What Is Gram-Negative Sepsis?

Gram-negative bacillus sepsis is one of the main complications of urinary tract infections, which mostly occurs in acute symptomatic urinary tract infections, especially after cystoscopy or urethral catheters (prolonged indwelling catheters are more common).

Gram-negative bacillus sepsis

Gram-negative bacillus sepsis is one of the main complications of urinary tract infections, which mostly occurs in acute symptomatic urinary tract infections, especially after cystoscopy or urethral catheters (prolonged indwelling catheters are more common).

Chinese Medicine Name

Gram-negative bacillus sepsis

Disease site

Urinary tract

The main symptoms

Chill, high fever

Main cause

Urinary tract infection

Severe and complicated pyelonephritis, especially those with acute renal papillary necrosis, are also prone to gram-negative bacillus sepsis. Occasionally seen in severe non-complex pyelonephritis. Multiple causes of urinary tract mucosal damage, Gram-negative bacteria invading the bloodstream, can cause sepsis. According to Tunn and Thieme statistics, in Gram-negative bacillus sepsis, 55% are caused by urinary tract infections. The mortality rate is higher, with 15% to 47% among those without shock, and 37% to 82% with shock. Urinary tract infection is one of the most important ways for Gram-negative bacilli to penetrate the bloodstream.

At the onset of Gram-negative bacillus sepsis, most patients have chills, high fever (high relaxation fever), and cold sweats throughout the body. Other patients have only mild general discomfort and moderate fever (shown as persistent fever). Onset is slow, and later, the condition can become dangerous, and the patient's blood pressure drops quickly, and even obvious shock can occur. Clinical manifestations of ischemia of important organs (heart, brain, kidney), such as oliguria, azotemia, acidosis, and circulatory failure. Shock usually lasts 3 to 6 days, and severe cases can die as a result.

At the onset, white blood cells may decrease, and then the number of white blood cells may increase moderately with nuclear left shift. Prior to oliguria, mild proteinuria is often present. Patients may have metabolic acidosis or respiratory alkalosis, and some patients may develop diffuse intravascular coagulation (DIC).

According to statistics, the fatality rate of Gram-negative bacillus sepsis is 20% to 40%, among which Pseudomonas aeruginosa and Proteus are the highest. If concomitant shock, its mortality rate can be as high as 50%. The key to reducing mortality is early diagnosis and proper treatment. Therefore, doctors should always be alert to the occurrence of urinary tract infections. If the patient appears suspicious, the blood should be drawn immediately for bacterial culture, and the source of infection should be found (such as indwelling urinary catheter, using urinary tract instruments, etc.). Removing the source of infection is an important measure for managing septic shock. At the same time, the following treatment measures should be taken immediately.

Anti-infective treatment

When gram-negative bacillus septicaemia is suspected, a powerful antibacterial treatment should be used promptly. Before there is no susceptibility result, it can be combined with the patient's situation and local epidemiological materials and the pharmacology of the antibiotic based on clinical work experience Role to decide. Usually, for a septicemia without comorbidities, if the drug is effective, a temperature drop can occur 48 to 96 hours after the medication, and the treatment can last 14 to 21 days. If it is not effective, the drug susceptibility result has already come out, you can adjust the medication according to the drug susceptibility result. Bergan analyzed 6,633 bacteriuria specimens and concluded that gentamicin, cefotaxime, cefoxitin, and cefuroxime were the most sensitive. Gillen Water's review of literature states that aminoglycoside antibiotics, or vancomycin plus broad-spectrum penicillin, are well-proven treatments for sepsis. Aminoglycosides, especially in combination with Pioneer molds, can aggravate nephrotoxicity and can easily cause acute renal failure during shock, so it is listed as a contraindication. Take a newly synthesized antibiotic that is not toxic to the kidney. The combination of these two antibiotics is preferred.

Water, electrolyte and acid-base balance

The main points are the intravenous replenishment of plasma volume substances, such as plasma, dextran, electrolyte solution, etc., to maintain blood perfusion of important organs of the body; alkali supplementation to correct acidosis; to prevent excessive input of fluid, central venous pressure should be measured at the same time. When taking the above measures, pay close attention to avoiding pulmonary edema. In addition, the use of isoproterenol (intravenous infusion, 2 to 3 g per minute) or low-dose dopamine (intravenous infusion, 75 to 100 g / min) can increase the cardiac output, expand the mesentery and renal blood vessels, and increase kidney Blood flow and urine volume prevent the occurrence of acute renal failure.

Corticosteroid therapy

This can alleviate the symptoms of toxic blood. The hormone should be used early, especially before the tissue cells are seriously damaged. Some people have suggested that dexamethasone may be injected intravenously at a rate of 20-30 mg, or hydrocortisone 200-300 mg, and repeated every 4 to 6 hours, and discontinued after 24 hours.

Heparin prevention and treatment of DIC

DIC is a serious complication of sepsis with extremely high mortality. Therefore, once the disease is established, heparin should be given early on the basis of anti-infection and improvement of microcirculation. Usage: 0.5 1.0mg / kg (usually 1.0mg / kg for the first time), intravenous injection or intravenous drip once every 4 6 hours, so that the coagulation time (test tube method) is maintained at 2 3 times of normal, after the DIC is fully controlled Can be discontinued (usually takes 3 to 7 days).

Unobstructed urinary tract

Tunn and Thime adopted comprehensive measures and oxypiperazine penicillin treatment for 32 cases of gram-negative bacillus sepsis. As a result, 2 of 7 cases died and only 1 of 25 cases died. Is a very important part of the treatment of this disease.