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For the genus of flies of this name, see Sepsidae. Sepsidae are a family of flies, commonly called the black scavenger flies or ensign flies.
Sepsis
Classification and external resources
ICD-10 A40. - A41.0
ICD-9 995.91
DiseasesDB 11960
MeSH D018805

Sepsis is a serious medical condition characterized by a whole-body inflammatory state caused by infection. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens An infection is the detrimental Colonization of a host Organism by a foreign Species.

Sepsis is broadly defined as the presence of various pus-forming and other pathogenic organisms, or their toxins, in the blood or tissues. [1] While the term sepsis is frequently used to refer to septicemia (blood poisoning), septicemia is but one type of sepsis. [1][2] Bacteremia specifically refers to the presence of bacteria in the bloodstream (viremia and fungemia are analogous terms for viruses and fungi). Bacteremia ( Bacteræmia in British English is the presence of bacteria in the Blood. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Viremia (UK viraemia) is a medical condition where Viruses enter the Bloodstream and hence have access to the rest of the body Fungemia (also known as Candidemia, Candedemia, and Invasive Candidiasis) is the presence of fungi or Yeasts in the Blood A virus (from the Latin virus meaning Toxin or Poison) is a sub-microscopic infectious agent that is unable A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ Bacteremia does not necessarily cause sepsis.

Contents

Signs and symptoms

In addition to symptoms related to the provoking infection, sepsis is characterized by evidence of acute inflammation present throughout the entire body, and is therefore frequently associated with fever and elevated white blood cell count (leukocytosis). Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris Leukocytosis is a raised white blood cell count (the Leukocyte count above the normal range The modern concept of sepsis is that the host's immune response to the infection causes most of the symptoms of sepsis, resulting in hemodynamic consequences and damage to organs. This host response has been termed systemic inflammatory response syndrome (SIRS) and is characterized by hemodynamic compromise and resultant metabolic derangement. In Medicine, systemic inflammatory response syndrome ( SIRS) is an inflammatory state of the whole body (the "system" without a proven source

This immunological response causes widespread activation of acute phase proteins, affecting the complement system and the coagulation pathways, which then cause damage to the vasculature as well as to the organs. Acute-phase proteins are a class of Proteins whose plasma concentrations increase (positive acute phase proteins or decrease (negative acute phase proteins in response to The complement system is a Biochemical cascade that helps clear Pathogens from an organism Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Various neuroendocrine counter-regulatory systems are then activated as well, often compounding the problem. Even with immediate and aggressive treatment, this may progress to multiple organ dysfunction syndrome and eventually death. Multiple organ dysfunction syndrome (MODS, previously known as multiple organ failure (MOF, is altered organ function in an acutely ill patient requiring Death is the termination of the biological functions that define living Organisms It refers both to a specific

Epidemiology

In the United States, sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common cause of death overall according to data from the Centers for Disease Control and Prevention. The United States of America —commonly referred to as the An intensive care unit (ICU critical care unit (CCU intensive therapy unit or intensive treatment unit (ITU is a specialized department used in The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated [3] Sepsis is common and also more dangerous in elderly, immunocompromised, and critically ill patients. It occurs in 1%-2% of all hospitalizations and accounts for as much as 25% of intensive care unit (ICU) bed utilization. Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of Life support or organ support systems in patients It is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for septic shock. Septic shock is a very serious medical condition caused by decreased tissue perfusion and oxygen delivery as a result of Infection and Sepsis, though the

Definition of sepsis

Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met:[4]

Fever and leukocytosis are features of the acute phase reaction, while tachycardia is often the initial sign of hemodynamic compromise. Leukopenia (or leukocytopenia, or leucopenia, from Greek λευκό -white and πενία -deficiency is a decrease in the number of Leukocytosis is a raised white blood cell count (the Leukocyte count above the normal range Bandemia refers to an excess of Band cells (immature White blood cells) released by the Bone marrow into the Blood. Acute-phase proteins are a class of Proteins whose plasma concentrations increase (positive acute phase proteins or decrease (negative acute phase proteins in response to Tachypnea may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism. Tachypnea (or "tachypnoea" ( Greek: "rapid breathing" is characterized by rapid breathing and is not identical with Hyperventilation - tachypnea

In children, the SIRS criteria are modified in the following fashion:[5]

Note that SIRS criteria are very non-specific,[6] and must be interpreted carefully within the clinical context. These criteria exist primarily for the purpose of more objectively classifying critically-ill patients so that future clinical studies may be more rigorous and more easily reproducible.

