SEPSIS

Diagnostic clinic si paraclinic

SIRS ( Systemic Inflammatory Response Syndrome)

Tahicardie ( > 90/min )

Tahipnee ( >20 resp/min )

Febra > 38,5 °C sau hipotermie ( 35,5 °C )

± leucocitoza

± trombocitopenie

SEPSIS = SIRS + dovada clinica / paraclinica a prezentei unei bacterii

SEPSIS SEVER SEPSIS + o insuficienta de organ / sistem

Cardio-vascular	-AV < 55 /min -TAS < 80 mm Hg -Tahicardie sau fibrilatie atriala recent aparute -PH arterial <7,25 sau paCO₂ > 50 mm Hg
Respirator	-frecv. resp > 50/min sau < 5/min -paCO₂ > 50 mm Hg -dependenta de respiratie artificiala 24 ore
Renal	- creatinina >3,5 mg/dl -uree >120 mg/ dl -diureza < 480 ml / 24 ore
Hematologic	-nr. leucocite <1.000 /mmc -nr. trombocite <20.000 /mmc -hematocrit <20%
Hepatic	-conc. de protrombina < 15 % -bilirubina totala >6 mg/dl
SNC	- scor Glasgow <6

SOC SEPTIC = SEPSIS + insuficienta aparatului cardio-vascular ( forma de sepsis

sever )

MSOF (Multiple Systemic Organ Failure ) = SEPSIS + min 3 insuf. de organ / sistem

-hemoculturi

-culturi din lichide / umori normal sterile ( LCR, lichid pleural, lichid pericardic, lichid articular etc.)

-culturi din focarele septice

Terapia de prima intentie, pana la izolarea si identificarea agentului patogen

( terapie de de-escaladare )

CARBAPENEME - Imipenem + Cilastatin

Ertapenem

CEFALOSPORINE - gen. III - Ceftriaxona

- Ceftazidim

- Cefoperazona

- gen. IV - Cefepim

- Cefpirom

GLICOPEPTIDE - Teicoplanina

OXAZOLIDINONE - Linezolid

± AMINOGLICOZIDE gen. III ( in asociere ) - Amikacina,

- Netilmicina

± FLUORCHINOLONE gen. III - Moxifloxacin, Levofloxacin

± Peniciline cu spectru larg + inhibitori de β lactamaza

(pt. suspiciunea de BGN, piocianic)

- Ticarcilina + Acid clavulanic ( Timentin)

- Piperacilina + Tazobactam ( Tazocin )

Propuneri de terapie specifica ( dupa izolarea si identificarea agentului etiologic )

AGENTUL ETIOLOGIC	TERAPIE RECOMANDATA DE PRIMA INTENTIE	ALTERNATIVE
meningococ	Ceftriaxona	Penicilina G
Streptococ β hemolitic gr. A	Penicilina G	Macrolide
Pneumococ - Pen - sensibil	AminoPen + inh β lactamaze	Penicilina G
Pneumococ - Pen - rezistent	Cefalosporine gen. III	Fluorchinolone gen III Glicopeptide ( Teicoplanina )
Streptococ gr. B	Ceftriaxona ± aminoglicozid
Enterococ - ampi - sensibil	Aminopeniciline ± aminoglicozid
Enterococ - ampi - rezistent	AminoPen + inh β lactamaze ± aminoglicozid	Glicopeptide / Carbapeneme ± aminoglicozid
Enterococ - genta - rezistent	AminoPen + inh β lactamaze	Glicopeptide / Carbapeneme
Enterococ vanco - rezistent	Linezolid	Cefalosporine gen. IV / Tazocin
Stafilococ auriu - meti - sensibil	Oxacilina + aminoglicozid	Fluorchinolone Cefalosporine gen I
Stafilococ auriu - meti - rezistent	Glicopeptide Carbapeneme	Linezolid Cefalosporine gen. IV
Haemophilus influenzae	Ceftriaxona	AminoPen + inh β lactamaze Cloramfenicol
BGN	Cefalosporine gen. III / Tazocin + aminoglicozid	Fluorchinolone + aminoglicozid Carbapeneme
Bacil piocianic	Carbapeneme Cefalosporine gen. IV	Cefalosporine gen. III / Tazocin Fluorchinolone
anaerobi	Carbapeneme	Metronidazol Cloramfenicol