外科感染 英语.ppt

Risks Factors of Sepsis Immunocompromised patients More frequent use of invasive devices or procedure Greater availability of life-sustaining technology Higher frequency of infections caused by resistant organisms Aging population Distribution of Sepsis Gram-Negative Sepsis——57% Gram-Positive Sepsis——40% Fungi Sepsis——3% Signs Symptoms of Sepsis Primary Fever Chills Hyperventilation Skin lesions Change in mental status Hypotension Bleeding Leukopenia Thrombocytopenia Cyanosis Acidosis Oliguia Anuria Congestive failure Jaundice Complication Bacteria of Gram-negative Sepsis Frequency Mortaliy E. Coli Pseudomonas Klebsiella） Klebsiella Pseudomonas Proteus Serratia E. Coli Enterobacter Serratia Proteus Enterobacter Gram-negative sepsis Endotoxin G(+) sepsis G(-) sepsis bacteria S.aureus E. Coli Pseudomonas toxin exotoxin endotoxin Primary sites carbuncle, cellulitis, burn biliary, uriary, GI, burn chill seldom common fever lasting high high or low skin lesion common seldom changes in CNS common seldom Hypoxia Cyanosis seldom common oliguria seldom common shock seldom common Secondary myocarditis common seldom secondary abscess common seldom Characteristics of Fungal Sepsis The result of opportunistic infection after broad-spectrum antibiotics therapy Candida albicans is the commonest pathogen Chill, fever39.5℃, change in mental status, hypotension, shock WBC25,000/dl Mortality Prognosis of Sepsis Clinical signs Mortality rate Fever, Leukocytosis 10% Multiple Organ Failure 64% Shock 69% Shock with MOF 88% Total 42% Treatment of Sepsis Debridement of primary infection Antibiotics therapy Supportive Miscellaneous Therapy Supportive Miscellaneous Therapy Recovery of enteral nutrition as possible Correction of acid-basis electrolyte balance Diuretics Naloxone Corticosteroids Transfusion of leukocyte concentrate Immunotherapy Resulted from exotoxin produced by C.tetani a severe disease primarily of older adults who are unvaccinated or i