[MEDSCAPE测验]: 更新你对全身性感染的认知(2/6) | 中国病理生理学会危重病医学专业委员会
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[MEDSCAPE测验]: 更新你对全身性感染的认知(2/6)
2018年07月21日 临床话题, 基本知识 暂无评论

Fast Five Quiz: Refresh Your Knowledge on Key Aspects of Sepsis

Richard H. Sinert, DO

June 07, 2018

Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection. Organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score greater than 2 points secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality. Septic shock is defined by persisting hypotension that requires vasopressors to maintain a mean arterial pressure of 65 mm Hg or higher and a serum lactate level greater than 2 mmol/L (18 mg/dL) despite adequate volume resuscitation.

Detrimental host responses to infection occupy a continuum that ranges from sepsis to severe sepsis to septic shock and multiple organ dysfunction syndrome (MODS). The specific clinical features depend on where the patient falls on that continuum. Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations.

Do you know important attributes of sepsis presentation, diagnosis, and treatment? Test your knowledge with this quick quiz.

Q1: Which of the following is accurate about the etiology and epidemiology of sepsis?

A1: Risk factors for sepsis and septic shock include extremes of age (<10 years, >70 years) and underlying genetic susceptibility

Risk factors for severe sepsis and septic shock include the following:

  • Extremes of age (<10 years and >70 years)
  • Primary diseases (eg, liver cirrhosis, alcoholism, diabetes, cardiopulmonary diseases, solid malignancy, and hematologic malignancy)
  • Immunosuppression (eg, from neutropenia, immunosuppressive therapy [eg, in organ and bone marrow transplant recipients], corticosteroid therapy, injection or intravenous drug use, complement deficiencies, asplenia)
  • Major surgery, trauma, or burns
  • Invasive procedures (eg, placement of catheters, intravascular devices, prosthetic devices, hemodialysis and peritoneal dialysis catheters, or endotracheal tubes)
  • Previous antibiotic treatment
  • Prolonged hospitalization
  • Underlying genetic susceptibility
  • Other factors (eg, childbirth, abortion, and malnutrition)

In the more common form of MODS, the lungs are the predominant, and often the only, organ system affected until very late in the disease. Patients with this form of MODS most often present with a primary pulmonary disorder (eg, pneumonia, aspiration, lung contusion, near-drowning, chronic obstructive pulmonary disease exacerbation, hemorrhage, or pulmonary embolism). In the second, less common, form of MODS, the presentation is quite different. Patients affected by this form often have an inciting source of sepsis in organs other than the lung; the most common sources are intra-abdominal sepsis, extensive blood loss, pancreatitis, and vascular catastrophes.

In most patients with sepsis, a source of infection can be identified. The exceptions are patients who are immunocompromised with neutropenia, in whom an obvious source often is not found. Respiratory tract and abdominal infections are the most frequent causes of sepsis, followed by urinary tract and soft tissue infections.

For more on the etiology and epidemiology of sepsis, read here.

Which of the following is accurate about the presentation and physical examination of sepsis?

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