Septicaemia

Bacteraemia = "presence of bacteria in blood"

Aet
- N flora - access to bloodstream
eg dental & soft tissue abscesses/cholecystitis/appendicitis/diverticulitis/upper renal tract infection
- **prosthetic surgery (orthop, CVS, neuro) - prosth can be 'seeded' by organism & infect irrev
- Pneumonia - S pneum
- Skin - S pyogenes/S aureus

Sy&Si

Asy (pray that it's not)
or
Severely ill
Fever (absent with child/eld)
Shock (later presentation)
Depressed consciousness (confused/drowsy)
?GN-ve vs G+ve - cannot clinically differentiate

h/e signs poss...
- N meningitidis - purpura
- S Aureus - embolic lesions
- N Gonorrhoeae - arthritis

Dx
x2 peripheral blood cultures b4 Tx
Septic screen
- blood cultures

- urine cult

- sputum cult

- CSF

- skin swabs

- CXR/AXR
- abdo US

Tx
1) empirical DO NOT WAIT!!! - BSp

Empirical Therapies

Skin - strep & staph
-Flucloxacillin
Abdo sepsis - enterobacteriaceae & obligate anerobes
-Ceftazidime & metronidazole/meropenem
Prosthetic devices - staphylococci
-Fluclox/vanc
Urinary Tract - enterobacteriaceae & enterococci
-Piperacillin/tazobactam (init if Hosp acq & sev)
Meninges - N Meningitidis, S pneumoniae, H influenzae
-Benzyl penicillin/Cefotaxime

Line-related septicaemia
- increased risk with time
- S aureus, S epidermidis, Klebsiella
- look for inflammation - remove if susp infection

- Ix - blood cultures from peripherally through cannula
- Tx - ABs, Glycopeptide (MRSA)

- Prevention - ANTT, device w/o dead space/side ports, good dressing, staff hygiene, regular inspection, periph resited every 48hrs, central & tunnelled lines - inspection changed with evidence of infection

- Cx - septicaemia, endocarditis, metastatic infection (eg OMyelitis)

Puerperal Fever
Sev
*bacteraemic infection
Entry of pathogens throo placental bed/cervix following delivery
*w/i 7d of deliv

Sy
Fever
Back pain
Offensive lochia
Shock

Ix

Fever - if in early puerperium = Ix! - bl/ur cult/endocervical swabs

Tx
Empirical
3rd gen cephalosporin & metronidazole
Remove any retained products of contraception
Intensive care if necess

Cx
DIC