SEVERE SEPSIS “1”+”2”+”3”

1. Documented or suspected infection

2. At least TWO of the following: 

   • Temp > 38.3°C (101°F) or < 36°C (96.8°F) 

   • Heart Rate > 90/min 

   • Respiratory Rate > 20/min 

   • WBC > 12,000 or < 4,000 

   • Bandemia > 10%

3. At least ONE of the following sepsis-induced organ dysfunction variables: 

   • SBP < 90 mmHg or MAP < 65 mmHg or decrease SBP > 40 mmHg from known baseline 

   • Lactate > 2 mmol/L 

   • Creatinine > 2 mg/dL 

   • UOP < 0.5 mL/kg/hr for 2 hours 

   • Bilirubin > 2 mg/dL 

   • Platelets < 100,000 /mm

   • INR > 1.5 or PTT > 60 seconds 

   • Acute respiratory failure evidenced by a new need for invasive or non- invasive mechanical ventilation

SEPTIC SHOCK

• Presence of severe sepsis as above AND

• Sepsis-induced hypoperfusion persisting despite adequate fluid resuscitation OR Lactate > 4 mmol/L

Criteria for pregnancy with EGA 20 weeks through day 3 post delivery

1. Documented or suspected infection

2. At least TWO of the following: 

   • Temp > 38°C (100.4°F) or < 36°C (96.8°F) 

   • Heart Rate > 100/min 

   • Respiratory Rate > 24/min 

   • WBC > 15,000 or 10% bands

   • Bandemia > 10%

3. At least ONE of the following sepsis-induced organ dysfunction variables: 

   • SBP < 85 mmHg or MAP < 65 mmHg or decrease SBP > 40 mmHg from known baseline 

   • Lactate > 2 mmol/L 

   • Creatinine > 1.2 mg/dL 

   • UOP < 0.5 mL/kg/hr for 2 hours 

   • Bilirubin > 2 mg/dL 

   • Platelets < 100,000 /mm

   • INR > 1.5 or PTT > 60 seconds 

   • Acute respiratory failure evidenced by a new need for invasive or non- invasive mechanical ventilation

To be completed

within 3 hrs of presentation

• Measure lactate level

• Obtain blood cultures prior to antibiotics administration

• Administer broad spectrum antibiotics

• Administer 30 mL/kg crystalloid if

  • • Hypotensive or

    • Lactate ≥ 4 mmol/L

within 6 hrs of presentation

• Repeat lactate if initial lactate is >2 mmol/L

• Apply vasopressors for hypotension that does not respond to initial fluid resuscitation

• Physician/APN/PA documentation with Date & Time that a repeat volume status was performed to assess patient’s response to crystalloid fluids.

• Examples: 

  • • “Review of systems completed” 

    • “I have reassessed tissue perfusion after bolus given.” 

    • “Sepsis re-evaluation was performed”

Antibiotics must be given IV/IO

Mono-therapy broad spectrum antibiotics:

• Ampicillin/sulbactam (Unasyn)

• Cefepime (Maxipime)

• Cefotaxime (Claforan)

• Ceftazidime (Fortaz)

• Ceftriaxone (Rocephin)

• Imipenem/Cilastatin (Primaxin)

• Levofloxacin (Levaquin)

• Meropenem (Merrem)

• Piperacillin/tazobactam (Zosyn) 

Combination-therapy other antibiotics: choose one group A, and one from group B

Section A 

• Aminoglycosides 

  • • Amikacin

    • Gentamicin

    • Tobramycin

• Aztreonam (Azactam) 

• Ciprofloxacin (Cipro) 

Section B 

• Cephalosporins

  • • Cefazolin (Ancef)

    • Cefuroxime (Zinacef)

    • Cefoxitin (Mefoxin) 

• Vancomycin

• Tigecycline 

• Clindamycin (Cleocin) 

• Linezolid (Zyvox)

• Macrolides

  • • Azithromycin (Zithromax)

    • Erythromycin (Erythocin)

• Penicillins

  • • Ampicillin (Ampicillin)

    • Nafcillin (Nafcillin) 

    • Oxacillin (Oxacillin)

    • Penicillin G (Pfizerpen)

• Daptomycin (Cubicin)