Ömer Faruk KÖKOĞLU, Selma ATEŞ GÜLER

SEPSİS VE SEPTİK ŞOK TEDAVİSİ

Ciddi sepsis ve septik şok morbidite, mortaliteye neden olmaktadır. Sepsisin erken dönemde tanınıp perfüzyonun sağlanması için sıvı replasmanı, vazopressör ve inotrop gibi ek destek tedavilerin başlanması önemlidir. Daha sonra enfeksiyonu teşhis etmek için uygun kültür alınmalı ve erken dönemde uygun geniş spektrumlu antimikrobiyal tedavi başlanmalıdır. Ampirik antibiyotik tedavi seçiminde konak özellikleri, enfeksiyonun yeri, lokal antibiyotik direnci göz önünde bulundurulmalıdır. Teşhis ve tedavide gecikme mortalite artışına sebep olur.

TREATMENT OF SEPSIS AND SEPTIK SHOCK

Severe sepsis and septic shock is a leading cause of morbidity and mortality. The management of a patient with severe sepsis is important to haemodynamic treatment is to restore perfusion by fluid resuscitation, vazopresör, and inotrope therapy. Diagnose the infection, to collect samples immediately after diagnosis and to initiate promptly broad-spectrum antibiotic treatment. The choice of empirical antimicrobial therapy should be based on host characteristics, site of infection and local antibiotic resistance. Delay in diagnosis and initiation of treatment have been shown to increase mortality.

PDF

___

1)Nathan Coxford R, Lang E, Dowling SDopamine versus norepinephrine in the treatment of shock. CJEM. 2011; 13: 395-7.
2)Wilkman K,Kaukonen K M, PettiläV, KuitunenA, Varpula A. Association between inotrope treatment and 90-day mortality in patients with septic shock. Acta Anaesthesiol Scand. 2013; 57: 431-42.
3)Bateman BT, Schmidt U, Berman MF, Bittner EA. Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample. Anesthesiology. 2010; 112: 917–925.
4)Controlled Comparison of Eritoran Tetrasodium and Placebo in Patients with Severe Sepsis. http://www.clinicaltrials. gov/ct2/show/NCT00334828 (Accessed on June 12, 2011).
5)Rice TW, Wheel er AP, Bernard GR, et al. A randomized, double-blind, placebo-controlled trial of TAK-242 for the treatment of severe sepsis. Crit Care Med. 2010; 38: 1685.6
6)Safety and Efficacy of Recombinant Human Lactoferrin to Treat Severe Sepsis. http://www.clinicaltrials.gov/ ct2/show/NCT00630656 (Accessed on June 12, 2011).
7)Guntupalli K, Dean N, Morris PE, Bandi V, Margolis B, Rivers E, Levy M, Lodato RF, Ismail PM, Reese A, Schaumberg JP, Malik R, Dellinger RP; TLF LF-0801 Investigator Group. Talactoferrin alfa reduces mortality in severe sepsis: Results of a Phase 2 randomized, placebo-controlled, double-blind study. Crit Care Med. 2013; 41: 706-16.
8)Rangel-Frausto MS, Pittet D, Costigan M, et al. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995 11; 273: 117-23
9)Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet. 2005; 365: 63-78.
10)Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2000. Crit Care Med. 2008; 36: 296-327.
11)Sessler CN, Perry JC, Varney KL. Management of severe sepsis and septic shock. Curr Opin Crit Care. 2004; 10: 354-63.
12)Hollenberg SM, Ahrens TS, Annane D, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med. 2004; 32: 1928-48.
13)Moore LJ, Moore FA. Early diagnosis and evidence- based care of surgical sepsis. J Intensive Care Med. 2013; 28: 107-17.
14)Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001; 345: 1368.17
15)Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004; 350: 22-47.
16)Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med. 2012; 367: 124-34.
17)Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008; 358: 125-39.
18)R. P. Dellinger Levy mm,Rhodes A,Annane D , Gerlach H , Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R Osborn TM, et al. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med. 2013; 39: 165–228.
19)De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock .N Engl J Med. 2010 4; 362: 779-89.
20)Mackenzie I, Lever A. Management of sepsis. BMJ. 2007; 335: 879-83.
21)Michael A. Puskarich E. mergency management of severe sepsis and septic shock. 2012.
22)Rhodes A, Bennett ED. Early goal-directed therapy: An evidence-based review. Crit Care Med 2004; 32: 448.-50.
23)Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med. 2008; 358: 111–124.
24)Raghavan M, Marik PE, Management of sepsis during the early golden hours The Journal of Emergency Medicine 2006: 185–199.
25)Weant KA, Baker SN Emergency Medicine Pharmacists and Sepsis Management. Emergency Medicine Pharmacists and Sepsis Management. Journal of Pharmacy Practice . 2012. December 2, 2012, doi: 10.1177/0897190012467211.
26)Leybaa CO, Gonzálezb JCM , Alonso CV.Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC- SENPE:Septic Patient Nutr Hosp. 2011; 26: 67-71.
27)Leone M, Garcin F, Bouvenot J, et al. Ventilator-associated pneumonia: Breaking the vicious circle of antibiotic overuse. Crit Care Med 2007; 35: 379–385.
28)Textoris J, Wiramus S, Martin C, Leone M. Antibiotic therapy in patients with septic shock. Eur J Anaesthesiol. 2011; 28: 318-24.
29)Johnson MT, Reichley R, Hoppe-Bauer J, et al. Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis. Crit Care Med. 2011; 39: 1859-65.
30)Gaieski DF, Mikkelsen ME, Band RA, et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med. 2010; 38: 1045-53.
31)Öztürk R. Sepsiste Antimikrobik Tedavi İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Sempozyum Dizisi 2006; cilt no eksik 61 – 68.
32)Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006; 34: 1589-96.
33)Third European Consensus Conference in Intensive Care Medicine. Tissue hypoxia: How to detect, how to correct, how to prevent. Société de Réanimation de Langue Française. The American Thoracic Society. European Society of Intensive Care Medicine. Am J Respir Crit Care Med. 1996; 154: 1573.
34)Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980; 68.344.
35)Lodise TP, Patel N, Kwa A, et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection. Antimicrob Agents Chemother. 2007; 51: 3510–3515.
36)Leibovici L, Paul M, Poznanski O, et al. Monotherapy versus beta-lactam-aminoglycoside combination treatment for gram-negative bacteremia: a prospective, observational study. Antimicrob Agents Chemother. 1997; 41: 1127-33.
37)McDonald JR, Friedman ND, Stout JE, et al. Risk factors for ineffective therapy in patients with bloodstream infection. Arch Intern Med 2005; 165: 308-13.
38)Miller LG,Pendreau- Remington F, Rieg G et AL. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005; 7; 352: 1445-53.
39)Marshall J, Lowry S. Evaluation of the adequacy of source control. In: Clinical Trials for the treatment of sepsis, Sibbald WJ, Vincent JL (Eds), Springer Verlag, Berlin 1995. p.329.