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Chapter 26. Sepsis Syndromes

Select the definition that describes a patient with septic shock.

a. GH has the presence of bacteria within the blood.

b. HH has a systemic inflammatory response to a clinical insult.

c. JA has an infection associated with organ dysfunction.

d. KS has an infection with persistent hypotension despite fluid resuscitation.

Answer d is correct. Septic shock is defined as sepsis with persistent hypotension despite fluid resuscitation. The American College of Chest Physicians and the Society of Critical Care Medicine developed definitions related to sepsis. Physiologic parameters categorize patients as having bacteremia, infection, sepsis, septic shock, and multiple-organ system failure.

Answer a is incorrect. Bacteremia (or fungemia) is the presence of viable bacteria (or fungi) within the bloodstream.

Answer b is incorrect. Systemic inflammatory responses to a variety of clinical insults can be either infectious or noninfectious.

Answer c is incorrect. This fits more with the definition of sepsis as outlined in the 2016 guideline update.

ZB is a patient with sepsis in the intensive care unit (ICU). ZB is currently receiving piperacillin/tazobactam, tobramycin, and vancomycin to treat his infection. The source of his infection is currently unknown. What type of organism(s) may cause septic shock? Select all that apply.

a. Gram-positive bacteria

b. Gram-negative bacteria

c. Fungal species

d. Viruses

Answer a is correct. Gram-positive and gram-negative bacteria, fungal species, and viruses cause sepsis. Gram-positive infections account for 30% to 50% of sepsis and septic shock cases. Additionally, multidrug-resistant bacteria are responsible for approximately 25% of sepsis cases, are difficult to treat, and increase mortality.

Answer b is correct. Gram-negative bacteria sepsis cases represent 25% of cases and multidrug-resistant bacteria are common.

Answer c is correct. The rate of fungal sepsis has increased 200% in recent years. This patient is not currently receiving fungal treatment. If the patient was not responding to the initial treatment a thorough evaluation of fungal risk factors should occur and empiric antifungal therapy should be considered.

Answer d is correct. Viral infections represent 4% of sepsis cases and could include viruses such as influenza and herpes simplex. An evaluation for risk factors and patient history should occur to guide consideration for empiric antiviral therapy.

Which of the following components make up the qSOFA score? Select all that apply.

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