Page 119 Complete Your CE Test Online - Click Here vancomycin-resistant Enterococcus (VRE). The norovirus can also be a cause. ● ● HIV/AIDS: Sepsis is the most common cause of death in patients with HIV/AIDS. Patients with HIV/AIDS are more at risk than other patient populations are for HAIs because of weakened immune response, frequent antibiotic use, and surgical procedures. ● ● Immunocompromised: Those patients with impaired immune system functioning are obviously more susceptible to infection. Patients receiving treatment for cancer, who have had a splenectomy, or who have received an organ transplant are at high risk for developing sepsis. Patients on certain medications that may suppress the immune response – such as corticosteroids, prednisone, and tubular necrosis factor (TNF) inhibitors–are also considered at greater risk for developing infections. ● ● Infection: The invasion of normally sterile tissue with a pathogen. ● ● Influenza: Influenza is a respiratory viral infection that can lead to sepsis when the body attempts to clear the infection. It can also lead to sepsis if secondary infections, such as pneumonia, occur as a complication of the flu. ● ● Kidney stones: Kidney stones are hard deposits of calcium, uric acid crystals, cysteine, or struvite that form a stone-like structure that can block the ureter and lead to an infection in the kidney, known as pyelonephritis. ● ● Liver disease: Cirrhosis of the liver is a chronic liver disease in which healthy liver tissue begins to break down and is replaced by scar tissue that impairs blood flow. It is most commonly caused by alcoholism and hepatitis C in North America. Other causes of cirrhosis include hepatitis B and nonalcoholic fatty liver disease. Cirrhosis caused by hepatitis carries the highest risk for bacteremic infections (Azzopardi, Fenech, & Piscopo, 2012). ● ● Malaria: Malaria is transmitted via mosquito bites and is considered a parasitic disease, as a parasite infects the mosquito that then bites a person who is infected with malaria. ● ● Meningitis: Meningitis is inflammation of the meninges that surround the spinal cord and brain. It is caused by a bacterium, a virus, a fungus, or a parasite. ○ ○ Bacterial meningitis: The most severe type of meningitis caused by one of the following bacteria – Haemophilus influenza, Streptococcus pneumoniae, group B Streptococcus, Listeria monocytogenes (in newborns), and Neisseria meningitidis. ○ ○ Viral meningitis: The most common cause of meningitis caused by either the flu virus or the mumps virus. Viral meningitis usually affects children under 5 or those with a weakened immune system and typically resolves on its own. ○ ○ Fungal meningitis: Caused by a fungus and is the rarest type of meningitis. It is usually found only in those who are immunocompromised. ● ● Methicillin-resistant Staphylococcus aureus (MRSA): MRSA is a bacterium found in hospitals and the community and is resistant to various antibiotics. It is sometimes found on the skin. It is not problematic unless it enters the bloodstream through a break in the skin. It is a common cause of HAIs. ● ● Multiple organ dysfunction syndrome (MODS): MODS consists of the failure of more than one organ. MODS may be attributed to an infectious or noninfectious cause. MODS may be primary (directly linked failure to the injury) or secondary (failure not directly linked with the injury but as a subsequent result of the original injury). ● ● Necrotizing fasciitis: Necrotizing fasciitis is also known commonly as the flesh-eating disease. The most serious form is caused by the bacterium Streptococcus pyogenes. It enters the body through a break in the skin and quickly spreads destroying skin, muscles, and tissues as it progresses. It can quickly develop into sepsis. People at risk for developing necrotizing fasciitis include those who have had surgery, have given birth, or have had a traumatic injury. It is important to note that this condition is not contagious. ● ● Paralysis: Those patients who have paralysis are highly likely to develop infections. This can be related to the inability to feel or express pain from, for example, a cut or a burn, which can result in a more severe injury that is more apt to lead to infection. Patients with paralysis may also need a urinary catheter, which leaves them