Sepsis defined

Severe disease is defined as the presence of complications of colitis, such as sepsis, volume depletion, electrolyte imbalance, hypotension, paralytic ileus, and toxic megacolon. Patients with signs of severe disease should receive oral vancomycin as initial therapy. Surgical intervention may be indicated and lifesaving, particularly in cases complicated by toxic megacolon or colonic perforation. 

O Sepsis represents a continuum of physiologic stages that is defined by categories that describe the sepsis process. 

L7. Leithauser, B., Matthias, F. R Nicolai, U., and Voss, R., Hemostatic abnormalities and the severity of illness in patients at the onset of clinically defined sepsis. Intensive Care Med. 22, 631-636(1996). 

Bacterial translocation is defined as the passage of viable indigenous bacteria from the GI tract to extraintesti-nal sites, such as the mesenteric lymph node complex, liver, spleen and bloodstream [183], Three major mechanisms promote bacterial translocation intestinal bacterial overgrowth, deficiencies in host immune defenses and increased permeability or damage to the intestinal mucosal barrier [184], These mechanisms can act in concert to promote synergistically the systemic spread of indigenous translocating bacteria to cause lethal sepsis. 

Systemic infections are those that have microorganisms (bacteria, viruses, yeasts, parasites) spread, usually via the bloodstream, beyond the portal of entry or original site of localized infection to multiple compartments of the body. When infections, either localized or systemic, are accompanied by signs and symptoms of a systemic inflammatory response (fever, rapid pulse, increase in white blood cells) the syndrome is called sepsis. Severe sepsis is defined by the additional occurrence of organ failure (either kidney, liver, brain, lungs), and is a potentially fatal condition (mortality around 50%). If there is hypotension not responding on fluid resuscitation it is called septic shock and the mortally is even higher (60-70%). 

In humans, sepsis can follow pulmonary and nonpulmonary infections, and ARDS can occur in either clinical setting (reviewed in ref. 5). Sepsis is defined as the systemic response to a definite or probable tissue infection, and typically includes changes in body temperature, blood leukocyte counts, hemodynamic parameters, and organ function (6). There is an important distinction to be made between bacteremia, defined simply by a positive blood culture, and sepsis, which includes a specific systemic response. Most cases of bacteremia are not associated with clinical evidence of sepsis, and bacteremia by itself is rarely associated with ARDS (7). Rather, it appears that a primary tissue infection is an important requirement for the onset of sepsis in humans, and an important antecedent for ARDS whether or not bacteremia is detectable (8). 

GBS remains a serious cause of neonatal infection. GBS disease in the newborn is classified as either early disease, which occurs within 1 week of fife and usually presents as a sepsis syndrome or pneumonia, or late disease, which is defined as that presenting at greater than 1 week of life and that presents most commonly as sepsis or meningitis. 

The use of corticosteroids in the treatment of septic shock has been a topic of controversy for many years. A meta-analysis of early studies of steroids in sepsis demonstrated a lack of benefit and potential harm in sepsis and septic shock. There is a renewed interest in corticosteroid use because of the increased awareness of adrenocortical insufficiency in critically ill patients with septic shock. Relative adrenal insufficiency has been defined as a poor adrenal response [<250 nmol/L (9 mcg/dL) irrespective of the initial serum cortisol level] to a dose of synthetic adrenocorticotropic hormone (ACTH), indicating a low fnnctional reserve of the adrenal cortex. Although absolute insufficiency is rare, relative adrenocortical insufficiency in the presence of normal or high cortisol concentrations at baseline is present in 30% to 50% of patients with septic shock and is associated with a poor outcome. ... 

Anemia is a common complication in critically ill patients and is almost universally found in this patient population. Contributing factors include sepsis, frequent blood samples, surgical blood loss, immune-mediated functional iron deficiency, decreased erythropoietin (EPO) production, reduced RBC life span, and gastrointestinal bleeding. Low serum iron, TIBC, and a low iron TIBC ratio result. Serum ferritin is normal to high. The role of EPO in treatment is yet to be defined. 

A UTI is defined as the presence of microorganisms in the urinary tract that caimot he accounted for hy contamination. The organisms present have the potential to invade the tissues of the urinary tract and adjacent structures. Infection may he limited to the growth of bacteria in the urine, which frequently may not produce symptoms. A UTI can present as several syndromes associated with an inflammatory response to microbial invasion and can range from asymptomatic bacteriuria to pyelonephritis with bacteremia or sepsis. 

Nitric oxide (NO), a potent endogenous vasodilator, improved arterial oxygenation and reduced pulmonary artery pressures in patients with ARDS. However, it is also associated with hypotension, as well as being a mediator of sepsis-induced refractoriness to the vasopressor effects of catecholamines. Additional work is needed to define any role for NO and ketoconazole in the management of sepsis. 

Hypertriglyceridemia, defined as serum triglyceride concentrations of 400 to 500 mg/dL in adults and 150 to 200 mg/dL in preterm infants, neonates, and older pediatric patients, may occur in patients receiving IVLE-based PN. Risk factors include preexisting liver or pancreatic dysfunction, sepsis, multiple organ failure, degree of prematurity, rate of IVLE infusion, and dose. ... 

Delayed catheter-related infections are divided into (1) exit site infections, (2) subcutaneous turmel or pocket infection, and (3) catheter-related bacteremia or sepsis (Raad and Bodey 1992). Exit site infections are defined as erythema and tenderness confined to 1 cm around the catheter exit site. A purulent exudate may also be present. The more serious turmel or pocket infection presents with tenderness and erythema over the pocket or along the turmel. Fluctuation suggests a subcutaneous abscess and demands immediate attention. Patients with catheter-related bacteremia often present with fever and a leukocytosis. Unfortunately, this is often a diagnosis of exclusion in a patient with a febrile illness with an indweUing catheter and no other apparent source of infection. More specific indications of a true... 

Bermejo-Martin JF, Andaluz-Ojeda D, Almansa R et al (2016) Defining immunologictil dysfunction in sepsis a requisite tool for precision medicine. J Infect 72(5) 525-536 Bu LL, Yang K, Xiong WX et al (2016) Toward precision medicine in Parkinson s disease. Ann... 

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