SEPSIS

an Overview

Doni Priambodo Wijisaksono

Subdivision of Tropical Medicine and Infectious Diseases
Internal Medicine Department
Faculty of Medicine Gajah Mada University / Dr Sardjito General Hospital
Jogjakarta

Microorganisms represent
the first species of living organisms
that populated our planet
and will probably continue
to survive well
beyond the extinction
of the human race
(Fasano, 2002)

Severe Sepsis:
A Significant Healthcare Challenge

Major cause of morbidity and

mortality worldwide
Leading cause of death in noncoronary ICU
(US)*
11th leading cause of death overall (US)

About 1,000,000 cases of severe

sepsis
in US annually
In the US, about 600-1000
patients die of severe sepsis
daily

*Sands KE et al. JAMA.

Based on data for septicemia. Murphy SL. National Vital Statistics
JAMA. 1997;278:234-40; Based
Reports.
Angus DC et al. Crit Care Med.
Med. 2001 (In Press); reflects hospital-wide cases of severe sepsis as defined by
www.themegallery.co
infection in

Severe Sepsis is a
Significant Healthcare
Burden
Sepsis consumes significant healthcare
resources.
In a study of Patients who contract
nosocomial infections, develop sepsis and
survive:
ICU stay prolonged an additional 8 days.
Additional costs incurred were $40,890/ patient.

Estimated annual healthcare costs

due to severe sepsis in U.S.
exceed $16 billion !!!

Cannon et al, US, 2012 :

Mortality rate of severe sepsis
Mortality rate of septic shock

: 20%
: 45%

Sardjito General Hospital

Jogjakarta :

In recent 2 years:
mortality rate of severe sepsis
mortality rate of septic shock

: 31%
: 64%

Martin et al, NEJM 2003; 348:1546

Definisi
Sepsis adalah: adanya bukti atau kecurigaan
kuat adanya infeksi, yang disertai tanda-tanda
sindroma respon inflamasi sistemik (SIRS:
Systemic Inflammatory Response Syndrome)
yang meliputi 2 atau lebih tanda di bawah ini:
- suhu badan 38C, atau 36C
- nadi 90 kali/menit
- respirasi 20 kali/menit atau P CO2 arteri <
32 mmHg
- angka lekosit 12000/mmk atau 4000/mmk
atau
sel lekosit muda > 10%

Sepsis: A Complex Disease

This Venn diagram provides a conceptual framework
to view
the relationships
between various
components of sepsis.

Adapted from: Bone RC et al. Chest. 1992;101:1644-55.

Opal SM et al. Crit Care Med. 2000;28:S81-2.

Sepsis: Defining a Disease

Continuum
Infection/
Trauma

SIRS

A clinical response arising

from a nonspecific insult,
including 2 of the
following:
Temperature 38oC or 36oC
HR 90 beats/min
Respirations 20/min
WBC count 12,000/mm3 or
4,000/mm3 or >10%
immature neutrophils

Sepsis

Severe
Sepsis

SIRS with a
presumed or
confirmed
infectious
process
SIRS = Systemic Inflammatory Response
Syndrome

Adapted from: Bone RC, et al. Chest 1992;101:1644

Opal SM, et al. Crit Care Med 2000;28:S81

ACCP/SCCM Consensus Definitions

www.themegallery.com

Question: Why do
Septic Patients Die?

Answer: Organ
Failure

IMUNOPATOGENESI
S
C3a, C5a
IMUNO.COM

APC

LPS

CD 4+

CD 14

TLR

IFN -

TLR2

MOD
PaI-1
SHOCK
SEPTIC

SUPER ANTIGEN

LPS bp

C7a

SEPSIS

(Guntur, 2000)

IL 8
IL 6

IL -1

PGE

TH - 1 TH - 2

NO

ICAM -1

IL - 10
IL - 4
IL - 5
IL - 6

B cell

CSF
N
Compl.

TNF -

TCR

Ig
IL-2

CD 8+
TF-VIIA

NK

Pathogenesis of sepsis: changes in the

circulation during sepsis

Wong et al, Gut 2005;54;718

Surviving sepsis campaign guidelines

for management of
severe sepsis and septic shock
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.

Diagnosis
Initial Resuscitation
Antibiotic therapy
Source Control
Fluid Therapy
Vasopressors
Inotropic Therapy
Steroids
Recombinant Human
Activated Protein C
Blood Product
Administration
Mechanical Ventilation of
Sepsis-Induced Acute
Lung Injury

L.

Sedation, Analgesia, and

Neuromuscular Blockade
in Sepsis
M. Glucose Control
N. Renal Replacement
O. Bicarbonate therapy
P. Deep Vein Thrombosis
Prophylaxis
Q. Stress Ulcer Prophylaxis
R. Consideration for
Limitation of Support
S. Pediatric consideration

Dellinger RP - Crit Care Med 2008; 32(3): 858-73

Summary
Sepsis:
Significant Healthcare Challenge &
Burden
The complexity of Sepsis:
Organisms,
Pathophysiology and
Management