What Is MRSA Sepsis?

Epistasis septicemia

Epistaphylococcal sepsis is an abnormal increase in plasma coagulase-negative epistasis present on human skin and mucosal surfaces. After 60s, scientists found that 10% to 15% of patients with sepsis have the disease.

Epistasis septicemia disease name

Epistasis septicemia

Overview of epistasis septicemia

In earlier years, coagulase-negative staphylococci were not pathogenic or saprophytic. After the 1960s, staphylococcal sepsis was found to account for 10% to 15% of the total number of sepsis, especially those infected in the hospital. It is common after foreign body indwelling, such as artificial valves, artificial joints, various catheters and pacemakers. Epidemic bacteria are severely resistant to methicillin-resistant bacteria (MRSE). When receiving broad-spectrum antibacterial drugs, the number of MRS strains in the intestine and respiratory tract increased significantly, which easily caused systemic infection.

Epidemic staphylococcal sepsis disease classification

Infectious Diseases

Epistasis septicemia disease description

In earlier years, coagulase-negative staphylococci were not pathogenic or saprophytic. E.staphylococcus

Epistasis septicemia Sepsis can account for 10% to 15% of the total number of sepsis, especially those infected in the hospital. It is common after foreign body indwelling, such as artificial valves, artificial joints, various catheters and pacemakers. Epidemic bacteria are severely resistant to methicillin-resistant bacteria (MRSE). When receiving broad-spectrum antibacterial drugs, the number of MRS strains in the intestine and respiratory tract increased significantly, which easily caused systemic infection.

Epistasis septicemia symptoms and signs

Etiology of staphylococcal sepsis

Nosocomial infection

Epistaphylococcal sepsis pathophysiology

Pathogenesis

1. Human factors: Deficient immune function is the most important cause of sepsis. In healthy people, after the invasion of pathogenic bacteria,

Epistasis septicemia Generally, it only shows transient bacteremia. Bacteria can be quickly eliminated by the body's immune defense system without causing obvious symptoms. However, people with various immune defense defects (including the loss of local and systemic barrier functions) are prone to induce sepsis. .

(1) Lack or decrease of neutrophils caused by various reasons is an important cause of sepsis, but the incidence of sepsis increases significantly when neutrophils fall below 0.5 × 109 / L, which is more common in acute leukemia and bone marrow transplantation. Later, patients with malignant tumors received chemotherapy, and patients with aplastic anemia.

(2) Immunosuppressive agents such as adrenal cortex hormones, broad-spectrum antibiotics, radiation therapy, cytotoxic drugs, and the development of various major surgeries are important causes of sepsis.

(3) Application of tracheal intubation, tracheotomy and artificial respirator. Indwelling of venous catheters, intra-arterial catheters, indwelling catheters; burn wounds. Various intubation examinations, such as endoscopy, intubation angiography, or placement of an internal drainage tube, can destroy the local barrier defense function and facilitate the invasion of pathogenic bacteria.

(4) Serious primary diseases, such as cirrhosis, connective tissue disease, diabetes, uremia, chronic lung disease

Epistasis septicemia Waiting is also the cause of sepsis. If a patient has two or more triggers at the same time, the risk of sepsis will increase significantly. Staphylococcal sepsis caused by indwelling of venous catheters in the above-mentioned various causes plays an important role in nosocomial infections. Intravenous catheters can remain locally for more than 72 hours, and phlebitis can occur locally, which can induce sepsis; venous catheter indwelling and assisted respirators Its application is also one of the common causes of Gram-negative sepsis such as Acinetobacter and Serratia; indwelling catheters are often the cause of sepsis in Escherichia coli and Pseudomonas aeruginosa. Long-term application of adrenocortical hormones and broad-spectrum antibacterial drugs are important factors inducing fungal sepsis.

2. Bacterial factors Staphylococcus aureus can produce a variety of exotoxins. Among them, plasma coagulase, -hemolysin, leukotoxin, and enterotoxin (A-E, more common in type A) play a major pathogenic role. , Toxins, rashes, etc. can cause severe sepsis; enterotoxin F isolated in recent years is related to the occurrence of toxic shock syndrome (TSS). The endotoxin produced by Gram-negative bacilli can damage the heart muscle and vascular endothelium, activate the complement system, kallikrein system, coagulology and fibrinolytic system, and the sympathetic adrenal spinal system, ACTH

