复旦大学：《儿科学》课程教学资源（PPT课件讲稿，英文版）第二讲 败血症

Sepsis or septicemia in children

Sepsis or septicemia in children

Definition Bacteremia a Bacter ia invade into blood temporarily with flora <100 CFU/ mI in blood Septicemia or Seps is: Pathogens(bacter ia or fung i)invade into blood, pro l iferate great ly, and release endotox in Toxemia Endotox in absor bed into blood with no bacter ia Septicopyaemia: Sepsis with metastatic foci in or gans pyemia is a status which no bacter ium in blood is cultured

Definition Bacteremia： Bacteria invade into blood temporarily with flora <100 CFU/ml in blood Septicemia or Sepsis： Pathogens(bacteria or fungi) invade into blood,proliferate greatly,and release endotoxin Toxemia： Endotoxin absorbed into blood with no bacteria Septicopyemia： Sepsis with metastatic foci in organs,pyemia is a status which no bacterium in blood is cultured

Pathogens Gram stain positive coci Gram stain negative bacilli Anaerobic bacteria Fung

Gram stain positive coci Gram stain negative bacilli Anaerobic bacteria Fungi Pathogens

Associated factors virulence and quantity Exotoxin. Endotoxin Defense mechanism Immunologic function, age, etc Chronical diseases: Nephropathy, Liversclerosis, Connective tissue diseases, Diabetes mellitus Malignant tumor and so on Medical factors: long-term Steriods, Antibiotics, All kinds of instrumentation such as invasive meauver catheterization

virulence and quantity Exotoxin, Endotoxin Defense mechanism Immunologic function,age,etc Chronical diseases： Nephropathy,Liver sclerosis,Connective tissue diseases,Diabetes mellitus,Malignant tumor,and so on Medical factors： long-term Steriods,Antibiotics,All kinds of instrumentation such as invasive meauver,catheterization Associated factors

Polymicrobial sepsis More than one bacterium isolated in the same blood samples Associated with immunocompromised status Commonly occurs in patients with chronic diseases or use of immnodepressors

More than one bacterium isolated in the same blood samples Associated with immnocompromised status Commonly occurs in patients with chronic diseases or use of immnodepressors Polymicrobial sepsis

Features Clinical feature endotoxemia and shock young baby is easy to suffer from sepsis, and deteriorate to MODs.it can be asymptomatic Blood test: WBC elavates or drops Metastatic foci: more commonly

Clinical feature： endotoxemia and shock young baby is easy to suffer from sepsis, and deteriorate to MODS.it can be asymptomatic Blood test：WBC elavates or drops Metastatic foci：more commonly Features

classification Shock virulence fe ver feature or MOSF DIC Common pathogens High common (pneumococcus, fever common no E. col Pathogens with High strong v acute fever Severely staphylococcus ill more more aureus, pseudomonas, to drop klebsiella) Conditional pathogens low subacute (staphylococcus medium common no epidermidis)

virulence fever feature Shock or DIC MOSF common Common pathogens （pneumococcus, E.coli） High fever common no no acute Pathogens with strong v （staphylococcus aureus,pseudomonas, klebsiella） High fever to drop Severely ill more more subacute Conditional pathogens （staphylococcus epidermidis） low ～ medium common no no classification

Mechanism Gram-negative Gram-positive bacteria bacteria lipoteichoic acid Endotoxin peptidogly como lex Comp l ement system coagulation cascades endothe Adrenocorticotrophic hormone Immno cell kallikrein-kinin system ACTH, RAS InfAmmatory medi ators SIRS MOSF

Mechanism Gram-negative bacteria Gram-positive bacteria Endotoxin Lipoteichoic acid -peptidoglycan complex SIRS Inflmmatory mediators ACTH,RAS endothe Immno cell Complement system、 coagulation cascades Adrenocorticotrophic hormone kallikrein-kinin system MOSF

Complication Metastatic foci endocarditis, meningitis, oestoarthritis, and so on mulnutrition Disturbed hemostasis such as acidosis Complications in organs: dysfunction

Metastatic foci： endocarditis,meningitis,oestoarthritis,and so on mulnutrition Disturbed hemostasis：such as acidosis Complications in organs:dysfunction Complication

Systemic Inflammatory Response Syndrome -SIRS Clinial syndrome manefested with strong inflmmation over-responsiveness of inflamatory mediators all over the body(cytokines Cascade) · pathogenic factors: infection: bacteria. virus non-infection: in juries, burns outcome organ and tissue injuries

Clinial syndrome manefested with strong inflmmation • over-responsiveness of inflmmatory mediators all over the body(cytokines Cascade） • pathogenic factors： infection:bacteria,virus,… non-infection:injuries,burns,… • outcome：organ and tissue injuries Systemic Inflammatory Response Syndrome -SIRS