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La definizione deve individuare un insieme
che abbia esattamente la stessa estensione
dell'insieme individuato dall'oggetto da definirsi.
Le Categorie, IV sec. a.C., Aristotele.
First and foremost, sepsis is a broad term applied to an incompletely understood process.
There are no simple clinical criteria or laboratory features that uniquely identify a septic patient.
The new definitions rely on expert opinion;
further understanding of sepsis
will fuel their reevaluation and revision.
InfezioneRisposta
dell’ospite
Danno d’organo
SIRS +
segni specifici
di infezione
Pathways:
-Pro-infiammatori
-Anti-infiammatori
-Autonomici
-Ormonali
-Metabolici
-Genetici
-Epigenetici
Sepsis is defined as life-threatening organ dysfunction
caused by a dysregulated host response to infection.
Sepsis-3 (2016)
Septic shock is a subset of sepsis in which
underlying circulatory and cellular abnormalities
are profound enough to substantially increase mortality.
Sepsi
Lattati >2Ipotensione
Mortalità > 40%
Con parole semplici…
Sepsis is a life-threatening condition
that arises when the body’s response to infection
injures its own tissues and organs.
Hall et al. Impatient care for sepsis. NCHS Data Brief, 2011
Ospedalizzazione con e per setticemia/sepsi
Hall et al. Impatient care for sepsis. NCHS Data Brief, 2011
Tasso di ospedalizzazione per sesso ed età
Epidemiologia in Medicina Interna
1/23 pazienti ricoverato con sepsi
68% sepsi severain Medicina Interna
Mortalità del 20-45%
31 Reparti Med InternaMar-Dic 2012
533 pazienti emocolture +
60% sepsi severa e 3.2% shock
7 pz trasferiti in ICU (1.3%)
For the overall group,mortality risk increases
12% every hour
Significant increase in mortality risk
with increasing delays in administration of Ab therapy
Bassetti et al. PLoS ONE 2011; 6(9): e24198
Mortalità per candidemia e ritardo di inizio della terapia antifungina
Surviving Sepsis Campaign
Within 3 hours…
Check Lactic acid
Send Blood Coltures
Give Antibiotics
30 mL/kg IV Fluids
(if low BP/high Lactate)
Surviving Sepsis Campaign
Within 6 hours…
Vasopressors if MAP<65mmHg
Re-assess Volume Status & Tissue Perfusion
Re-check Lactic Acid (unless initially normal)
CVP - ScvO2 - Cardiac US - Passive leg raise
In conclusione
Alta mortalità
Elevata incidenza in Medicina Interna
Necessario: Rapidità di diagnosi e terapia
Non necessario: approccio invasivo
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