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- Sepsis (Greek, putrefaction): life-threatening organ dysfunction caused by host response to infection.
- Septic shock: a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone.
- Risk of sepsis is associated with both virulence of pathogen and immunologic vulnerabilities of host.
- Pathogens are associated with site of antecedent infection: not comprehensive list
- Gram-negative bacteria: E. coli, Klebsiella, Enterobacter, Pseudomonas, Serratia
- Gram-positive bacteria: Staphylococcus aureus, S. pneumoniae, Streptococcus species
- Toxin mediated: Staphylococcal or streptococcal toxic shock, Clostridium difficile, Clostridium sordellii.
- Viral: influenza A, human metapneumovirus, coronavirus, and respiratory syncytial virus
- Fungal: candida
- Rickettsial: R. rickettsii, R. typhi
- Consider both (1) hosts with recognized vulnerabilities and (2) exposures to pathogens of recognized virulence.
- Maternal and neonatal: Group B streptococci, E. coli., Group A streptococci (puerperal sepsis)
- Injection drug users: S. aureus, esp. MRSA, and Candida
- Splenectomized or functionally asplenic pts: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Capnocytophaga canimorsus,Babesia spp.
- Neutropenic: GNB, Aspergillus.
- Traveler: malaria, salmonellosis.
- Healthy young adult: toxic shock syndromes (S. aureus or group A strep), N. meningitidis, bioterrorism (anthrax, plague), Hantavirus, severe influenza +/- bacterial superinfection.
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