SEPSIS

SEPSIS (generalized purulent infection) is a common severe infectious disease that results from the spread of infection from the primary focus in connection with the violation of mechanisms of local and general immunity. The primary septic focus can be any suppurative process of soft tissues, bones, joints and internal organs. The continued existence of a local purulent focus (for example, in connection with the patient's refusal to provide timely medical assistance, ineffective long-term polyclinic stage of treatment), as well as non-radical surgery for a purulent process may be accompanied by the development of sepsis. Sometimes the primary septic focus can not be detected - the so-called cryptogenic, or primary, sepsis.

There are surgical, odontogenic, otogenous, rhinogenic, obstetric-gynecological sepsis, urosepsis. Surgical sepsis, which occurs most often, can be a complication of various surgical diseases, especially purulent (peritonitis, lung abscess , etc.), and damage (for example, burns - burn sepsis). The primary septic focus in odontogenic sepsis is purulent processes in the gums or jaws; The latter can be complicated by suppuration of submandibular lymph nodes and phlegmon cavity of the mouth. It can also be a consequence of angina (tonsillitis sepsis). Otogenic sepsis occurs as a complication of purulent otitis and can quickly lead to a contact spread of pathogens of infection to the brain envelopes with the development of meningitis. Rhinogenic sepsis can occur as a complication of purulent diseases of the nose and paranasal sinuses. Local spread of the process leads to regional thrombophlebitis or osteomyelitis of the bone structures forming the sinus walls, the phlegmon of the orbit accompanied by conjunctivitis, exophthalmos. Possible thrombosis of the sagittal sinus and meningitis. Obstetrical and gynecological sepsis can be the result of complicated labor, surgical interventions on female genital organs or their purulent-inflammatory diseases. It is extremely difficult (often in the form of septic shock) sepsis occurs, arising as a result of criminal abortion. Primary septic focus in urosepsis is localized in the genitourinary system (ascending urethritis, cystitis , pyelitis, nephritis , bartolinitis in women, prostatitis in men).

By type of pathogen distinguish staphylococcal, streptococcal, pneumococcal, gonococcal, colibacillary, anaerobic, mixed sepsis, etc. Anaerobic sepsis can be observed with anaerobic infection. The leading mechanism in the pathogenesis of sepsis is bacteremia and intoxication. Septicemia (sepsis with bacteremia, but without purulent metastases) is the most common form of sepsis. It usually proceeds acutely and is accompanied by intoxication, dystrophic changes in internal organs. Staphylococci, streptococci, often gram-negative microorganisms (Pseudomonas aeruginosa and Escherichia coli), as well as non-spore-forming (nonclostridial) anzarobes (bacteroides, fusobacteria, peptostreptococci, etc.) serve as causative agents. Septicopyemia (pyemia) - sepsis with the formation of purulent metastases in internal organs. Pathogens can be any microorganisms located in the primary purulent focus, which with the blood flow enter the vascular system, more often the lungs and kidneys.

Common symptoms of sepsis are high body temperature (up to 39 - 40 ° C), severe tachycardia , often chills and sweating. Intoxication is manifested by severe weakness, loss of appetite; Often show an increase in the liver and spleen. Characteristic multiple lesions of organs and systems with the development of cardiac, respiratory, renal, hepatic, adrenal insufficiency; Violation of blood clotting in the form of thrombosis in combination with hemorrhages, hemorrhagic skin rash. The examination reveals high leukocytosis , less leukopenia with a shift of the leukocyte formula to the left, sharply increased ESR, lymphopenia, hypoproteinemia, as well as signs of damage to internal organs (toxic nephritis, hepatitis, myocarditis).

The clinical course distinguishes lightning, acute, subacute, recurrent and chronic sepsis. With fulminant sepsis, clinical symptoms rapidly increase, and within 1-3 days the disease ends with a fatal outcome. With the most common acute sepsis there is a rapid development of symptoms; The duration of the course depends on the nature and effectiveness of the treatment - usually 1.5 - 2 months, after which the recovery period or the disease becomes subacute. With subacute sepsis, acute symptoms gradually disappear (fever, intoxication, etc.). About chronic sepsis is said with preservation of its manifestations for more than 6 months, which is usually explained by the presence of purulent foci, difficult to surgical treatment (in bones, joints, but more often in the internal organs - endocarditis , chronic lung abscess , pleural empyema). Recurrent sepsis is characterized by a change in periods of exacerbation with bright symptoms and periods of remission when it is not possible to detect any noticeable clinical symptoms.

One of the complications of sepsis is a bacterial-toxic shock - the body's reaction to a breakthrough in the blood of pyogenic microorganisms or their toxins, which can occur in any period of the course of the disease. Initial signs of shock - high fever (up to 40 - 41 ° C) with tremendous chills, which are followed by severe sweating (heavy sweats) with a drop in body temperature to normal or subfebrile. The main sign of bacterial-toxic shock, as well as of any shock, is acute vascular insufficiency: a frequent pulse (120-150 beats per minute) of weak filling, a drop in blood pressure. Motional agitation, pallor of the skin, acrocyanosis, increased respiration (up to 30-40 in 1 min) are noted. Severe changes in hemodynamics and disruption of the blood coagulation system lead to a sudden sudden decompensation of the functions of vital organs and systems.

Treatment is complex, it should be performed in intensive care units for patients with purulent infection. Includes active surgical treatment of purulent foci (available for surgery) and general intensive multicomponent therapy. Surgical treatment consists in excision of all affected tissues, prolonged active drainage of the operating wound and the fastest closing of the wound surfaces by suturing or applying dermal plastics. After surgical treatment of the purulent focus for rapid cleaning and preparation for closure, osmotically active ointments on a water-soluble basis (levosin, levomecol, dioxydin ointment) with pronounced antiseptic and sorption properties are used. For extensive flat wounds, treatment is applied in a controlled, non-microbial environment: the affected area of ​​the body is placed in a plastic insulator through which sterile air is blown.

Intensive therapy of sepsis includes the administration of antibiotics and antiseptic agents, taking into account the sensitivity of the isolated microflora to them (at the stage of empirical therapy, ie before obtaining an antibioticogram, a combination of cephalosporins of III and III generations and aminoglycosides is usually used). Disinoxication therapy, anti-inflammatory treatment with glucocorticoids, correction of protein-energy losses (high-calorie nutrition, probing and parenteral nutrition), infusion therapy (transfusion of electrolytes, poly- and reopolyglucin, fat and protein emulsions), pressor amines (dopamine) with persistent hypotension, Oxygen therapy, correct the impaired functions of various organs and systems, prescribe heparin , transfuse platelet mass and freshly frozen plasma.

The prognosis for any form of sepsis is always serious. The earlier a patient has been hospitalized, the sooner the primary septic focus is established and surgical sanitation is performed, the more complex the treatment is, the more likely the patient will recover.

Prevention is based on correct and timely treatment of local purulent processes. If inpatient treatment is ineffective, the patient should be hospitalized in the surgical department.