Consensus definitions however continue to evolve with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience. [6]

To qualify as sepsis, there must be an infection suspected or proven (by culture, stain, or polymerase chain reaction(PCR)), or a clinical syndrome pathognomonic for infection. Specific evidence for infection includes WBCs in normally sterile fluid (such as urine or cerebrospinal fluid(CSF), evidence of a perforated viscus (free air on abdominal x-ray or CT scan, signs of acute peritonitis), abnormal chest x-ray (CXR) consistent with pneumonia (with focal opacification), or petechiae, purpura, or purpura fulminans

The more critical subsets of sepsis are severe sepsis (sepsis with acute organ dysfunction) and septic shock (sepsis with refractory arterial hypotension). Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system Peritonitis is defined as Inflammation of the Peritoneum (the Serous membrane which lines part of the abdominal cavity and some of the Viscera Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal A petechia (pɨˈtiːkiə plural petechiae (pɨˈtiːkɪiː is a small (1-2mm red or purple spot on the body caused by a minor Hemorrhage (broken Capillary Purpura (from the Latin purpura, meaning "purple" is the appearance of red or purple discolorations on the Skin, caused by Bleeding underneath Purpura fulminans is a haemorrhagic condition usually associated with Sepsis or previous infection In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. Alternatively, when two or more of the systemic inflammatory response syndrome criteria are met without evidence of infection, patients may be diagnosed simply with "SIRS. In Medicine, systemic inflammatory response syndrome ( SIRS) is an inflammatory state of the whole body (the "system" without a proven source " Patients with SIRS and acute organ dysfunction may be termed "severe SIRS. "

Patients are defined as having "severe sepsis" if they have sepsis plus signs of systemic hypoperfusion: either end organ dysfunction or a serum lactate greater than 4 mmol/dL. In Medicine, ischemia ( Greek ισχαιμία, isch- is restriction hema or haema is Blood) is a restriction Other signs include oliguria and altered mental status. Oliguria and anuria are the decreased or absent production of Urine, respectively Patients are defined as having septic shock if they have sepsis plus hypotension after aggressive fluid resuscitation (typically upwards of 6 liters or 40 ml/kg of crystalloid). Septic shock is a very serious medical condition caused by decreased tissue perfusion and oxygen delivery as a result of Infection and Sepsis, though the

Examples of end-organ dysfunction include the following:[7]

More specific definitions of end-organ dysfunction exist for SIRS in pediatrics. Acute lung injury (ALI is a diffuse heterogeneous lung injury characterized by hypoxemia non cardiogenic pulmonary edema low lung compliance and widespread capillary leakage Encephalopathy /ɛnˌsɛfəˈlɒpəθi/ literally means Disease of the Brain. Coagulopathy is a medical term for a defect in the body's mechanism for Blood Clotting. Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby Bilirubin (formerly referred to as hematoidin) is the yellow breakdown product of normal Heme Catabolism. Oliguria and anuria are the decreased or absent production of Urine, respectively Oliguria and anuria are the decreased or absent production of Urine, respectively Electrolytes play a vital role in maintaining Homeostasis within the body Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular Troponin is a complex of three regulatory proteins that is integral to Muscle contraction in skeletal and Cardiac muscle, but not Smooth muscle [5]

Neonatal sepsis

In common clinical usage, sepsis specifically refers to the presence of a serious bacterial infection(SBI) (such as meningitis, pneumonia, pyelonephritis, or gastroenteritis) in the setting of fever. The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurological scale which aims to give a reliable objective Developmental disability is a term used to describe life-long disabilities attributable to mental and/or physical or combination of mental and physical impairments Mental retardation is a generalized triarchic disorder characterized by subaverage cognitive functioning and deficits in two or more adaptive behaviors with onset before the age Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved The prothrombin time ( PT) and its derived measures of prothrombin ratio ( PR) and international normalized ratio ( INR) are measures Creatinine is a break-down product of Creatine phosphate in Muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass Creatinine is a break-down product of Creatine phosphate in Muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years Bilirubin (formerly referred to as hematoidin) is the yellow breakdown product of normal Heme Catabolism. Alanine transaminase or ALT is a Transaminase Enzyme ( It is also called serum glutamic pyruvic transaminase (SGPT or alanine aminotransferase Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Pyelonephritis is an ascending Urinary tract infection that has reached the pyelum ( pelvis) of the Kidney ( nephros in Greek Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the Criteria with regards to hemodynamic compromise or respiratory failure are not useful clinically because these symptoms often do not arise in neonates until death is imminent and unpreventable.