Epistasis septicemia / Endorphin system, etc., and can activate a variety of blood cells and endothelial cells. Production of a variety of cytokines (such as TNF-, IL-1, IL-6, IL-8 and other cytokines, of which TNF- plays a key role in the successful pathological changes), inflammatory mediators, cardiovascular regulatory peptides Etc., leading to microcirculation disorders, septic shock and so on. Inhibitors of protein synthesis in Pseudomonas aeruginosa, such as proteases, leukocidin, phospholipase C, and exotoxin A, etc. The latter is a strong inhibitor of protein synthesis and can cause tissue necrosis; exotoxin A and elastase coexist At the time, its virulence is the largest, and pneumococcal disease is mainly dependent on it, which has anti-phagocytosis; it can often produce hemolytic toxin and neuraminidase. Klebsiella pneumoniae and the like also have the effect of anti-phagocytosis and bactericidal substances in body fluids. Pathological changes Toxins from pathogenic bacteria can cause tissue and organ cell deformation, and edema, necrosis, and fat deformation can occur. Hairline blood vessel damage causes skin and year-end silt spots and rashes. The migration caused by bacteria is more common in the lung, liver, kidney, bone, and subcutaneous tissue, and can be complicated by endocarditis, meningitis, and osteomyelitis. Monocyte-phagocytic cells proliferate actively, and both liver and spleen can enlarge.

Epistaphylococcal sepsis diagnostic test

(1) The total number of blood cells in the blood image increases, generally at (10-30) × 109 / L, and the percentage of neutrophils increases.

Epistasis septicemia Apparent left shift of the nucleus and intracellular toxic particles may occur, and eosinophils may decrease or disappear. The total number of white blood cells of the poorly responsive and a small number of patients with Gram-negative bacillus sepsis may be normal or low, but the number of neutrophils is still increased.

(2) Blood culture is the most important for pathogenic examination. It should be performed before the application of antibacterial drugs and during chills and high fever. It should be repeated for multiple tests. The blood volume of each time is 5ml for newborns and infants. 10ml. Those who have the right conditions should do both anaerobic and fungal culture. In cases where antibacterial drugs have been used, it is appropriate to add magnesium sulfate, -lactamase, p-aminobenzoic acid and other antibacterial drugs to the culture medium, or use a blood clot culture method to increase the positive rate. The positive rate of bone marrow culture was higher than that of blood culture. Pap, cerebrospinal fluid, thoracic and ascites fluids, smears, and other smears are used for examination and culture, and there are also opportunities to detect pathogenic bacteria. The post-sensitivity test of the isolated pathogens to determine the minimum inhibitory concentration (MIC) for reference in the selection of antibacterial drugs. Measure the minimum bactericidal concentration (MBC) when necessary. Serum sterilization experiments also have important reference significance. Generally, there is no bacterial growth on the culture medium. When L-type bacterial septicemia is suspected, hypertonic saline culture should be used. Fungi grow slowly and the positive rate of culture is low. Latex agglutination experiments to determine antigens or corresponding antibodies (for cryptococcosis), as well as pathological examinations are helpful for diagnosis. It takes at least 1 week to isolate and culture anaerobic bacteria, which can not provide bacteriological basis for clinical treatment in time. In recent years, rapid diagnostic techniques such as gas chromatography and ion chromatography have been developed. Chromatography can also diagnose the presence or absence of anaerobic bacteria in forest-loaded specimens within 1 hour, which is convenient for guiding medication. Immunofluorescence is fast, sensitive, and can specifically identify anaerobic bacteria; other immunoenzymatic expressions are used to quickly identify Clostridium perfringens, etc., which has a good effect on early diagnosis.

(3) Other tests: The lysate test (LLT) can detect the endotoxin of Gram-negative bacilli in serum and other specimens, but it cannot identify the pathogenic bacteria, which is helpful for the diagnosis of Gram-negative sepsis. In the course of the disease, such as heart, liver, kidney and other organ damage, or shock, DIC, etc., should be checked accordingly. X-ray examination of septic arthritis was found 2 weeks after the onset.

Diagnosis and differential diagnosis: The diagnosis is based on patients with anti-acute fever. Leukocytes and neutrophils are significantly increased, and

Epistasis septicemia When not limited to acute infection of a system, the possibility of sepsis should be considered. Medical history inquiry and detailed physical examination are of certain significance to assist in the diagnosis. Those with recent skin infections, traumas, and especially crush sores; or those with infections such as urinary tract, biliary tract, and respiratory tract; or those with localized infections that have been treated with effective antibacterial drugs and whose temperature cannot be controlled The possibility of sepsis should be highly suspected. If rash, hepatosplenomegaly, migrating abscess appear during the course of the disease, the clinical diagnosis of sepsis can be basically established. Detailed physical examination can often find the primary lesion or invasion pathway, and infer the type of pathogenic bacteria from the location and nature of the lesion. After obtaining a positive blood culture, further examination should be performed, and the primary lesion can often be found, which is convenient for radical treatment. A positive blood culture (and bone marrow culture) is the basis for the diagnosis of sepsis.

