Management of bacterial severe sepsis and septic shock

Abstract

Bacterial sepsis is a leading cause of pediatric morbidity and mortality worldwide. Early diagnosis, a coordinated and aggressive approach to initial resuscitation, and timely and appropriate antibiotic therapy are paramount to improving outcomes of these dangerous infections. The basic tenants of initial and ongoing resuscitation include rapid isotonic intravenous fluid boluses with reassessment for physiologic response, empiric broad-spectrum antibiotics directed to cover suspected sources of infection, source control, vasoactive infusions, supportive critical care and monitoring of response to therapy. In addition to resuscitation of bacterial sepsis, this article will review approaches to empiric antibiotic choice in septic shock, and detail definitive management of infections caused by several specific organisms, including Staphylococcus aureus, group A Streptococcus, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Clostridium difficile. Lastly, management of several common pediatric infections, including community acquired bacterial pneumonia and bacterial meningitis, will be reviewed.