Septicaemia

28. Septicaemia




Questions


image What are the clinical features and possible causes of septicaemia?

image How is a blood culture taken?

Septicaemia is a clinical term describing signs of infection associated with microorganisms in the bloodstream. The term bacteraemia simply refers to the presence of bacteria in the blood, sometimes transiently, with or without symptoms. Septicaemia carries a high mortality and must be recognized, investigated and treated promptly.



Aetiology


There are a number of different risk factors associated with community- or hospital-acquired septicaemia. The incidence of many community-acquired infections has changed little in recent years, and typical risk factors are urinary tract infection, pneumonia, diabetes and old age. Common organisms are Escherichia coli, Neisseria meningitidis, Streptococcus pyogenes, Streptococcus pneumoniae and, in some countries, Salmonella typhi. In hospital-acquired infections, the increase in invasive procedures (intravascular lines, prosthetic implants or urinary catheters), immunosuppressive therapy and broad-spectrum antimicrobial drugs has led to an increase in the proportion of Gram-positive isolates, especially coagulase-negative staphylococci, although Gram-negative isolates (Pseudomonas spp. and enterobacteria) are also not uncommon. Figure 3.28.1 shows the organisms isolated in a large teaching hospital laboratory.


image

Fig. 3.28.1 Causes of hospital-acquired septicaemia.



Clinical features


The clinical features of septicaemia often include:


image fever, rigors

image tachycardia

image hypotension

image confusion or agitation

image evidence of a focus of infection.

In severe cases, the patient may present with circulatory collapse (shock) and the temperature may be paradoxically low (hypothermia). Acute infections are traditionally associated with Gram-negative bacteria but cannot be distinguished clinically from Gram-positive septicaemia. A careful history and examination may reveal the source of infection and help to predict the likely organism.

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Related posts:

Epidemiology of infectious diseases Infections of the immunocompromised host Pathogenesis of infectious disease Zoonoses Antibacterial therapy: principles Antibacterial therapy: practice

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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Septicaemia

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