Pharmacotherapy/Treatment Of Septicemia (Sepsis)

Septicemia is an infection of the blood by bacteria and it's toxins. It can lead to death if not treated on time and treated well. It begins with tissue damage, organ failure, septic shock and eventually death. Organ failure such as kidney failure, dead tissue (gangrene) on fingers and toes leading to amputation, heart, brain and lungs damage.

The bacteria can be of any origin. They managed to get to the blood where it gets to the heart and distributed to every part of the body. The body's immune system respond causing inflammatory reaction. It is these inflammatory responses that lead to septicemia complications.

Septicemia caused by bacteria can be called bacteremia. However, it has been shown that funga, virus and protozoan (eikenella corrodens, haemophilus influenzae, and candida) can also cause it.

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Septicemia affects about 1 million Americans yearly. About 28-50 percent die. Majority of those who enter septic shock don't survive.

There are three stages of septicemia. They are sepsis, severe sepsis and septic shock.

Septic Shock

Septic shock is a situation whereby the systolic blood pressure becomes dangerously low with inflammation. Toxins are responsible for low blood pressure. A systolic blood pressure reading of less than 100mgHg with other symptoms is considered septic shocks. The other symptoms are;

1. Confuse and losing alertness

2. Feeling dizzy or faint

3. Unusual mental changes including fear of dooms day or death

4. Slurred speech

5. Difficulty breathing

6. Difficulty passing urine with little quantity

7. Nausea, diarrhea and vomiting

8. Cold, pale or mottled skin

9.  Cold, pale or unusual warm extremities

Septicemia
Wikipedia

Symptoms Of Septicemia

1. Hemorrhagic rash that gets bigger and begins to look like fresh bruise. They eventually join together to form a larger area of purple skin discoloration and damage.

2. Loss of appetite and interest in the surrounding

3. Fever

4. Increase in heart rate

5. Nausea and vomiting

6. Photophobia

7. Pain, cold in hands and feet

8. Lethargy, anxious, agitated and confuse

9. Meningitis

10. Coma and death

Cause

1. Pneumonia

2. Urinary tract infection (UTI)

3. Soft tissue infection (skin infection, intestine and gut)

Common infections among them are pneumonia aeruginosa, staphylococcus aureus, escherichia coli, some species of streptococcus, enterococcus and klebsiella. Infection of the blood with these microbes lead to inflammation that causes blood clot. This prevents the transport of oxygen to vital organs.

Acute respiratory distress syndrome (ARDS) prevents oxygen from reaching the lungs and blood leading to lung and brain damage. Systemic inflammatory response syndrome (SIRS) is the whole body response to insult which could be infection. SIRS can be used for diagnosis.

Risk Factors

1. Diabetes

2. Cancer

3. Kidney disease

4. Weak immune system

5. Lung disease

6. Children below the age of 6 years and adults above 65 years old

Diagnosis

Any test or diagnosis to determine any type of known infection. They include but not limited to urine, wound, respiratory secretion and blood test. Blood test to find the chemical characteristics of the blood can also be use to diagnose septicemia or blood infection. They are carbon dioxide and oxygen level. This can be use to predict organ damage. Also, cell and platelets count can be used to indicate the presence of infection. X-ray, CT scan, MRI and ultrasound are other tests required as time permits.

The use of physical finding is very important in management of septicemia. This is because disease progression is very fast. Waiting for laboratory investigations before commencement of therapy can be dangerous. Hence the need to critically access patient physical condition to predict the presence of blood infection or septicemia and possible the type of infection.

The first diagnosis is blood pressure. Low blood pressure is a very important marker and most not be ignored. Others are fever, increased heart rate and increased breathing rate.

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But due to difficulty in diagnosing septicemia, the following guidelines have been recommended. Treatment of septicemia should begin pending laboratory investigations if the patient has two out of these three datas; an altered mental status, increase respiratory rate of more than 22 beat/minutes and low systolic blood pressure below 100mgHg. The quick sequential organ failure assessment (qSOFA) is one of the many types of score given to different methods of defining organ failure in septicemia.

Four SIRS criteria were defined, namely tachycardia (heart rate >90 beats/min), tachypnea (respiratory rate >20 breaths/min), fever or hypothermia (temperature >38 or <36 °C), and leukocytosis, leukopenia, or bandemia (white blood cells >1,200/mm3, <4,000/mm3 or bandemia ≥10%).

Accelerate pheno test BC kit has been approved by food and drug administration (FDA) for diagnosis. It is a test that provides a wide range of information from laboratory findings down to recommendation of best drugs within 42 hours. However, prescribers can give a broad spectrum antibiotics pending when the result will be out.

Pharmacotherapy/Treatment Of Septicemia

Treatment is at the hospital. Most septicemia occur in hospitalised patient. The main goal is to maintain blood flow to organs. To achieve this, intravenous fluids and ventilators help keep organs supplied with blood and oxygen. Antibiotics are needed immediately.

Both oral and parenteral antibiotics can be combined. It is recommended to combine 2 or 3 broad spectrum antibiotics and laboratory findings are available. Vancomycin is used to treat methicillin resistant staphylococcus aureus (MRSA). Others are ceftriaxone, meropenem, ceftazidime, cefotaxime, cefepime, piperacillin and tazobactam, ampicillin and sulbactam, imipenem and cilastatin, levofloxacin and clindamycin.

Norepinephrine and phenylephrine is used to treat low blood pressure. In critical cases, a ventilator can be added.

Prevention is simple hygiene and treatment of chronic disease conditions.