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Fevers and chills, often with abrupt onset
However, some patients are hypothermic (temperature ≤ 36.4 °C) at presentation
Hyperventilation with respiratory alkalosis and changes in mental status are important early manifestations
Hypotension and shock are unfavorable prognostic signs
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Neutropenia or neutrophilia, often with increased numbers of immature forms of polymorphonuclear leukocytes
If possible, three sets of blood cultures from separate sites should be obtained in rapid succession before starting antimicrobial therapy
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See Table 30–4
Antibiotics should be given as soon as the diagnosis is suspected, since delays in therapy have been associated with increased mortality rates, particularly once hypotension develops
In general, bactericidal antibiotics should be used and given intravenously to ensure therapeutic serum levels
Penetration of antibiotics into the site of primary infection is critical for successful therapy—ie, if the infection originates in the CNS, antibiotics that penetrate the blood-brain barrier should be used—eg, third- or fourth-generation cephalosporin—but not first-generation cephalosporins or aminoglycosides, which penetrate poorly
Initial therapy for sepsis should include antibiotics active against both gram-positive and gram-negative organisms
Combination therapy has not been shown to be superior to a single-drug regimen with any of several broad-spectrum antibiotics (eg, a third-generation cephalosporin, piperacillin-tazobactam, carbapenem)
If multiple drugs are used initially, the regimen should be modified and coverage narrowed based on the results of culture and sensitivity testing
Remove predisposing factors
Identify source of bacteremia and remove it (central venous catheter) or drain it (abscess)
Supportive measures include maintaining blood pressure with vasopressor medications and managing disseminated intravascular coagulation with antimicrobials for underlying infection and blood products for significant bleeding (Table 14–6)
Corticosteroids are not helpful
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