Epistaphylococcal sepsis treatment plan

At present, Staphylococcus has a serious resistance to antibiotics. In addition to being highly resistant to mood (over 95%), the demand for ceftiophen and cefazolin has also increased, with a rate of about 30% -40%. About half of the strains are resistant to oxacillin, and MRSA sepsis with multidrug resistance has not appeared in different proportions in different regions. However, staphylococci are usually sensitive to vancomycin. In view of the above situation, oxacillin or amoxicillin should be the first choice for staphylococcal sepsis, and cefalotin or ceftizolin combined with rifampin can be used. Can be adjusted according to the drug sensitivity results. MRSA and MRSE sepsis can be combined with vancomycin (or norvancomycin) fosfomycin or rifampicin. Drugs to replace vancomycin include lanin, fusidic acid and the like.

Epistasis septicemia disease prevention

Strengthen the health care during the sanitary period. Guided secretion examination should be performed before delivery. If culture group B is found to be hemolytic streptococcus

Epistasis septicemia Prompt treatment to prevent infection of the newborn. Protective isolation should be adopted in neonatal rooms, burn wards, and patients receiving chemotherapy for leukemia or bone marrow transplants to prevent the occurrence of nosocomial infections such as drug-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Medical staff of chronic Staphylococcus aureus should be temporarily removed and treated, and those with obvious or hidden infection should be treated in time. Catheters in the indwelling body should be replaced regularly, and infection should be removed in time, and antibacterial drugs should be given at the same time. Do not squeeze skin infections such as pimple and pimple. Use adrenocortical hormones and antibiotics reasonably, and closely observe the oral digestive tract, respiratory tract, urethra and other fungal infections during use. For diabetes, chronic liver disease, leukemia and other chronic diseases that are prone to infection, active treatment should be performed to prevent infection as much as possible. Preventive oral antibacterial drugs (including antifungal drugs) for neutropenia and other immunodeficiency patients can significantly reduce the incidence of infection. Medical staff must strictly implement the disinfection and isolation system and operating procedures, wash their hands frequently, and use medical supplies as much as possible once. This is an important measure to reduce hospital infection and sepsis.

Epistaphylococcal sepsis main drugs

Epistaphylococcal sepsis, first-generation cephalosporins

The antibacterial agent of pathogenic bacteria and the daily dosage for adults can be combined (optional). The drug phytopenicillin G sensitive strain penicillin G500 10 million u

Gentamicin, Amikacin, Penicillin G-resistant oxacillin penicillin 6-12g

O-chloropenicillin 6 12g

First-generation cephalosporins, erythromycin, vancomycin, lincomycin, and methicillin-resistant vancomycin 1.5-2.0g

1.2g of droperifenic acid, 4-8g of cefalotin, fucomycin, rifampicin, gentamicin, SMZco, pneumococcus or hemolytic streptococcus penicillin G300-6 million u, 1.5-1.8g

Epistasis septicemia aminoglycosides

Chloramphenicol, Enterococcus penicillin G600 10 million u, Ampicillin 4 12g

Cephalosporin (such as ceftazimid), vancomycin 1.5-2.0g, gentamicin, streptomycin, 1.2 g of E.coli or pneumococcal amikacin or 240,000 u of gentamicin, and oxygen piperazine Penicillin 4 8g

Cephalosporins

Ceftizolin, ampicillin, amikacin, aminoglycosides of Pseudomonas aeruginosa, 4-8g of piperazine penicillin, 15-30g of carbenicillin, and polymyxin B 1.5-2 million

Epistasis septicemia cephalosporins

Anaerobic bacteria, fragile bacillus metronidazole 1.2 1.8g, chloramphenicol, clindamycin, other anaerobic bacteria penicillin G600-8 million u, metronidazole, fungal amphotericin B (first dose 0.1mg / kg, gradually increased to 0.5 1.0mg / kg), ketoconazole 200 400mg, miconazole 50 1800mg

Epistaphylococcal sepsis in infants and young children

E. staphylococcal sepsis identified staphylococci by routinely taking specimen strains. It was identified with neonatalmycin drug-sensitive paper and plasma coagulase test. Staphylococcus epidermidis was judged to be negative for plasma coagulase and sensitive to neomycin. Adopt drug sensitivity kits: ampicillin, penicillin G, ampicillin / penicillin sulfone, oxacillin, erythromycin, clindamycin, jiemycin, vancomycin, ofloxacin, ciprofloxacin Flaxin, cefoperazone / penicillone sulfone, ampicillin / penicillone sulfone.

