Lecture of septicaemia

2021-03-23 12:00 AM

Gram-negative sepsis is usually secondary to the gastrointestinal tract, genital urinary tract, bile, liver, hospital procedures, catheter, tracheostomy, peritoneal dialysis.

Define

Sepsis is a serious systemic infection caused by the continuous entry into the blood of pathogenic bacteria and its toxins.

The clinical picture is diverse because the progression of the disease depends not only on the pathogen but also on the response of each patient's body.

The disease progresses seriously, does not tend to go away on its own (if not treated).

Epidemiology

Pathogens

There are many different reasons.

Due to bacteria:

Gram bacteria (-): Escherichia coli; Enterobacter; Klebsiella; Proteus; Pseudomonas aeruginosa (green purulent bacillus); Neisseria meningitidis:

Bacteria Positive-Gram: Staphylococcus (include 3 species: S. aureus; S. Epidermidis; S. Saprophyticus); Streptococcus; Pneumococci: (Diplococcus pneumoniae).

Anaerobic bacteria.

Due to fungus.

Do mycobacterium.

Inoculum

As external sources (soil, water, air ...) pollution, bacteria enter the body through the wound, squeeze pimples early to break down the protective barrier, or possibly normal bacteria. symbiosis in the body when facing favourable conditions such as damage to internal organs, the body's resistance will be reduced to pathogenic bacteria.

Infection

Blood sugar.

Sense of the body

Any age, any sex can be, but more common in immunocompromised bodies

Mechanism of pathogenesis

 The clinical picture of sepsis is the result of the interaction between the bacteria, the bacterial product, and the host's response system.

Bacterial factors: Including LPS, lipid A of bacteria G (-) and Peptidoglycan of bacteria G (+). The type of pathogen, its virulence, is related to the clinical symptom and disease progression.

Body response: The role of cytokine, antibodies play an important role in the pathogenesis and progression of sepsis.

Sepsis occurs in patients with severe, chronic diseases (leukaemia, diabetes, cancer ... etc). Immunodeficiency diseases, patients taking corticosteroid immunosuppressants, taking long-term antibiotics, etc. often make their clinical picture worse.

clinical

Divide the clinical form

Paroxysm: Progresses in 1 week.

Acute form: Progresses from 1 to 4 weeks, sometimes lasting up to 3 months.

Semi-level: Lasts 3-6 months.

Chronic: Lasts a year or a few.

Symptoms study by individual

Drama:

Progression violently, very severe symptoms of intoxication, accompanied by heart failure. Death in the first 1-2 days. The metastases have not formed in time.

Acute:

Clinical manifestations of sepsis are diverse. Basically, include symptoms of systemic intoxication and clinical manifestations of metastatic foci. And the primary cause (entrance) of sepsis is not always clinically apparent (endogenous sepsis).

There is a primary infection:

Sepsis G (+) is usually primary in the skin, muscles, pimples, dendrites, ripening, post ploidy, infected wounds, and myositis.

Inflammation of the ear, nose, throat, sinuses, teeth.

Deep pus: abscess around the kidneys, under the diaphragm.

Medical equipment: Sonde, catheter.

Sepsis G (-) is usually secondary to: gastrointestinal tract, genital urinary tract, bile, liver, hospital procedures: Catheter, tracheostomy, peritoneal dialysis.

In general: G (+) sepsis are easier to find sugar in than G (-) sepsis.

Severe systemic intoxication:

Fever: A common symptom of ARI, features: Fever is 39-41 degrees high, often fluctuates strongly, sometimes continuously. There are cold thorns and chills shivering during the day (corresponding to when bacteria spills into the blood)

Blue skin, yellowish colour, emaciated face, clearly infected expression. Skin rash is common: maculopapular rash, pustules or purpura, necrosis ...

Ban is caused by infected particles carried by the bloodstream. Transplanting at these boards can reveal pathogenic bacteria.

Psychiatric: In different degrees: fatigue, lethargy, lethargy or agitated, most severe is coma.

Consciousness disorder is often accompanied by septic shock.

Cardiovascular: The pulse is usually fast, easy to change, blurred heart sound, systolic murmur, and arterial blood pressure is often low.

Respiratory: Often rapid breathing, difficulty breathing (not because of the central respiratory apparatus, but because of CNS poisoning).

Liver, spleen enlargement is a reaction of the retinal system of the endothelium. It is common that the liver is larger than the enlarged spleen. Characteristics: hepatosplenomegaly 1-3 cm below ribs, soft, pressure.

Symptoms of secondary foci:

Depending on the metastatic sepsis to any organ, there are manifestations of infection in that organ.

