What is the treatment for suspected sepsis with a skin issue from the lower abdomen to the legs?

Treatment for Suspected Sepsis with Skin Issue from Lower Abdomen to Legs

For suspected sepsis with skin involvement from the lower abdomen to legs, immediate administration of broad-spectrum antibiotics, aggressive fluid resuscitation, and diagnostic imaging with contrast-enhanced CT abdomen/pelvis are essential first-line interventions to reduce mortality. 1

Initial Assessment and Stabilization

• Early recognition of sepsis is crucial for improving outcomes, with mortality rates increasing dramatically from 4.4% in sepsis to 67.8% in septic shock 1
• Assess for signs of tissue hypoperfusion: abnormal capillary refill time, skin mottling, cool extremities, weak peripheral pulses, altered mental status, and decreased urine output 1
• Evaluate using physiological parameters including blood pressure, pulse rate, respiratory rate, temperature, oxygen saturation, and level of consciousness 1
• Measure lactate levels as an important component of initial evaluation, though elevated levels are not required to diagnose sepsis 1

Immediate Interventions

• Begin intravenous fluid resuscitation with crystalloid solutions as first choice (well-tolerated and cost-effective) 1
• Administer fluid rapidly but titrate to clinical response rather than following a predetermined protocol 1
• Initiate antimicrobial therapy within 1 hour of recognizing sepsis, using adequate dosages likely to be effective against suspected pathogens 1
• Consider vasopressor therapy (dopamine or epinephrine) if fluid resuscitation fails to restore tissue perfusion 1

Diagnostic Imaging

• CT abdomen and pelvis with IV contrast is highly recommended as it has high positive predictive value (81.82%) for identifying septic foci 1
• Abdominal and pelvic regions are common sites for septic foci, with 22.0% of septic foci found in the abdomen and 20.5% in the pelvis/genitourinary tract 1
• CT imaging frequently leads to changes in management (45% of cases), including modifications to antimicrobial regimens, surgical interventions, and placement of drainage catheters 1
• For skin and soft tissue involvement, imaging helps identify the extent of infection and any deeper tissue involvement 1

Source Control

• Drain or debride the source of infection whenever possible 1
• Remove any foreign body or device that may potentially be the source of infection 1
• Surgical intervention may be necessary for adequate source control, particularly with abscesses or necrotizing infections 1
• Consider non-surgical interventions such as placement of drainage catheters when appropriate 1

Skin-Specific Management

• For extensive skin involvement, assess for Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) if there is epidermal detachment 1
• Apply bland emollients to support barrier function, reduce transcutaneous water loss, and encourage re-epithelialization 1
• Use appropriate dressings on exposed dermis to reduce fluid and protein loss, limit microbial colonization, and help with pain control 1
• Monitor for cutaneous infection which can impair re-epithelialization and lead to systemic sepsis 1

Ongoing Management

• Monitor for signs of systemic infection including confusion, hypotension, reduced urine output, and reduced oxygen saturation 1
• Administer oxygen to achieve saturation >90%; if no pulse oximeter is available, administer oxygen empirically 1
• Place patients in semi-recumbent position (head of bed raised 30-45°) to improve respiratory function 1
• Consider hydrocortisone (up to 300 mg/day) or prednisolone (up to 75 mg/day) for patients requiring escalating vasopressor doses 1

Common Pitfalls to Avoid

• Delaying antibiotic administration beyond 1 hour of sepsis recognition significantly increases mortality 1
• Overaggressive fluid resuscitation may lead to pulmonary, cutaneous, and intestinal edema 1
• Indiscriminate use of prophylactic systemic antibiotics may increase skin colonization with resistant organisms 1
• Failing to reassess frequently for clinical improvement or deterioration 1
• Overlooking the need for source control, which is essential for successful treatment 1