Sepsis
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A41.9 For neonatal sepsis, see: Septicaemia of the newborn . DESCRIPTION Severe sepsis is an uncontrolled inflammatory response as a result of suspected or proven infection. DIAGNOSTIC CRITERIA Clinical A systemic inflammatory response with at least two of the following four criteria, on
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: A41.9
For neonatal sepsis, see: Septicaemia of the newborn.
DESCRIPTION
Severe sepsis is an uncontrolled inflammatory response as a result of suspected or proven infection.
DIAGNOSTIC CRITERIA
Clinical
- A systemic inflammatory response with at least two of the following four criteria, one of which must be abnormal temperature or leucocyte count:
- core temperature of < 36 ºC or > 38.5 ºC,
- tachycardia,
- tachypnoea,
- elevated leucocyte count.
PLUS one of the following: - cardiovascular dysfunction,
- acute respiratory distress syndrome, or
- ≥ 2 other organ dysfunctions.
Investigations
- Blood culture and identify focus of infection, e.g. osteomyelitis, abscess.
- Investigate for malaria, especially in endemic areas, or if there is a relevant travel history.
- Where meningitis due to meningococcus is suspected, i.e. with petechial rash, lumbar puncture is contraindicated (see: Lumbar puncture). Do petechial scrapes and blood culture to confirm diagnosis.
GENERAL AND SUPPORTIVE MEASURES
- For suspected meningococcaemia: Notifiable condition and requires isolation for 24 hours after commencement of appropriate antibiotics.
- Admit to a high care area.
- Early recognition and treatment of septic shock.
- Antimicrobials do not penetrate necrotic tissue or abscesses, so debridement, incision and drainage are essential aspects of care.
MEDICINE TREATMENT
Empiric antibiotic therapy
Choice of antibiotic depends on the severity of the condition and predisposing factors.
- Ceftriaxone, IV, 100 mg/kg, once daily for 7 days.
Confirmed meningococcal septicaemia
- Benzylpenicillin (Penicillin G), IV, 100 000 units/kg/dose immediately, then 4 hourly for 7 days
Suspected staphylococcal infection (e.g. osteomyelitis)
- Cloxacillin, IV, 50 mg/kg/dose 6 hourly
PLUS
- Ceftriaxone, IV, 100 mg/kg, once daily
Reconsider choice and descalation of antibiotics, aiming for monotherapy where possible, when the results of cultures become available or if the child does not improve.
Continue IV antibiotics until there is a good clinical response and laboratory markers of infection improve (usually less than a week). Oral antibiotics are then appropriate.
See: Staphylococcal septicaemia, for management of invasive S. aureus infections.
Nosocomial sepsis: Manage according to the background microbiological flora within your institution.
Septic shock
See: Shock.
REFERRAL
- Septicaemia with complications.
- Patients requiring intensive care.
- Patients requiring debridement of necrotic areas or drainage of collections.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 8: Infective/Infectious Diseases, 8.27 Sepsis