SEPTICAEMIA

Blood infection due to various bacteria which may be associated with infection in specific sites (e.g. lungs, urinary tract, gastrointestinal tract) or there may be no specific focus. It is life threatening because it can progress into multi-organ dysfunction and septic shock.

Cause

  • Organisms commonly involved are Staphylococcus aureus,
    Klebsiella, Pseudomonas, Staphylococcus epidermidis, fungal (Candida spp), Coliforms and Salmonella spp, Pneumococci, Proteus spp

Risk factors

  • Extremes of age (children, elderly)
  • Diabetes, cancer, immunosuppression
  • Hospital admission
  • Community acquired pneumonia

Clinical features

  • Fever, prostration (extreme tiredness)
  • Hypotension, anaemia
  • Toxic shock is a complication
  • Signs and symptoms of the primary site of infection (e.g. pneumonia)

Differential diagnosis

  • Severe cerebral malaria
  • Meningitis
  • Typhoid fever (enteric fever)
  • Infective endocarditis

Investigations

  • Look for possible primary source of infection
  • Blood: WBC count, culture and sensitivity

Management

General measures

  • IV fluids
  • Control of temperature
  • Nutrition support (NGT if necessary)
  • Monitoring of vitals and urinary output

If known focus of infection, treat immediately with IV antibiotics as per guidelines. If unknown focus, give:
Adult

  • Gentamicin 7 mg/kg IV every 24 hours or 1.5-2 mg/kg IV or IM every 8 hours
  • Plus either cloxacillin 2 g IV every 4-6 hours
  • Or chloramphenicol 750 mg IV every 6 hours

Child

  • Gentamicin 3.5-4 mg/kg IV every 8 hours (neonate: every 8-12 hours)
  • Plus either: Ceftriaxone 50 mg/kg every 8 hours (< 7 days old: every 12 hours)
  • Or cloxacillin 50 mg/kg IV every 4-6 hours
  • Or benzylpenicillin 50,000 IU/kg IV every 4-6 hours

Prevention

  • Protect groups at risk, for example immunosuppressed and post-surgical patients
  • Follow strictly aseptic surgical procedures