Sepsis

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Introduction

This is a clinical syndrome resulting from bacterial blood stream infection with active proliferation of the organisms.

Early-Onset sepsis manifests within the first 48 hours of life or at most 7 days of life while Late-Onset sepsis manifests after 7 days of life.

Terminologies.

  • Early-Onset sepsis is presumed when risk factors for sepsis are present but the infant has no clinical feature suggestive of sepsis.
  • In probable sepsis, an infant has clinical and/or laboratory features suggestive of sepsis without bacteriological confirmation.
  • Sepsis is latent when clinical features are present with laboratory features such as deranged full blood count or elevated serum C-Reactive Proteins and serum Interleukins but without positive blood culture.
  • Sepsis is confirmed when blood culture is positive in addition to clinical manifestations.

Clinical Features

  • Non-specific features include fever, vomiting, poor feeding, poor activity
  • More specific features include hypothermia, poor skin color, jaundice, abdominal distension, respiratory distress, apnea and bleeding tendencies.
  • There may be local manifestations of serious illnesses such as omphalitis, otitis media, pneumonia, diarrhoea or urinary tract infestation.

Investigations

  • FBC and ESR
  • Elevated C-Reactive Protein
  • Elevated procalcitonin
  • Elevated interleukins 1,6,8 and positive blood culture
  • Others will include specific ancillary tests for localized diseases such as:
    • Chest X-Ray
    • Mid-stream urine
    • And other swabs for bacteriological studies

Treatment

  • For presumed sepsis in the developing world, it is recommended that blood culture should be requested and the infant is immediately commenced on empirical antibiotic therapy based on the local pattern of organisms and their sensitivity pattern.
    • Intravenous cefuroxime 50mg/kg 12-hourly and gentamicin 2.5mg/kg 12-hourly.
    • The infant should be closely monitored for any evidence of clinical deterioration.
    • If the infant remains asymptomatic and the blood culture yields no growth, the antibiotics can be safely discontinued after 48 hours.
  • For probable sepsis, blood culture should be requested while the infant is commenced on antibiotics:
    • intravenous second or third generation cephalosporins; Cefuroxime 50mg/kg 12-hourly or Ceftriaxone 75mg/kg daily or Cefotaxime 50mg/kg 8-hourly and gentamicin 2.5mg/kg 12-hourly for 10 to 14 days depending on the clinical response.
    • It may be necessary to change the antibiotics if the sensitivity report from the laboratory suggests resistance to the drugs in use.
  • Support care: Fluid and caloric balance, dextrose for hypoglycaemia, blood transfusion for severe anaemia, oxygen therapy and ventilators supports for hypoxaemia.