Inappropriate Sepsis Treatment Leads to Multiple Amputations

Joseph O'Neill

Written by
— Updated on April 11, 2018

Infectious Disease Expert WitnessThis case involves a teenage boy who was admitted to the emergency room after several days of worsening pulmonary symptoms including cough, bloody phlegm, and fever. During admission, he was also found to be suffering from rapid heartbeat and blood test results that were suspicious for possible sepsis. A few hours after the patient was admitted to the hospital she was started on IV antibiotics, but continued to deteriorate and was admitted to the ICU. The patient was given more potent antibiotics, and was started on a regimen of medications to raise his blood pressure. However, the dosage of this medication was not properly monitored, compromising the oxygenation of his limbs. as a result, the patient was forced to undergo multiple amputations, losing both of his hands as well as both of his feet.

Question(s) For Expert Witness

  • 1. What do the Surviving Sepsis Campaign guidelines recommend for the administration of antibiotics in a septic patient?
  • 2. What interventions/consults should be undertaken in a septic patient?

Expert Witness Response E-102917

The surviving sepsis guidelines recently underwent revision and update in 2016 from the previous version in 2012. The guidelines make a somewhat generalized statement that “broad spectrum” therapy be utilized and initiated as soon as possible with a target administration of 1-hour after recognition of severe sepsis. However, logistically the guidelines acknowledge that this target may not always be feasible and in many hospital systems the time between ordering/pharmacy/administration may likely exceed the 1-hour target. As far as consultations, certainly for severe sepsis, the priority is maintenance of organ perfusion and intensive care level management — so definitely critical care intensivists are recommended. Based on the circumstances, infectious disease, nephrology and occasionally other specialists are requested. Specifically in regard to this case, I have taken care of patients with profound hypotension and ischemic gangrene of digits. I have treated and evaluated many patients that have had MRSA infections. As a generalized statement, this would be a very difficult case, specifically because the patient had a life threatening condition, MRSA septicemia, with hypotension requiring pressors. They were placed on an appropriate antibiotic option. I have an understanding of pressors, and certainly they may have contributed to some degree to extremity loss — but this aspect, and the titration of pressors is usually addressed by critical care/ICU specialists who would be better able to review the appropriateness of pressor management.

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