Therapeutics - Sepsis 2

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kyleannkelsey
ID:
289368
Filename:
Therapeutics - Sepsis 2
Updated:
2014-11-16 15:08:33
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Therapeutics Sepsis
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Therapeutics - Sepsis
Description:
Therapeutics - Sepsis
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  1. Empiric combination therapy should not be administered for more than ______________.
    3–5 days
  2. Duration of therapy for sepsis is typically 7–10 days (3-5 for empiric). Longer courses may be appropriate in patients who have what conditions?
    • Slow clinical response
    • Undrainable foci of infection
    • Bacteremia with S. aureus
    • Some fungal and viral infections
    • Immunologic deficiencies
    • Neutropenia
  3. What patient parameters should be assessed when determining therapy for Community Acquired sepsis?
    • Collect cultures first
    • Treat with broad-spectrum coverage if organism
    • is uncertain (ensure adequate coverage)
    • Do not delay therapy
    • Consider local resistance patterns
    • Assess prior antibiotic use
  4. What is the relative incidence of G- vs. G+ organisms in microbial sepsis?
    • G- 43%
    • G+ 38%
    • Mixed 14%
    • Fungi 5%
    • Anaerobic 2%
  5. What are the common G + pathogens that cause G+?
    • Staphylococcus aureus 13%
    • Enterococci 8%
    • Coagulase-negative staphylococci 7%
    • Streptococcus pneumonia 4%
  6. What are the common G - pathogens that cause G-?
    • Escherichia coli 12%
    • Klebsiella pneumonia 8%
    • Pseudomonas aeruginosa 8%
    • Enterobacter species 6%
  7. What comorbidities put a patient at risk for G- sepsis?
    • Diabetes mellitus
    • Lymphoproliferative diseases
    • Cirrhosis
    • Burns
    • Invasive procedures/devices
    • Neutropenia due to immunosuppressive therapy
    • UTI
  8. What comorbidities put a patient at risk for G- sepsis?
    • Vascular catheterization
    • Indwelling mechanical devices
    • Burns
    • IV drug use
    • COPD
    • Chronic heart disease
  9. What are the main sites for primary infection for severe sepsis?
    • Lung
    • Bloodstream
    • IA
    • UT
    • Skin/Soft tissues
  10. What are the common pathogens that cause sepsis and arise from the lung?
    • Streptococcus pneumoniae
    • Haemophilus influenzae
    • Legionella species
    • Chlamydia pneumoniae
    • Pneumocystis carinii
  11. What is the Antimicrobial treatment recommended for Community-acquired Lung derived sepsis?
    • Ceftriaxone 1-2 g q24h or cefotaxime 1-2 g q8h or ampicillin/sulbactam 3 g q6h
    • +
    • Azithromycin 0.5 g q24h or levofloxacin 0.5 g q24h
  12. What is the Antimicrobial treatment recommended for Nosocomial Lung derived sepsis?
    • Vancomycin (15 mg/kg q 12h) or linezolid (600 mg q 12h)
    • +
    • Aminoglycoside (gentamicin, tobramycin),† or fluoroquinolone (ciprofloxacin
    • 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)‡
    • +
    • Antipseudomonal cephalosporin (ceftazidime 1-2 g q8h or cefepime 1-2 g q12h)
    • ORCarbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h)
    • OR
    • B-Lactam/B-Lactamase inhibitor (piperacillin-tazobactam 4.5 g q6h
  13. What are the common pathogens that cause sepsis and arise from the Abdomen?
    • Escherichia coli
    • Bacteroides fragilis
  14. What is the Antimicrobial treatment recommended for Community-acquired Abdomen derived sepsis?
    • Carbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h) or piperacillin-tazobactam 4.5 g q6h
    • OR
    • Antipseudomonal cephalosporin (ceftazidime 1-2 g q8h, cefepime 1-2 g q12h) or aminoglycoside (gentamicin, tobramycin)or fluoroquinolone (ciprofloxacin 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)
    • +
    • Metronidazole 0.5 g q8h
    • (Same as Nosocomial)