Lungs: Pneumonia, bronchitis inflammation, lung abscess, bronchial pus.

Heart: Inflammation of the endocardium, myocarditis.

Liver, spleen: abscess

Kidney: Pyelonephritis, inflammation around the kidney.

No- no, no, no, come no, no.

Musculoskeletal: purulent cavity.

Gastrointestinal: Enteritis, bloating.

Subacute and chronic:

The disease lasts in waves because the bacteria are not eradicated from the infected foci each wave into the blood. Patient gradually deteriorates and high mortality

Diagnose

Clinical basis:

Primary drive (visible or not).

Syndrome of severe systemic intoxication, damage to many organs.

Metastasis drive.

Test grounds:

BC is high, N increases (In gram (-) sepsis, BC usually decreases).

Blood sedimentation rate increased.

HC usually decreases.

Common: increased urea, increased creatinine, increased bilirubin, increased SGOT, SGPT, increased blood sugar (seen in 50% of patients). The urine contains Albumin, HC, BC, cylindrical.

Diagnosis is decisive to have blood culture (+).

Conclusion (+) is certain when: blood culture (+) 2 times or blood culture and culture of primary and secondary drives have the same bacteria.

Epidemiological basis:

Septicaemia often occurs oddly, not into a large epidemic

Differential diagnosis

Typhoid [especially NKHG (-)]:

Both diseases have prolonged fever, hepatosplenomegaly, and systemic toxic infection.

But in typhoid, there is rarely tremor of malaria, usually slow pulse (dissociation temperature circuit), disorder usually on 2nd week, roseola, blood culture with Salmonella.

Focal infection in place:

Urinary tract infections, cholangitis, abscesses under the diaphragm, deep purulent cavity ...

Both diseases have prolonged fever, many cold spells during the day.

But in local infections systemic symptoms (liver, spleen enlargement) are rare. Clearly manifest in damaged organs. Blood cultures (+).

Primary malaria:

Both diseases have prolonged fever, chills, enlarged liver and spleen.

But in primary malaria, usually on 7-10 days, fever becomes cyclical. Sedimentation blood test less increased. Malaria parasite (+), epidemiology: in malaria endemic areas.

Symptoms

Respiratory failure: An infection causes Adult Respiratory Distress Syndrome (ARDS).

Impairment of clotting factors.

CKD:

Septic shock.

A common complication in sepsis, especially in G (-) sepsis.

Other organs: Myocardial necrosis, liver, kidney, spleen, intestinal haemorrhagic necrosis ... etc

Treatment

Principles of treatment of sepsis

Kill the pathogens.

Correction of disorders caused by sepsis.

Resistance enhancement.

Treat the cause

Use antibiotics according to the following principles:

Use antibiotics according to the pathogen and antibiotic map.

Antibiotic dose must be high.

Use parenteral antibiotics, preferably intravenously in the early days.

Need to coordinate antibiotics (with antibiotic resistant bacteria and unknown pathogens).

Time to use antibiotics not less than 2 weeks, depending on specific cases may have to use monthly ...

Combine antibiotics when

For siege treatment when pathogens have not been isolated.

The pathogen is resistant to antibiotics or an infection caused by many pathogens.

Prevent and delay the emergence of resistant strains.

Increases the inhibitory and bactericidal ability of the antibiotic.

Attention: Must thoroughly resolve primary and secondary infectious foci by surgery such as abscess drainage incision, removal of infectious causes such as catheters, drainage catheters, etc.

Some effective treatment regimens for sepsis are currently available

Sepsis caused by gram (+) bacteria often combines first generation Cephalosporin antibiotics with Quinolone group or aminoglycoside group.

Sepsis caused by gram (-) bacteria often combined with Cephalosporin class III antibiotics with Quinolone group or aminoglycoside group.

Treatment according to the pathogenetic mechanism

Adjust water and electrolyte disorders, detoxify with solutions Dextro, Ringerlactat.

Anti-acidosis (PH <7.2): Bicarbonate solution

In the presence of DIC syndrome, treat Heparin.

Cardiovascular, respiratory resuscitation, cardiovascular.

Treatment of sepsis shock.

Strengthening the body's resistance: by blood transfusion, protein, vitamins.

Diet: Increase protein, fruit.

Prevention

Aseptic work in hospital: Especially when doing surgeries, procedures ...

A thorough treatment of diseases with pus and apex. Do not squeeze, extract pimples early, especially nails, juniors.

Use antibiotics early, enough doses, effective in diseases that can convert to sepsis (diseases caused by staphylococci, streptococci, pneumococcus, intestinal bacteria ...).

The use of immunosuppressants requires a strict regimen and is used with drugs to increase the patient's resistance.