Upon completion of the chapter, the reader will be able to:
Compare and contrast the definitions of syndromes related to sepsis.
Identify the pathogens associated with sepsis.
Discuss the pathophysiology of sepsis as it relates to pro- and anti-inflammatory mediators.
Identify patient symptoms as early or late sepsis and evaluate diagnostic and laboratory tests for patient treatment and monitoring.
Assess complications of sepsis and discuss their impact on patient outcomes.
Design desired treatment outcomes for septic patients.
Formulate a treatment and monitoring plan (pharmacologic and nonpharmacologic) for septic patients.
Evaluate patient response and devise alternative treatment regimens for nonresponding septic patients.
Sepsis is a continuum of stages defined by physiologic measures and signs and symptoms of a sepsis process.
Gram-positive and gram-negative bacteria, fungal species, and viruses may cause sepsis.
Inflammation is the key factor in the development of sepsis. Patients with severe infections, trauma, debilitating conditions, or an immunocompromised status may experience an imbalance among inflammatory mediators that progresses to sepsis.
The cumulative burden of sepsis complications is the leading factor of mortality. The risk of death increases 20% with failure of each additional organ. Severe sepsis averages two failed organs, with a mortality rate of 40%.
Treatment is aimed at early goal-directed resuscitation; reducing or eliminating organ failures; treating and eliminating the source of infection; avoiding adverse reactions of treatment; and providing cost-effective therapy.
Appropriate empiric anti-infective therapy administered within 1 hour of the recognition of sepsis decreases complications and 28-day mortality.
Sepsis is a continuum of physiologic stages characterized by infection, systemic inflammation, and hypoperfusion with widespread tissue injury.1 The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions to utilize for sepsis (Table 82–1).2 Physiologic parameters categorize patients as having bacteremia, infection, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, or multiple-organ dysfunction syndrome (MODS).2 Standardized definitions have been developed for infections in critically ill patients.3
Table 82–1Definitions Related to Sepsis |Favorite Table|Download (.pdf) Table 82–1 Definitions Related to Sepsis
Bacteremia (fungemia): Presence of viable bacteria or fungi in the bloodstream.
Infection: Inflammatory response to invasion of normally sterile host tissue by microorganisms.
SIRS: A systemic inflammatory response to a variety of clinical insults that can be infectious, but can have a noninfectious etiology. The response is manifested by two or more of the following conditions: temperature greater than 38.0°C (100.4°F) or less than 36.0°C (96.8°F); pulse greater than 90 beats/min; respir-atory rate greater than 20 breaths/min or Paco2 less than 32 torr or mm Hg (4.26 kPa); WBC count greater than 12 × 103/mm3 (12 × 109/L), less than 4 × 103/mm3 (4 × 109/L), or greater than 10% (0.10) immature (band) forms.
Log In to View More
If your institution is currently a subscriber
of Pharmacotherapy Principles & Practice please sign in below.
If your institution is not a subscriber
please click here
to learn more.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.