  15. What is the Antimicrobial treatment recommended for Nosocomial Abdomen derived sepsis?
    • Carbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h) or piperacillin-tazobactam 4.5 g q6h
    • OR
    • Antipseudomonal cephalosporin (ceftazidime 1-2 g q8h, cefepime 1-2 g q12h) or aminoglycoside (gentamicin, tobramycin)or fluoroquinolone (ciprofloxacin 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)
    • +
    • Metronidazole 0.5 g q8h
    • (Same as community)
  16. What are the common pathogens that cause sepsis and arise from the Urinary Tract?
    • Escherichia coli
    • Klebsiella species
    • Enterobacter species
    • Proteus species
  17. What is the Antimicrobial treatment recommended for Community-acquired Urinary Tract derived sepsis?
    Ceftriaxone 1-2 g q24h or cefotaxime 1-2 g q8h or fluoroquinolone (ciprofloxacin 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)
  18. What is the Antimicrobial treatment recommended for Nosocomial Urinary Tract derived sepsis?
    • Antipseudomonal cephalosporin (ceftazidime 1-2 g q8h, cefepime 1-2 g q12h)
    • OR
    • Aminoglycoside (gentamicin, tobramycin)† or fluoroquinolone (ciprofloxacin 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)‡ or carbapenem or extended spectrum penicillin
  19. What are the common pathogens that cause sepsis and arise from the Skin and Soft Tissue?
    • Group A streptococcus
    • Staphylococcus aureus
    • Clostridium species
  20. What is the Antimicrobial treatment recommended for Community-acquired Skin and Soft Tissue derived sepsis?
    Carbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h) or piperacillin-tazobactam 4.5 g q6h
  21. What is the Antimicrobial treatment recommended for Nosocomial Skin and Soft Tissue derived sepsis?
    • Carbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h) or piperacillin-tazobactam 4.5 g q6h
    • +/-
    • Vancomycin 1 g q12h
  22. What is the Antimicrobial treatment recommended for Community-acquired sepsis from an unknown source?
    • Antipseudomonal cephalosporin (ceftazidime 1-2 g q8h, cefepime 1-2 g q12h)
    • OR
    • Carbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h)
    • OR
    • ß-Lactam/ß-lactamase inhibitor (piperacillin-tazobactam 4.5 g q6h)
    • +
    • Aminoglycoside (gentamicin, tobramycin)† or fluoroquinolone (ciprofloxacin 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)
    • +
    • Vancomycin (15 mg/kg q 12h) or linezolid (600 mg q 12h)
    • (Same as nosocomial)
  23. What is the Antimicrobial treatment recommended for Nosocomial derived sepsis from an unknown source?
    • Antipseudomonal cephalosporin (ceftazidime 1-2 g q8h, cefepime 1-2 g q12h)
    • OR
    • Carbapenem (imipenem-cilastatin 0.5 g q6h, meropenem 1 g q8h)
    • OR
    • ß-Lactam/ß-lactamase inhibitor (piperacillin-tazobactam 4.5 g q6h)
    • +
    • Aminoglycoside (gentamicin, tobramycin)† or fluoroquinolone (ciprofloxacin 0.4 g q8-12h, levofloxacin 0.5-0.75 g q24h)
    • +
    • Vancomycin (15 mg/kg q 12h) or linezolid (600 mg q 12h)
    • (Same as Community)
  24. How long after diagnosis of sepsis does an anatomical identification of the source and commencement of intervention has to have occured?
    • 12 hours
    • Excludes: pancreatitis until necrotic and non-necrotic tissue is determined
  25. How should ventilator associated pneumonia (Leading to sepsis) be prophylaxed?
    • Selective oral decontamination and selective digestive decontamination should be introduced and investigated
    • Oral chlorhexidine gluconate be used as a form of oropharyngeal decontamination (Swab)
  26. What is the recommended Hemodynamic Support and Adjunctive Therapy for sepsis?
    • Fluid therapy
    • Vasopressors
    • Inotropic therapy
    • Corticosteroids

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