Sepsis additional refinement of model Septic shock septicemia

Sepsis – additional refinement of model Septic shock, septicemia, endotoxicosis, endotoxemia

Sepsis – proposed model* *Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801– 810. doi: 10. 1001/jama. 2016. 0287

Sepsis vs. septicemia* • Over many years, the terms sepsis and septicemia have referred to several ill-defined clinical conditions present in a patient with bacteremia. Definitions have not changed greatly since 1914, when Schottmueller wrote, “Septicemia is a state of microbial invasion from a portal of entry into the blood stream which causes sign of illness. ” • In practice, these 2 terms have often been used interchangeably; however, only about half of patients with signs and symptoms of sepsis have positive results on blood culture. Furthermore, not all patients with bacteremia have signs of sepsis. It follows, therefore, that sepsis and septicemia are not in fact identical. *https: //emedicine. medscape. com/article/168402 -overview#a 3 • There is a recent proposal for ICD-11 to expunge septicemia from the vocabulary

Sepsis vs. septicemia in SNOMED CT 127 concepts contain “sepsis” in the FSN 19 concepts contain “septicemia” in the FSN without a synonym of sepsis 8 concepts contain “sepsis” in the FSN with a synonym of septicemia 1 concept (310669007 |Septicemia caused by enterococcus (disorder)| ) contains “septicemia” in the FSN with a synonym of sepsis • 2 concepts, 5085001 |Gonococcemia (disorder)|and 4089001 |Meningococcemia (disorder)|have synonyms containing “septicemia” • All septicemia concepts are descendants of sepsis concepts. • • a. b. c. From the previous slide, sepsis and septicemia are frequently used interchangeably but likely have different meanings The meaning of septicemia is unclear. It might mean an infection of the bloodstream or sepsis due to an infection of the bloodstream Due to the ambiguity of “septicemia”, it is recommended that concepts containing this word in the FSN be retired and replaced with concepts referring to sepsis

Severe sepsis with acute organ dysfunction • 19 concepts contain both severe sepsis and acute organ dysfunction in the FSN • As the Sepsis-3 consensus has eliminated the use of severe sepsis (all sepsis is severe) and considers sepsis a kind of organ dysfunction, these concepts should also be retired and replaced by sepsis equivalents Examples Concept 127361000119109 |Severe sepsis with acute organ dysfunction caused by Salmonella (disorder)| 127391000119102 |Severe sepsis with acute organ dysfunction caused by Staphylococcus (disorder)| Replace by 449083008 |Sepsis caused by Salmonella (disorder)| 447894003 |Sepsis caused by Staphylococcus (disorder)|

Septic shock Current FSN of above concept is Septic shock co-occurrent with acute organ dysfunction caused by anaerobic bacteria (disorder)

Gram negative sepsis, endotoxemia and endotoxicosis • Gram negative sepsis • • Endotoxemia • • Sepsis due to bloodstream infection caused by gram negative bacteria The presence of endotoxin in the blood Endotoxicosis • A disease caused by endotoxin

Gram negative sepsis, endotoxemia and endotoxicosis models

Endotoxic shock

Endotoxin • Although the term "endotoxin" is occasionally used to refer to any cell -associated bacterial toxin, in bacteriology it is properly reserved to refer to the lipopolysaccharide complex associated with the outer membrane of Gram-negative pathogens such as Escherichia coli, Salmonella, Shigella, Pseudomonas, Neisseria, Haemophilus influenzae, Bordetella pertussis and Vibrio cholerae. • Emerging evidence suggests that the systemic spread of microbial toxins, rather than bacteremia itself, is the crucial event in the pathogenesis of this dramatic dysregulation (sepsis).