新光医院感染科败血症951005.ppt

新光醫院感染科敗血症標準作業流程severe sepsis and septic shock 新光醫院 感染科 黃建賢 SEPSIS DEFINITIONS microbes involves a rapidly amplifying polyphony of signals and responses that may spread beyond the invaded tissue. 1. 敗血症的定義 敗血症的定義 1.1宿主因微生物感染大量繁殖並造而造成全身性症狀，臨床上可表現出發燒，低體溫，寒顫，呼吸加速，心搏加速，宿主因為微生物的侵犯而表現出”系統性發炎反應症候群”(systemic inflammatory response syndrome，SIRS) 1.2 ”系統性發炎反應症候群”定義為包函下列或兩者以上 1.2.1 體溫38度C以上或36度C以下 1.2.2 心跳速度超越每分鐘90下 1.2.3 呼吸速率超越每分鐘20下 1.2.4 血液中白血球大於每毫升12000或小於每毫升4000或含百分之10以上之不成熟白血球(bands) ETIOLOGY gram-negative and gram-positive bacteria fungi, mycobacteria, rickettsiae, viruses, or protozoans… Positive blood cultures : 30 to 60 % of patients with sepsis 60 to 80 % of patients with septic shock Sepsis EPIDEMIOLOGY 2/3: in hospitalized patients. Risk Factors to GNB bacteremia diabetes mellitus lymphoproliferative diseases cirrhosis of the liver burns invasive procedures or devices drugs that cause neutropenia EPIDEMIOLOGY Risk factors for GPC bacteremia vascular catheters, indwelling mechanical devices, burns, intravenous drug injection. Fungemia : immunosuppressed patients neutropenia broad-spectrum antimicrobial therapy TPN Intestinal perforation PATHOPHYSIOLOGYEndotoxin Gram negative bacilli Lipopolysaccharide (LPS, also called endotoxin) PATHOPHYSIOLOGYMicrobial signals Gram positive cocci peptidoglycan and lipoteichoic acids extracellular enzymes 敗血症的症狀 Fever or hypothermia (low body temperature) Hyperventilation Chills Shaking Warm skin Skin rash Rapid heart beat Confusion or delirium Decreased urine output CLINICAL MANIFESTATIONS S/S: fever, chills, tachycardia, tachypnea, altered mental status, and hypotension. afebrile common in neonates, in elderly patients and in persons with uremia or alcoholism. CLINICAL MANIFESTATIONS Llaboratory finding: C-reactive protein fibrinogen complement components transferrin inhibits albumin synthesis Leukocytosis, left shift LABORATORY FINDINGS Early sepsis leukocytosis with a left shift Res