Which of the following are symptoms of systemic infection

SIRS may indicate infection but is not specific; potentially being present in inflammation, ischaemia or trauma and so should be interpreted in the clinical context. CRP may be elevated in infection (and in other conditions) but cannot be used to judge severity of infection. CRP may also remain elevated even when infection is resolving and must not be used in isolation to assess the severity of infection (including the need for IV therapy).

N.B. Signs of sepsis (or SIRS) may be masked in: immunosuppression, the elderly and in the presence of anti-inflammatory drugs or beta-blockers.

Figure 1 – qSOFA scoring tool

A score of ≥2 of:

• Confusion (<15 of Glasgow Coma Scale)
• Respiratory rate ≥22/minute
• Systolic blood pressure ≤100mmHg

Seymour CW et al. Assessment of Clinical Criteria for Sepsis - For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):762-774. Adapted with permission.

Mortality from sepsis increases with delay in initiating IV antibiotic therapy. In patients with sepsis, or severe infection, aim to complete the "Sepsis 6" within 1 hour.

Figure 2 – "Sepsis 6" - within 1 hour

1. Blood cultures and any other relevant samples prior to administration of antibiotics. Consider source control.
2. IV antibiotic administration according to GG&C infection management guidelines. For each hour’s delay in administering antibiotics in septic shock, mortality increases by 7.6%. Record first dose of antibiotic in the 'one-off' section of the kardex and communicate with the member of staff who is responsible for administration of IV antibiotic therapy to ensure it is administered immediately. N.B. administer the antibiotic in the clinical area where infection has been recognised and do not delay until arrival at destination ward. 
3. Oxygen to maintain target saturation (>94% or 88%-92% in people at risk of hypercapnic respiratory failure)
4. Measure lactate
5. Start intravenous fluid resuscitation
6. Monitor hourly urine output

Review empirical (best guess) antimicrobial therapy no later than 48 hours after initiation. Simplify and switch to narrow spectrum therapy when microbiology results become available.

If you have the early signs of sepsis, you'll usually be referred to hospital. You'll then be given a diagnosis and treatment.

Emergency treatment

You'll need emergency treatment, or treatment in an intensive care unit (ICU), if:

• the sepsis is severe
• you develop septic shock – when your blood pressure drops to a dangerously low level

ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection.

Sepsis is treatable if it's identified and treated quickly. In most cases it leads to full recovery with no lasting problems.

Antibiotics

The main treatment for sepsis, severe sepsis or septic shock is antibiotics. These will be given directly into a vein (intravenously).

Ideally, antibiotic treatment should start within an hour of diagnosis.

Intravenous antibiotics are usually replaced by tablets after 2 to 4 days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition.

Types of antibiotics

If sepsis is suspected, broad-spectrum antibiotics are given first. This is because there won't be time to wait until a specific type of infection has been identified.

Broad-spectrum antibiotics work against a wide range of known infectious bacteria. They usually cure most common infections.

Once a specific bacterium has been identified, a more focused antibiotic can be used.

Viral infections

If the sepsis is caused by a virus, antibiotics won't work. However, it would be too dangerous to delay treatment to find out the specific cause. This means antibiotics are usually given anyway.

With a viral infection, you'll need to wait until your immune system starts to tackle it. However, antiviral medication may be given in some cases.

Intravenous fluids

If you have sepsis, your body needs more fluid to prevent dehydration and kidney failure.

If you have severe sepsis or septic shock, you'll usually be given fluids intravenously for the first 24 to 48 hours.

It's important that the doctors know how much urine your kidneys are making when you have sepsis. This helps them spot signs of kidney failure.

If you're admitted with severe sepsis or septic shock, you'll usually be given a catheter. This is inserted into your bladder to monitor your urine output.

Oxygen

Your body's oxygen demand goes up if you have sepsis.

If you're admitted to hospital with sepsis and the level of oxygen in your blood is low, you'll usually be given oxygen. This is given through a mask or tubes in your nostrils.

Treating the source of infection

If a source of the infection can be identified, like an abscess or infected wound, this will also need to be treated.

For example, any pus may need to be drained away. In more serious cases, surgery may be needed to remove the infected tissue and repair any damage.

Increasing blood pressure

Medications called vasopressors are used if you have low blood pressure caused by sepsis.

Vasopressors are normally given intravenously while you're in an ICU. Extra fluids may also be given intravenously to help increase blood pressure.

What are symptoms of a systemic infection?

What are the symptoms of a systemic bacterial infection?

Which of the following may be signs or symptoms of a localized infection?

What is a systemic infection called?