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Sepsis

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Sakkunnig:


Definition:
Sepsis är ett tillstånd där en infektion har utlöst en självupprätthållande och okontrollerbar organdysfunktion.
Förekomst:
Speciellt vanligt i definierade riskgrupper, men också i befolkningen i övrigt. 
Symtom:
Lokaliserad eller systemisk infektion med bland annat feber eller hypotermi, snabb puls och andningsfrekvens, hypotension, förändrat psykiskt status med flera. 
Kliniska fynd:
Feber, hypotermi, takykardi, takypne, altererat mentalt status, hypotension, hypoperfusion, minskad diures. 
Diagnostik:
Lokaliserad eller systemisk infektion, samt systemiska tecken på organinvolvering. 
Behandling:
Syrgastillförsel, intravenös vätska samt intravenöst antibiotika. 
  1. Svenska Infektionsläkarföreningen, Vårdprogram för Sepsis och septisk chock - Tidig identifiering och initial handläggning. Rev 2018. infektion.net  
  2. Personcentrerat och sammanhållet vårdförlopp – Sepsis. Nationellt system för kunskapsstyrning Hälso- och sjukvård. Godkänt 2021-05-21 (Hämtad 2021-06-21). nationelltklinisktkunskapsstod.se  
  3. Mellhammar L, Wullt S, Lindberg Å et al. Sepsis Incidence: A Population-Based Study.Open Forum Infect Dis. 2016 Dec 8;3(4). PMID: 27942538. PubMed  
  4. Johansson D, Ekström H, Beronius E, Rasmussen M. Läkartidningen. 2015;112:DI7S www.lakartidningen.se  
  5. Henriksen DP, Laursen CB, Jensen TG, Hallas J, Pedersen C, Lassen AT. Incidence rate of community-acquired sepsis among hospitalized acute medical patients-a population-based survey. Crit Care Med. 2015 Jan;43(1):13-21. doi: 10.1097/CCM.0000000000000611. DOI  
  6. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, ... CDC Prevention Epicenter Program. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. 2017 Oct 3;318(13):1241-1249. doi: 10.1001/jama.2017.13836. DOI  
  7. Schroder K, Tschopp J. The Inflammasomes. Cell 2010; 140: 821. pmid:20303873 PubMed  
  8. Annane D, Bellissant E, Cavaillon J-M. Septic shock. Lancet 2005; 365: 63-78. PubMed  
  9. Angus DC, van der Poll T. Severe Sepsis and Septic Shock. New Engl J Med 2013; 369: 840. pmid:24256390 PubMed  
  10. van der Poll T, Opal SM. Host-pathogen interactions in sepsis. Lancet Infect Dis 2008; 8: 32. pmid:18063412 PubMed  
  11. Classification of patients with sepsis according to blood genomic endotype: a prospective cohort study.Scicluna BP, van Vught LA, Zwinderman AH, Wiewel MA, Davenport EE, ... MARS consortium. Lancet Respir Med. 2017 Oct;5(10):816-826. doi: 10.1016/S2213-2600(17)30294-1.
  12. Shankar-Hari M, Phillips GS, Levy ML, et al.. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). . JAMA. 2016. pmid:26903336 PubMed  
  13. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definition for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801-10. doi: 10.1001/jama.2016.0287 DOI  
  14. Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017; 317: 301. doi:10.1001/jama.2016.20329 DOI  
  15. Fernando SM, Tran A, Taljaard M, et al. Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis. Ann Intern Med 2018 Feb 20; 168(4): 266-275. pmid:29404582 PubMed  
  16. Dellinger RP, Levy MM, Rhodes A. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Int Care Med 2013; 39: 165. pmid:23361625 PubMed  
  17. Karlsson S, Varpula M, Ruokonen E, et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Medicine 2007; 33: 435-43. PubMed  
  18. Vesteinsdottir E, Karason S, Sigurdsson SE et al. Severe sepsis and septic shock: a prospective population-based study in Icelandic intensive care units. Acta Anaesthesiol Scand 2011; 55:722-31. PubMed  
  19. Nygård ST, Langeland N, Flaatten HK. Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital. BMC Infect Dis 2014; 14: 121. pmid:24588984 PubMed  
  20. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 2006; 34: 1996-2003.
  21. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004; 350: 2247-56. PubMed  
  22. Patel A, Laffan MA, Waheed U, Brett SJ. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality . BMJ 2014; 349: g4561. BMJ (DOI)  
  23. Rivers E, Nguyen B, Havstad S, et al. Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368-77. New England Journal of Medicine  
  24. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y. Corticosteroids for severe sepsis and septic shock: a systematic review and meta-analysis. BMJ 2004; 329: 480. British Medical Journal  
  25. Sprung CL, Annane D, Keh D et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358: 111-24. New England Journal of Medicine  
  26. Lamontagne F, Rochwerg B, Lytvyn L, et al. Corticosteroid therapy for sepsis: a clinical practice guideline . BMJ 2018; 362: k3284. doi:10.1136/bmj.k3284 www.bmj.com  
  27. Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock The VITAMINS Randomized Clinical Trial. JAMA 2020. pmid:31950979 PubMed  
  28. Oscarson A, Bjurman C, Edman Wallen J, Werner M. Sepsis hos vuxna - tidig upptäckt och initial behandling. Läkartidningen, volym 114, 2017 www.lakartidningen.se  
  29. Rangel-Frausto MS, Pittet D, Hwang T, Woolson RF, Wenzel RP. The dynamics of disease progression in sepsis: Markov modeling describing the natural history and the likely impact of effective antisepsis agents. Clin Infec Dis 1998; 27: 185-90. PubMed  
  30. Annane D, Aegerter P, Jars-Guincestre MC, Guidet B. Current epidemiology of septic shock: the CUB-Rea Network. Am J Respir Crit Care Med 2003; 1687: 165-72. PubMed  
  31. Flaatten H. Epidemiology of sepsis in Norway in 1999. Critical Care 2004; 8: 180-4. PubMed  
  32. Raith EP, UdyAA, Bailey M,, et al. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA 2017; 317: 290-300. doi:10.1001/jama.2016.20328 DOI  
  33. Linder A, Guh D, Boyd JH. Walley KR, Anis A, Russell J. Long-Term (10-Year) Mortality of Younger Previously Healthy Patients With Severe Sepsis/Septic Shock Is Worse Than That of Patients With Nonseptic Critical Illness and of the General Population Critical Care Medicine: October 2014 - Volume 42 - Issue 10 - p 2211–2218doi: 10.1097/CCM.0000000000000503 DOI  
  34. Yende S, Linde-Zwirble W, Mayr F, A. Weissfeld L, Reis S, and C. Angus D. Risk of Cardiovascular Events in Survivors of Severe Sepsis. https://doi.org/10.1164/rccm.201307-1321OC American Journal of Respiratory and Critical Care Medicine Vol. 189, No. 9 May 01, 2014
  35. Folkhälsomyndigheten, Läkemedelsverket, Strama. Behandlingsrekommendationer för vanliga infektioner i öppenvård. 2021-03-01 (Hämtad 2021-06-21). www.folkhalsomyndigheten.se  
  • Athena Adeli, legitimerad läkare, Karolinska Institutet

Tidigare sakkunniga

  • Bertil Christensson, professor och överläkare, Infektionskliniken, Skånes universitetssjukhus