Fast Five Quiz: Sepsis Key Aspects

Richard H. Sinert, DO

Disclosures

June 17, 2020

The prognosis of sepsis depends on underlying health status and host defenses, prompt and adequate surgical drainage of abscesses, relief of any obstruction of the intestinal or urinary tract, and appropriate and early empirical antimicrobial therapy. Sepsis treated in a timely manner with appropriate therapy is usually associated with a good prognosis, except in patients with intra-abdominal or pelvic abscesses due to organ perforation. When timely and appropriate therapy has been delivered, the underlying physiologic condition of the patient determines the outcome.

Important risk factors for mortality include the patient's comorbidities, functional health status, new-onset atrial fibrillation, hypercoagulability state, hyperglycemia on admission, AIDS, liver disease, cancer, alcohol dependence, and immune suppression.

Sepsis due to urinary tract infection has a lower mortality rate than sepsis due to other causes. Mortality rates are higher with unknown sources of infection, gastrointestinal sources (highest in ischemic bowel), and pulmonary sources.

Sepsis due to nosocomial pathogens has a higher mortality rate than sepsis due to community-acquired pathogens. Increased mortality is associated with bloodstream infections due to Staphylococcus aureus, fungi, and Pseudomonas, as well as polymicrobial infections. When bloodstream infections become severe (ie, septic shock), the outcome may be similar regardless of whether the pathogenic bacteria are gram-negative or gram-positive.

Failure to attempt aggressive restoration of perfusion early may also be associated with an increased mortality risk. A severely elevated lactate level (> 4 mmol/L) is associated with a poor prognosis in patients with sepsis.

Read more about the prognosis of sepsis.

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