Editing Urinary Tract Infections (section)

== Bacteremia, sepsis, and septic shock ==

* '''Definitions:'''
** '''Systemic inflammatory response syndrome (SIRS): a clinical syndrome characterized by extremes of body temperature, heart rate, ventilation, and immune response.'''
*** SIRS can occur in response to multiple insults, including systemic infection, trauma, thermal injury, or a sterile inflammation.
** '''Sepsis: SIRS + infection (either documented or strongly suspected)'''
** '''Severe sepsis: sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion, typically systolic blood pressure (SBP) <90 mm Hg or mean arterial pressure (MAP) <70 mm Hg'''
** '''Septic shock: an extreme form of sepsis with sepsis-induced hypotension persisting despite adequate fluid resuscitation; findings may include elevated lactic acid or oliguria'''
* '''Earliest metabolic change in septicemia is respiratory alkalosis'''
** '''Even before temperature extremes and the onset of chills, bacteremic patients often begin to hyperventilate, resulting in respiratory alkalosis'''
* In classic studies of sepsis syndrome and septic shock, gram-negative bacteria were predominant organisms isolated in 30-80% of cases and gram-positive bacteria in 5-24%.
** '''Anaerobic organisms may cause bacteremia when the source is a postsurgical intra-abdominal abscess or transrectal prostatic biopsy.'''
** '''The prime initiator of gram-negative bacterial septic shock is endotoxin, an LPS component of the bacterial outer membrane.'''
*** The exotoxins produced by some bacteria can initiate septic shock. However, the bacteria themselves, and in particular their cell wall components, are primarily responsible for the development of septic shock.
* Clinical factors have been predictive of the subsequent isolation of a resistant pathogen:
** Use of an antimicrobial drug in the last month
** Advanced age
** Male sex
* The principles of management of sepsis include resuscitation, supportive care, monitoring, administration of broad-spectrum antimicrobial agents, and drainage or elimination of infection