Sepsis

A41.9

For Neonatal Sepsis see Septicaemia of the Newborn .

• Description
• Diagnostic criteria
• General and supportive measures
• Medicine treatment
• Referral

DESCRIPTION

Severe sepsis is an uncontrolled inflammatory response as a result of suspected or proven infection.

DIAGNOSTIC CRITERIA

Clinical

• A systemic inflammatory response with at least two of the following four criteria, one of which must be abnormal temperature or leucocyte count:
  • core temperature of < 36ºC or > 38.5ºC,
  • tachycardia,
  • tachypnoea,
  • elevated leucocyte count,
    PLUS , one of the following:
  • cardiovascular dysfunction,
  • acute respiratory distress syndrome, or
  • ≥ 2 other organ dysfunctions.

Investigations

• Blood culture and identify focus of infection e.g. osteomyelitis, abscess.
• Investigate for malaria especially in endemic areas or if there is a relevant travel history.
• Where meningitis due to meningococcus is suspected, i.e. with petechial rash, lumbar puncture is contraindicated (see Lumbar Puncture ). Do petechial scrapes and blood culture to confirm diagnosis.

GENERAL AND SUPPORTIVE MEASURES

• For suspected meningococcemia: Notifiable condition and requires isolation for 24h after commencement of appropriate antibiotics.
• Admit to high care area.
• Early recognition and treatment of septic shock.
• Antimicrobials do not penetrate necrotic tissue or abscesses, so debridement, incision and drainage are essential aspects of care.

MEDICINE TREATMENT

Empiric antibiotic therapy

Choice of antibiotic depends on the severity of the condition and predisposing factors.

• Ceftriaxone, IV, 50 mg/kg/dose 12 hourly for 7 days.

Confirmed meningococcal septicaemia

• Benzylpenicillin (Penicillin G), IV, 100 000 units/kg/dose immediately, then 4 hourly for 7 days.

Suspected staphylococcal infection (e.g. osteomyelitis)

• Cloxacillin, IV, 50 mg/kg/dose 6 hourly.
  PLUS
  
• Ceftriaxone, IV, 50 mg/kg/dose, 12 hourly.

Reconsider choice of antibiotic, aiming for monotherapy where possible, when the results of cultures become available or if the child does not improve.

Continue IV antibiotics until there is a good clinical response and laboratory markers of infection improve (usually less than a week). Oral antibiotics are then appropriate.

See Staphylococcal Septicaemia , for management of invasive S. aureus infections.

Nosocomial sepsis: manage according to the background microbiological flora within your institution.

Septic shock

See Shock .

REFERRAL

• Septicaemia with complications.
• Patients requiring intensive care.
• Patients requiring debridement of necrotic areas or drainage of collections.