Page 137 Complete Your CE Test Online - Click Here (Martin, 2012). Invasive fungal infections, usually caused by Candida albicans, are seen with more frequency in critically ill patients, accounting for 10% to 15% of all health care-associated infections (Delaloye & Calandra, 2014). Fungal infections are responsible for 5% of all sepsis and septic shock cases and are the fourth most common organism found in positive blood cultures in the United States (Delaloye & Calandra, 2014). Candida is a normally found in the skin, vagina, and GI tract and does not typically cause a problem for people with an intact and healthy immune system. The risk of developing an infection from a fungus like Candida increases with the following factors (Delaloye & Calandra, 2014): ● ● Patient age. ● ● Broad-spectrum antibiotic use. ● ● Length of hospital stay. ● ● Central vascular catheter placement. ● ● Diabetes mellitus. ● ● Parenteral nutrition. ● ● Mechanical ventilation. ● ● Renal insufficiency or hemodialysis. ● ● Antifungal prophylaxis. ● ● Surgery. ● ● Pancreatitis. ● ● Treatment with corticosteroids and chemotherapy. Parasitic infections Parasitic causes of sepsis are rare, especially in North America, but they occur in other parts of the world. In the case of sepsis caused by malaria, for example, a parasite infects a mosquito and the mosquito, in turn, infects a person. Key points ● ● Sepsis can be caused by bacterial, viral, fungal, or parasitic organisms. ● ● Bacterial agents are the most common cause of infection that leads to sepsis, specifically gram-positive bacteria. ● ● Respiratory infections, such as pneumonia, are the most frequent cause of sepsis and septic shock, followed by intraabdominal infections, urinary tract infections, and bloodstream infections. ● ● The incidence of sepsis caused by multiresistant bacteria and fungal infections has risen in recent years. Self-evaluation: Question 6 Which of the following statements is false? a. Gram-negative bacteria used to be the most common cause of sepsis, but the incidence of gram-positive bacteria has risen and is now the most frequent causative organism of sepsis. b. Parasitic infections are a common cause of sepsis, and incidence of parasitic infection is more than fungal and viral infections combined. c. Respiratory infections, particularly pneumonia, lead to sepsis and septic shock in the respiratory tract, the most frequent site of infection that lead to sepsis. d. The incidence of fungal infections and multiresistant bacterial infections that lead to sepsis is on the rise. Sites of infection Pneumonia The most common site for infection that leads to sepsis and septic shock is the respiratory tract following a respiratory infection, such as pneumonia. Organisms responsible for various types of pneumonia include (LaRosa, 2010) the following. Community acquired: Streptococcus pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumonia. Early hospital acquired (patient is hospitalized < 5 days): S. pneumoniae, H. influenzae, L. pneumophila, M. pneumonia; nonresistant gram-negative rods. Late hospital acquired: Pseudomonas aeruginosa, Klebsiella spp., Acinetobacter spp., methicillin-resistant Staphylococcus aureus. Following are other common sites of infection. Abdomen: Appendicitis, peritonitis, cholecystitis (gall bladder infection). Organisms responsible for infection include enteric gram- negative rods and anaerobes (LaRosa, 2010). Genitourinary tract: Kidney or urinary tract infection. An indwelling catheter increases risk of infection. Organisms responsible for infection include gram-negative rods and Enterococcus spp. Skin: Infectious organisms can enter anywhere there is a break in the skin—wounds and IV sites, surgical sites, skin ulcerations. Postsurgical wounds: Infectious organisms can enter the wound during surgery if a sterile field is compromised. Postsurgical sites can also become infected if exposed to infectious organisms. Nervous system: Inflammation and infection of brain and spinal cord (encephalitis, meningitis). Pneumococcal meningitis is the common form of meningitis. Bones: Osteomyelitis, or infection in the bone, may originate in the blood in IV drug users, may begin as a pelvic infection or UTI, and may be seen in surgical or trauma patients and those with an overlying skin infection (Friedrich, 2016). Patients at risk for developing pseudomonal bone infection include those with a puncture wound to the foot, diabetics, those who have peripheral vascular disease, and those who are IV drug users (Friedrich, 2016). Heart: Pseudomonas aeruginosa may cause infective endocarditis, an infection in the right or left heart valves. IV drug users and those with prosthetic heart valves may be highly susceptible to development of endocarditis. General symptoms include fever and malaise. Left -sided heart failure symptoms include those consistent with congestive heart failure (Friedrich, 2016). Nursing consideration: Nurses should closely monitor any patient who has a suspected or known infection of the lungs, particularly pneumonia. The respiratory tract is the most common site of infection that leads to sepsis. Nurses should report any signs and symptoms that may indicate sepsis immediately so prompt treatment can begin. POPULATIONS AT RISK FOR DEVELOPING SEPSIS Though it is true that sepsis can occur after something as seemingly benign as a cut or scrape, which anyone can have, it is most likely to affect those populations considered at risk. Following are populations at particular risk (Neviere, 2017; Sepsis Alliance, n.d.): ● ● Patients admitted to the ICU. ● ● Those with bacteremia.