Staphylococcus epidermidis (staph, epidernidis) is one of the main pathogens of blood infections in infants in hospitals. In the past, most of Staphylococcus epidermidis isolated from blood were considered to be contaminating bacteria. In recent years, it has been reported that the infection of humans, especially infants, has increased year by year. According to the results of drug efficacy, it can be seen that the penicillin resistance rate is as high as 96% and erythromycin; clindamycin is 88% and 72% respectively, and jiemycin also reaches 52%. Cefoperazone / penicillin is in the epidermis Staphylococcal sepsis has a very significant application effect, with a sensitivity rate of over 94%. With the widespread use of antibiotics, bacterial resistance gradually increases, and infections caused by drug-resistant strains are more common; therefore, bacterial infections must be tested for drug sensitivity, rational use of antibiotics, and strengthening the control of nosocomial infections to provide a basis.

Information about staphylococcal sepsis

Septicaemia Staphylococcus sepsis Septicemia is an acute systemic infection caused by pathogenic bacteria continuously invading the blood circulation from the human body. Pathogenic bacteria grow and reproduce in human blood, and newly produced toxins can cause systemic dysfunction and poisoning symptoms. Common pathogenic bacteria are Staphylococcus aureus and E. coli, followed by Staphylococcus epidermidis, Pseudomonas aeruginosa, Streptococcus faecalis, anaerobic bacteria and fungi.

Whether the bacteria that invade the tissue can cause sepsis depends on the number of invading bacteria, the virulence and the body's resistance, especially the latter. If a person with strong resistance has a small amount of pathogenic bacteria invading tissue or blood (such as tooth extraction, urinary catheterization, etc.), due to the body's strong defense function, bacteria can be quickly killed by phagocytic cells and white blood cells, so no disease will occur. When immature abscesses, mules are squeezed hard, or biliary and urinary tract obstructions cause stagnation of contents and visceral wall tension, pathogenic bacteria can enter the blood from the local area and cause sepsis.

A considerable part of sepsis is caused by diseases that affect the body's immune function, such as leukemia, cirrhosis, diabetes, malignant tumors, etc. These patients use the immunosuppressive drugs such as adrenal corticosteroids, antitumor drugs or radiation therapy to make the body The defense function was damaged and caused infection. In addition, there is a type of sepsis that is often resistant to bacteria or weakly toxic and not pathogenic. This type of sepsis is infected in the hospital, such as intravenous infusion, retention of catheterization, Various intubation angiography and organ transplantation can bring in bacteria and cause sepsis.

Most of the onset of the disease is acute, with toxic blood symptoms such as high fever, chills, chills, headaches, joint pain, and accompanied by abdominal distension, rash, hepatosplenomegaly and so on. Severe cases may have symptoms such as shortness of breath, irritability, unconsciousness, coma, and even emergent symptoms such as septic shock, disseminated intravascular coagulation, and acute endocarditis. In some patients with S. aureus sepsis, bacteria can enter the organs of the body from the blood, causing purulent lesions such as lung abscesses, liver abscesses, meningitis, osteomyelitis, arthritis, and subcutaneous abscesses. Patients with chronic disease may develop progressive anemia, weight loss, water and electrolyte disorders in the body.

Determining the focus or invasion path through detailed understanding of the medical history and physical examination is very important for the diagnosis of the pathogen of sepsis. According to the types of pathogenic bacteria, early and reasonable selection of antibiotics.

The treatment of this disease mainly lies in early, reasonable and combined application of antibiotics. For severe sepsis of unknown etiology, aminoglycoside antibiotics (gentamicin, tobramycin, etc.) can be combined with carbenicillin or cephalosporin antibiotics; if staphylococcus is suspected, oxacillin, Fosfomycin, etc .; For those suspected of Pseudomonas aeruginosa, cefradine and carbenicillin can be used; for suspected anaerobic bacteria, chloramphenicol, metronidazole, etc. can be used. Amphotericin B is preferred for fungal sepsis. The dosage of antibiotics should be large, and the daily volume should be quickly dripped intravenously in 2 to 4 times in order to achieve a high blood concentration and quickly kill the pathogenic bacteria. After the temperature drops and the clinical symptoms improve, the dosage should be continued for at least 7 to 10 days. When pus is present, incision and drainage should be performed in time, and antibiotics should be applied locally.

In the course of treating sepsis, closely observe changes in blood pressure, pulse, and consciousness. Keep your mouth and skin clean. Give digestible foods to ensure calorie supply. Daily intake of 2000-3000 milliliters of fluid is necessary to facilitate excretion of toxins. When oral administration is difficult, it should be replenished intravenously, while sodium, potassium, chlorine and other electrolytes should be replenished.

To prevent sepsis, care should be taken to protect the integrity and cleanliness of the skin and mucous membranes. If damaged, disinfection should be performed in a timely manner. Infective lesions in the body should be treated in a timely manner. Sore infections should be treated in a timely manner. Do not squeeze or puncture with a needle. Biliary tract, urinary tract infections and other infections need to be removed, and surgical treatment if necessary. When inflammation is not limited, incision and drainage cannot be performed.