Septicaemia

A septicaemia or sepsis (of the Greek Σήψις , putrefaction) is a Infection general low register of the organization by germs Pathogène S. This term literally meaning “infection of blood” was used for the first time by the French doctor Pierre Adolphe Piorry.

It is the association of a Bactériémie (presence of alive bacteria in blood) and of a Syndrome of inflammatory answer systemic (answer to an aggression serious but not inevitably infectious) presenting at least two signs among the following: temperature lower than 36 °C or higher than 38,3 °C, pulsations higher than 90 beats per minute, Polypnée or Hypocapnie, Leucocytose.

Septicaemia can develop starting from any severe systemic infection. The majority of the responsible germs are germs of the digestive Tract.

Formerly, the forecast of a septicaemia was often fatal. The arrival of the modern Antibiotique S made it possible to the medical teams to effectively fight these infections which remain nevertheless very dangerous on a weakened organization or in the case of immunizing Défenses insufficient.

Classification of the septic states

The classification of the septic states in 3 categories goes back to 1992 and remains currently valid. One can also add a first category, called syndrome of inflammatory answer systemic.

These three septic states are by increasing order of gravity:

  1. the inflammatory syndrome of answer

  2. the noncomplicated sepsis,
  3. the Sepsis engraves: sepsis with acute dysfonction of one or several bodies (“multi-visceral failure”),
  4. the septic Shock: sepsis serious with arterial Hypotension refractory).

The forecast is very different for each one of them. Thus mortality with the 28e day is of 10-15% in the noncomplicated sepsis, of 20-30% in the serious sepsis and 40-50% in the septic shock.

Inflammatory syndrome of answer

  • Definition: it comprises at least 2 signs according to:
    • higher temperature with 38°C or lower than 36°C
    • pulse higher than 90/minute
    • respiratory frequency higher than 20/minute
    • Hyperleucocytosis.

Noncomplicated Sepsis

  • Definition: Infection clinically suspectée or microbiologiquement documented, associated with a Syndrome of systemic inflammatory answer.

Sepsis engraves

  • Definition:
- sepsis + lactates > 4 mmol/l or
- hypotension before filling or
- dysfonction of one or more bodies consecutive to their hypoperfusion and the cellular toxicity of bacterial toxins:
  • Lung: attack of the respiratory function defined by PaO2/FiO2<300,
  • Kidney: attack of the renal function defined by a creatinin > 176 micromol/l, >2x the normal or an oliguria,
  • Blood (as a body): thrombocytopenia < 100/mm ³; coagulation: INR > 1.5,
  • Liver: attack of the hepatic function defined by a INR >4, Bilirubine > 78 micromol/l,
  • Brain: disorder of vigilance measured by the scale of Glasgow with a GCS <13.

septic Shock

  • Definition: sepsis serious + arterial hypotension in spite of an adequate vascular filling (20-40 ml/kg)

See too

External bonds

  • Dealt with hemodynamic of the severe sepsis (excluded newborn) - Conference of consensus - short Text, on www.sfar.org .
  • Transverse Group Sepsis - initial Assumption of responsibility of the serious septic states of the adult and the child, on www.sfmu.org .

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