more susceptible to UTIs. Infection may not be recognized early as a result of fluctuations in vital signs that often occur with a patient who has paralysis. ● ● Parkinson’s disease: Parkinson’s disease is a progressive neurological disease that affects muscles and causes tremors, poor balance, unsteady and stiff gait, and memory loss. A patient with Parkinson’s disease is vulnerable to aspiration pneumonia, HAIs, and infections related to falls from broken bones or wounds. ● ● Pneumonia: Pneumonia is the most common cause of lung infection that leads to sepsis. It can be caused by bacteria, viruses, or fungi. ● ● Pregnancy and childbirth: Women who are pregnant or have recently given birth may develop infections and sepsis because of cerclage (stitches used to close the cervix to prevent preterm birth), retained products of conception, intrauterine infection, multiple gestation, stillbirth, preterm delivery, and hemorrhage (Bauer, Bateman, Bauer, Shanks, & Mhyre, 2013). Women more apt to develop infections related to pregnancy and childbirth include those with preexisting conditions, such as lupus, renal/liver disease, and heart failure (Bauer et al., 2013). Sepsis is the number one cause of maternal death in the United Kingdom. Maternal sepsis mortality is on the rise in the United States as well (Bauer et al., 2013). ● ● Septicemia: The presence of any infectious organism and their toxins in the blood, including bacterial, fungal, parasitic, and viral organisms. This term is often confusing, with many people assuming it means blood poisoning or sepsis. Sepsis is the body’s dysregulated response to infection. ● ● Septic shock: Sepsis with the presence of circulatory, cellular, and metabolic dysfunction associated with a higher risk of mortality. Clinically, septic shock is present when a patient who has sepsis requires vasopressors to maintain a mean arterial pressure (MAP) higher than or equal to 65 mmHg and who has a lactate level > 2 mmol/L. ● ● Severe sepsis: A term previously used to describe SIRS of infectious origin with organ dysfunction. The term severe sepsis is no longer used, as it was thought to be redundant. ● ● Systemic inflammatory response syndrome (SIRS): SIRS is a systemic inflammatory response by the body to an infectious or noninfectious cause. It is a cascade of effects that are a regulated response by the body. SIRS is the presence of at least two of the following factors, one of which must be either leukocytosis or elevated temperature: ○ ○ Core temperature > 38.5˚C (101.3˚F) or < 36˚C (96.8˚F). ○ ○ Tachycardia. ○ ○ Tachypnea. ○ ○ Leukocytosis. SIRS is no longer part of the definition for sepsis. Sepsis was previously defined as SIRS in the presence of infection. ● ● Strep throat: Strep throat is caused by the bacteria group A Streptococci. Teens and children are most affected, but adults can contract strep throat as well. Strep throat is a bacterial infection that can lead to rheumatic fever, poststreptococcal glomerulonephritis (kidney infection), or sepsis. ● ● Toxic shock syndrome (TSS): Toxic shock syndrome is most commonly known as an infection caused by Staphylococcus aureus and more rarely group A Streptococcus. It is well known for its association with superabsorbent tampons in the 1980s, which have since been taken off the market. TSS has also been associated with cellulitis and pneumonia. TSS can cause shock and multiorgan failure due to leaky capillaries and tissue damage secondary to the release of cytokines released in response to the bacteria (Stevens, 2016). Those at higher risk for developing TSS include those who have had recent surgery, use superabsorbent tampons, have had TSS in the past, have a viral infection like chicken pox, or have recently had a child, a miscarriage, or an abortion. TSS is also associated with patients who have necrotizing fasciitis (Stevens, 2016). ● ● Urinary tract infections (UTIs): UTIs are a common type of infection present in the urinary tract, including kidneys, ureter, bladder, and urethra. An upper UTI that affects the kidney is known as pyelonephritis. If the urethra is affected, the infection is known as urethritis. If the bladder is affected, the infection is known as cystitis. UTIs are either bacterial or, more rarely, fungal, as seen in patients with weakened immune systems.