatment. Should be noted that early, in sufficient quantities to fungicides; generally two kinds of antibacterial drugs in combination, more than self-administered intravenously; the first dose should be large, pay attention to the half-life of the drug in divided doses; the course of treatment should not be too short, the general more than three weeks, or hot back 7 to 10 days before, where appropriate, the withdrawal.
Local lesion treatment: pyogenic lesions regardless of primary or migration, should be properly used, on the basis of sufficient quantities of antibiotics in a timely manner to puncture or incision and drainage. Purulent pleurisy, joint abscess puncture and drainage after local injection of antimicrobial drugs. Biliary and urinary tract infections, obstruction should be considered in the surgical treatment.
The key lies in the choice of appropriate and timely antimicrobial agents, and be rest and the right amount of nutrition. Should be treated as soon as possible after diagnosis of the basic affirmation, before the culture has not been positive results can be speculated that bacterial invasion pathways and clinical manifestations of the pathogenic bacteria of the type of administration, by the positive culture and treatment is ineffective, you can choose the appropriate drug sensitivity test antimicrobial agents. Gram-positive bacterial infections, the choice of penicillin, erythromycin, cephalosporins; gram-negative bacilli infections selection of gentamicin, amikacin, cephalosporins and semi-synthetic broad-spectrum penicillin; anaerobic infection is preferred metronidazole can also choose to penicillin, chloramphenicol, chlorine lincomycin; sepsis is indeed fungus caused by amphotericin should be selected. Correctly handle prominent contradictions of local lesions and the stage (such as septic shock, disseminated intravascular coagulation, heart and kidney dysfunction) is also very important.
Sepsis - treatmentStepLiu suffered from sepsis ① completely eliminate the primary tumor and migration damage to eradicate the source of the pathogen.
② the use of effective antibiotics to eliminate all bacteria in the blood as soon as possible.
③ early detection of new migratory lesions, to be completely removed at any time.
(4) improve the body's resistance to strengthen the supportive therapy, physical weakness, migratory children with lesions and more severe disease potential, multiple transfusions, plasma, albumin or gamma globulin, should ensure adequate caloric, fluid and nutritional needs.
The ⑤ symptomatic treatment, hyperthermia, antipyretics and physical cooling. With convulsions, to the sedative, if necessary, may be considered artificial hibernation therapy.
⑥ careful and meticulous care.
The selection and use of antibioticsTreatment of sepsis, antibiotics are the primary drugs, should be adopted as soon as possible, without waiting for culture results. General choose two antibiotics. G + cocci and G bacteria without culture results often need to take into account the choice of the aminoglycoside antibiotics (kanamycin or gentamicin) combination therapy with penicillins or cephalosporins. After train pathogens and drug sensitivity, the replacement of the most appropriate antibiotics. The patient's condition is particularly severe disease children, should also consider whether use of adrenal cortex hormones. Application of adrenal cortical hormone is beneficial to sepsis or septic shock, remained open. Large doses of methylprednisolone, 15 ~ 30mg/kg intravenously or equivalent doses of other agents and to repeat the dose two to four hours, the role of enhanced cardiac contractility and stability of lysosomal membranes, can be resistance to bacterial toxins damage, but because it allows latent infection in vivo lesion development and dissemination, must be used in conjunction with sufficient quantities of effective antibiotics. Therefore, before the addition of this therapy should be fully careful consideration, the only short-range (3 to 5 days) treatment. Three trimethoprim (TMP) in combination with antibiotics, can often improve efficacy.
In general, the G-bacteria resistance generally, and sepsis can choose a broad-spectrum penicillin or cephalosporin and aminoglycoside combination. Pseudomonas aeruginosa septicemia is preferable to the third-generation cephalosporin and aminoglycoside combination. Streptococcal, pneumococcal sepsis should be preferred to penicillin or cephalosporins.
Anaerobic sepsis, Bacteroides fragilis sepsis may be a larger dose of chloramphenicol and metronidazole (Flagyl) in combination. Anaerobic cocci septicemia available to large doses of penicillin and metronidazole.
Aureus septicemia is more complicated, the treatment method to be discussed in the special section below.
If the inappropriate use of antibiotics, could easily lead to the difficulties, a variety of bacterial infections such as drug resistant strains and in vivo a variety of flora, diagnosis, treatment and prognosis. Use of antibiotics must be carefully considered. Recently advocated the intermittent intravenous administration.
Sepsis - preventionKeep the skin and mucous membranes clean and complete, to avoid trauma, avoid squeezing or with a needle to prick the boils should be actively treated, and control of chronic diseases, rational use of immunosuppressive agents and antibiotics, burn ward should be strict disinfection measures can be prevent the occurrence of sepsis.
All obvious or hidden purulent lesions, such as early as possible to clear the sepsis could be reduced. Children when each Yi secondary heavier common infectious diseases such as measles, influenza, whooping cough and other respiratory tract bacterial infection, which occurred in sepsis. Must strengthen the protection of such sick children. No matter how small skin wounds must be attached to early for proper treatment. Continuous improvement of environmental sanitation, personal hygiene, nutritional status and pediatric care work, the incidence of sepsis is bound with the decline.
