Page 40 Complete Your CE Test Online - Click Here 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. ● ● Those previously admitted to the hospital, especially those with an infection. ● ● Those with a nosocomial infection. ● ● Patients who are immunocompromised. ● ● Infants and children under 10 years of age. ● ● Persons over age 65. ● ● Those with a chronic illness. ● ● Those who have diabetes, kidney disease, liver disease, HIV/AIDS, or cancer. ● ● Those who have suffered a severe burn or a physical trauma. Sepsis can occur after an infection of common sites in patients who have a surgical procedure/incision, an indwelling catheter, or an intravenous catheter or who are mechanically ventilated. There may also be a genetic component to the likelihood of developing sepsis (Neviere, 2017). In general, African Americans have a higher incidence of sepsis that is likely to be more severe and are at a higher risk for developing septic shock than Whites are, possibly because of a genetic predisposition or a higher prevalence of comorbidities (Artero et al., 2012 ). Men are more likely to experience sepsis that has progressed and to develop septic shock than women are (Artero et al., 2012). Key points ● ● Populations at risk for sepsis include patients who are over age 65, have chronic diseases, are admitted to the ICU, are immunocompromised, or are burn or trauma victims. ● ● Infection can occur in surgical patients, those with indwelling catheters, and those who are mechanically ventilated. ● ● There may be a genetic predisposition to sepsis. Nursing consideration: Nurses should always be aware of the signs and symptoms of sepsis in every patient with documented or suspected infection. Nurses should be particularly vigilant in screening for sepsis in those patients who are highly susceptible to the development of sepsis, including patients who are immunocompromised, have a chronic disease, are very young or elderly, or have undergone an invasive procedure. Sepsis in the older adult The risk for developing sepsis is 13 times higher in patients who are over age 65 than in younger patients (Artero et al., 2012). Pneumonia is the most frequent cause of sepsis in older patients, followed by urinary tract infections (Surviving Sepsis Campaign, n.d. ). This population is also more likely to have gastrointestinal infections, skin tears or pressure sores, tooth infections, and health care-associated infections. There are numerous reasons that the older adult is more at risk than the younger adult for developing infection and sepsis, including these: ● ● Immune system changes and immunodeficiency. ● ● Nutritional deficits. ● ● Comorbidities. ● ● Exposure to health care-associated infections (HAIs) and community-acquired infections (CAIs). ● ● Altered clinical presentation. Immune system changes in the older adult The ability of the body to fight invaders declines as the body ages. The immune system in the older adult has less ability to recognize and kill foreign invaders leading to the development of more infections, malignancy, and autoimmune disorders (Azar & Ballas, 2017). The age- related changes in the immune system that result in the development of infections, malignancy, and autoimmune disorders is termed immunosenescence.