It is difficult to clinically exclude sepsis in newborns less than 90 days old who have fever (defined as a temperature > 38° C (100. 4° F). Except in the case of obvious acute viral bronchiolitis, the current practice in newborns less than 30 days old is to perform a complete workup including complete blood count with differential, blood culture, urinalysis, urine culture, and cerebrospinal fluid(CSF) studies and CSF culture, admit the newborn to the hospital, and treat empirically for serious bacterial infection for at least 48 hours until cultures are demonstrated to show no growth. Bronchiolitis is inflammation of the Bronchioles the smallest air passages of the lungs A complete blood count ( CBC) also known as full blood count ( FBC) or full blood exam ( FBE) or blood panel, is A urinalysis (or "UA" is an array of tests performed on Urine and one of the most common methods of Medical Diagnosis. Cerebrospinal fluid ( CSF) Liquor cerebrospinalis, is a clear Bodily fluid that occupies the Subarachnoid space and the Ventricular system Attempts have been made to see if it is possible to risk stratify newborns in order to decide if a newborn can be safely monitored at home without treatment despite having a fever. One such attempt is the Rochester criteria.

A study performed at Strong Memorial Hospital in Rochester, New York, showed that infants ≤ 60 days old meeting the following criteria were at low-risk for having a serious bacterial illness[8]:

Those meeting these criteria likely do not require a lumbar puncture, and are felt to be safe for discharge home without antibiotic treatment, or with a single dose of intramuscular antibiotics, but will still require close outpatient follow-up. Rochester is a city in Monroe County, New York State, south of Lake Ontario in the United States.

Treatment

Sepsis in Adults and Children

The therapy of sepsis rests on antibiotics, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa This may include hemodialysis in kidney failure, mechanical ventilation in pulmonary dysfunction, transfusion of blood products, and drug and fluid therapy for circulatory failure. In Medicine, dialysis (from Greek "dialusis" meaning dissolution "dia" meaning through and "lusis" meaning loosening is primarily Renal failure or kidney In Medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing when patients cannot do so on their own lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Blood plasma is the Liquid component of Blood, in which the Blood cells are suspended Ensuring adequate nutrition—preferrably by enteral feeding, but if necessary by parenteral nutrition—is important during prolonged illness. Total Parenteral nutrition (TPN is the practice of feeding a person Intravenously bypassing the usual process of Eating and Digestion.

A problem in the adequate management of septic patients has been the delay in administering therapy after sepsis has been recognized. Published studies have demonstrated that for every hour delay in the administration of appropriate antibiotic therapy there is an associated 7% rise in mortality. A large international collaboration was established to educate people about sepsis and to improve patient outcomes with sepsis, entitled the "Surviving Sepsis Campaign. The Surviving Sepsis Campaign (SSC is a global initiative to bring together professional organizations in reducing mortality from Sepsis. " The Campaign has published an evidence-based review of management strategies for severe sepsis,[9] with the aim to publish a complete set of guidelines in subsequent years.

