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Sepsis (treatment based on unknown source)


Possible Therapeutic Options


"Sepsis: potentially fatal whole-body inflammation (a systemic inflammatory response syndrome or SIRS) caused by severe infection. Sepsis can continue even after the infection that caused it is gone. Severe sepsis is sepsis complicated by organ dysfunction. Septic shock is sepsis complicated by a high lactate level or by shock that does not improve after fluid resuscitation. The most common primary sources of infection resulting in sepsis are the lungs, the abdomen, and the urinary tract.  Typically, 50% of all sepsis cases start as an infection in the lungs. No source is found in one third of cases."

"The infectious agents are usually bacteria but can also be fungi and viruses. While gram-negative bacteria were previously the most common cause of sepsis, in the last decade, gram-positive bacteria, most commonly staphylococci, are thought to cause more than 50% of cases of sepsis."

Common Pathogens

Multiple possible pathogens depending on the source of the infection (intra-abdominal,  lung, urinary tract, skin, other).

Enterobacteriaecea:( E.coli, serratia, klebsiella, enterobacter, citrobacter), Pseudomonas, S. pneumo, Bacteroides fragilis, Neisseria meningitidis, others.

Initial therapy:
[Detailed clinical history should be obtained. Review possible risk factors such as malignancy, comorbidities, presence of indwelling catheters, etc.  Adjust therapy based on patient response.   Therapy should be guided by susceptibility testing, presence of drug allergies, and recent antibiotic therapy. ]

Therapy based on an unknown source:
 [ Meropenem 1 gram IV q8h  OR  Imipenem 500mg IV every 6 hours [Range: 250-1000 mg q6-8h]  OR  Ertapenem 1 gm IV q24h OR Doripenem 500 mg IV q8h]
PLUS   Vancomycin 1 gram  ivpb q12h (patient-specific dosing required) [ Piperacillin-tazobactam (Zosyn ®)  3.375 to 4.5  grams IV q6h  OR   Cefepime 2 grams IV every 8-12 hours OR  Ceftazidime 2 grams IVPB q8h ]   
PLUS  Vancomycin 1 gram  ivpb q12h (patient-specific dosing required) Several other possible regimens. 



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