Early Goal Directed Therapy (EGDT), developed at Henry Ford Hospital by E. Henry Ford Hospital is a part of the Henry Ford Health System located in Detroit Michigan. Rivers, MD, is a systematic approach to resuscitation that has been validated in the treatment of severe sepsis and septic shock. Septic shock is a very serious medical condition caused by decreased tissue perfusion and oxygen delivery as a result of Infection and Sepsis, though the It is meant to be started in the Emergency Department. The theory is that one should use a step-wise approach, having the patient meet physiologic goals, to optimize cardiac preload, afterload, and contractility, thus optimizing oxygen delivery to the tissues. [10]

In EGDT, fluids are administered until the central venous pressure (CVP), as measured by a central venous catheter, reaches 8-12 cm of water (or 10-15 cm of water in mechanically ventilated patients). Central venous pressure (CVP describes the pressure of blood in the thoracic Vena cava, near the Right atrium of the heart In Medicine, a central venous catheter ( CVC or central venous line or central venous access catheter) is a Catheter placed into a This may require around 6 liters of isotonic crystalloid solution, rapidly administered. If the mean arterial pressure is less than 65 mmHg or greater than 90 mmHg, vasopressors or vasodilators are given as needed to reach the goal. The mean arterial pressure ( MAP) is a term used in medicine to describe a notional average Blood pressure in an individual Once these goals are met, the mixed venous oxygen saturation (SvO2), i. e. the oxygen saturation of venous blood as it returns to the heart as measured at the vena cava, is optimized. If the SvO2 is less than 70%, blood is given to reach a hemoglobin of 10 g/dl and then inotropes are added until the SvO2 is optimized. Elective intubation may be performed to reduce oxygen demand if the SvO2 remains low despite optimization of hemodynamics. Urine output is also monitored, with a minimum goal of 0. 5 ml/kg/h. In the original trial, mortality was cut from 46. 5% in the control group to 30. 5% in the intervention group. [10] The Surviving Sepsis Campaign guidelines recommends EGDT for the initial resuscitation of the septic patient with a level B strength of evidence (single randomized control trial). A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare [9]

Most therapies aimed at the inflammation process itself have failed to improve outcome, however drotrecogin alfa (activated protein C, one of the coagulation factors) has been shown to decrease mortality from about 31% to about 25% in severe sepsis. Drotrecogin alfa (activated ( Xigris, marketed by Eli Lilly and Company) is a Recombinant form of human activated Protein C that has Protein C is a major physiological Anticoagulant. It is a Vitamin K -dependent Serine protease Enzyme ( that is activated by Thrombin Coagulation is a complex process by which Blood forms Clots It is an important part of Hemostasis (the cessation of blood loss from a damaged vessel whereby To qualify for drotrecogin alfa, a patient must have severe sepsis or septic shock with an APACHE II score of 25 or greater and a low risk of bleeding. [11] Low dose hydrocortisone treatment has shown promise for septic shock patients with relative adrenal insufficiency as defined by ACTH stimulation testing. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex) Adrenal insufficiency is a condition in which the Adrenal glands located above the Kidneys do not produce adequate amounts of steroid hormones (chemicals produced by the The ACTH stimulation test (also called the Cosyntropin test or Tetracosactide test) is a Medical test usually ordered and interpreted [12]

Rule Out Sepsis and Suspected Sepsis in Neonates

Note that in neonates, sepsis is difficult to diagnose clinically. They may be relatively asymptomatic until hemodynamic and respiratory collapse is imminent, so if there is even a remote suspicion of sepsis, they are frequently treated with antibiotics empirically until cultures are sufficiently proven to be negative. In addition to fluid resuscitation and supportive care, a common antibiotic regimen in infants with suspected sepsis is a beta-lactam antibiotic (usually ampicillin) in combination with an aminoglycoside (usually gentamicin) or a third-generation cephalosporin (usually cefotaxime—ceftriaxone is generally avoided in neonates due to the theoretical risk of causing biliary stasis. ||-||-||-||-||-||-||}A beta-lactam ring ( β -lactam or penam is a Lactam with a Heteroatomic Ring structure, consisting of three Ampicillin is a beta-lactam Antibiotic that has been used extensively to treat bacterial Infections since 1961 An aminoglycoside is a molecule composed of a sugar group and an Amino group Gentamicin is an Aminoglycoside Antibiotic, used to treat many types of bacterial infections particularly those caused by Gram-negative The cephalosporins (ˌsɛfələˈspɔrən/ /ˌkɛfə- are a class of β-lactam antibiotics. Cefotaxime ( INN) (sɛfəˈtæksiːm/ /kɛfə- is a third-generation Cephalosporin Antibiotic. Ceftriaxone ( INN) (ˌsɛftraɪˈæksoʊn/ /ˌkɛf- is a third-generation Cephalosporin Antibiotic. ) The organisms which are targeted are species that predominate in the female genitourinary tract and to which neonates are especially vulnerable to, specifically Group B Streptococcus, Escherichia coli, and Listeria monocytogenes (This is the main rationale for using ampicillin versus other beta-lactams. Infection with Group B Streptococcus (GBS also known as Streptococcus agalactiae and more colloquially as Strep B and group B Strep can cause serious Listeria monocytogenes is a Gram-positive Bacterium, in the division Firmicutes, named for Joseph Lister. ) Of course, neonates are also vulnerable to other common pathogens that can cause meningitis and bacteremia such as Streptococcus pneumoniae and Neisseria meningitidis. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. Bacteremia ( Bacteræmia in British English is the presence of bacteria in the Blood. Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus aerotolerant anaerobe and a member of the Genus Neisseria meningitidis, also simply known as meningococcus, is a heterotrophic Gram-negative diplococcal Bacterium best known for Although uncommon, if anaerobic species are suspected (such as in cases where necrotizing enterocolitis or intestinal perforation is a concern, clindamycin is often added. Necrotizing enterocolitis (NEC is a medical condition primarily seen in premature Infants where portions of the bowel undergo Necrosis (tissue death Gastrointestinal perforation is a complete penetration of the wall of the stomach small intestine or large bowel resulting in intestinal contents flowing into the abdominal cavity Clindamycin ( rINN; klɪndəˈmaɪsɨn is a lincosamide Antibiotic.

Prognosis

Prognosis can be estimated with the MEDS score. [13]

Related conditions/complications

References

  1. ^ a b Sepsis. eMedicine Online Medical Dictionary. Retrieved on 2008-02-22. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1495 - King Charles VIII of France enters Naples to claim the city's throne
  2. ^ Septicemia. eMedicine Online Medical Dictionary. Retrieved on 2007-06-30. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 350 - Roman usurper Nepotianus, of the Constantinian dynasty, is defeated and killed by troops of the Usurper
  3. ^ Martin GS, Mannino DM, Eaton S, Moss M (2003-04-17). "The epidemiology of sepsis in the United States from 1979 through 2000". N Engl J Med 348 (16): 1546-54. doi:10.1056/NEJMoa022139. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12700374.  
  4. ^ Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (June 1992). "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine" (PDF). Chest 101 (6): 1644-55. doi:10.1378/chest.101.6.1644. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 1303622.  
  5. ^ a b Goldstein B, Giroir B, Randolph A (2005). "International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics". Pediatr Crit Care Med 6 (1): 2–8. doi:10.1097/01.PCC.0000149131.72248.E6. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15636651.  
  6. ^ a b Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (April 2003). "2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference". Crit Care Med 31 (4): 1250-1256. doi:10.1097/01.CCM.0000050454.01978.3B. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  
  7. ^ Abraham E, Singer M (2007). "Mechanisms of sepsis-induced organ dysfunction". Crit. Care Med. 35 (10): 2408–16. PMID 17948334.  
  8. ^ Dagan R, Powell KR, Hall CB, Menegus MA (December 1985). "Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis". J. Pediatr. 107 (6): 855–60. PMID 4067741.  
  9. ^ a b Dellinger RP, Levy MM, Carlet JM, et. al, for the International Surviving Sepsis Campaign Guidelines Committee. (2008). "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008". Crit Care Med 36 (1): 296-327. PMID 18158437.  
  10. ^ a b Rivers E, Nguyen B, Havstad S, et al (2001). "Early goal-directed therapy in the treatment of severe sepsis and septic shock". N. Engl. J. Med. 345 (19): 1368-77. doi:10.1056/NEJMoa010307. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 11794169.  
  11. ^ Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr (2001-03-08). "Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis". N Engl J Med 344 (10): 699-709. PMID 11236773.  
  12. ^ Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E (2002-08-21). "Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock". JAMA 288 (7): 862-71. doi:10.1001/jama.288.7.862. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12186604.  
  13. ^ Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW (2003). "Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule". Crit. Care Med. 31 (3): 670-5. doi:10.1097/01.CCM.0000054867.01688.D1. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12626967.  

See also

External links

Dictionary

sepsis

-noun

  1. (pathology) Septicemia
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