Relatively few pathogens can cause sepsis. For causing sepsis bacteria should have certain features that provide their survival, proliferation and dissemination in human body. The characteristics of the pathogens, that most frequently cause sepsis, may or may not be common for all of them (see tab. 2).
Sepsis causing bacteria are both gram positive and gram negative. Gram-positive organisms are better suited to invade host tissues and elicit, in general, a brisker phagocytic response than gram-negative organisms [37]. The lack of endotoxin in the outer cell wall is compensated for by the presence of exposed peptidoglycan and a range of other toxic secreted products. It appears that cell wall components of gram-positive bacteria may signal
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via the same receptor as gram-negative endotoxin, although the type of signal and coreceptor may differ [37]. Gram-negative organisms are associated with poorer outcomes in first-hit infections; an inverse relationship between Gram status and mortality is observed in second-hit infections [38]. The majority of sepsis causing bacteria is facultative anaerobes [39]. This type of respiration is the most flexible and it facilitates pathogen survival, proliferation and dissemination in the variety of environmental conditions. The pathogens that are not facultative anaerobes, may express additional respiratory mechanisms that make their respiration close to facultative anaerobes [40, 41]. All sepsis causing bacteria produce superoxide dismutase (SOD), catalase and glutathione peroxidases (see the table), that protect them against oxidative stress caused by reactive oxygen species. The primary source of oxidative stress for sepsis causing bacteria is the attack by host phagocytic cells. All successful pathogens, including sepsis causing bacteria, have evolved effective systems for defense against oxidative stress [42]. Phagocytes utilize the cytotoxic effects of the reactive oxygen species, such as superoxide, hydrogen peroxide, and the highly toxic hydroxyl radical. Sepsis causing bacteria have evolved effective enzymatic pathways of oxidant inactivation, including those catalyzed by superoxide dismutase (SOD), catalase/peroxidase, and glutathione in combination with glutathione peroxidase and glutathione reductase [43]. The same pathways may protect sepsis causing bacteria from oxidation and killing on the surface of erythrocytes [34]. Sepsis causing bacteria may be either oxidase positive or oxidase-negative.
The production of cytochrome c oxidase has no critical role in causing sepsis.
Certain structures of bacteria are indispensable for causing sepsis. All sepsis causing bacteria have S-layer and produce capsules, slime layer and biofilm (see tab. ). These structures protect the bacteria in the tissues against phagocytosis, ROS, lytic enzymes, immune complexes, etc., whereas in the bloodstream capsule and slime layer prevent triboelectric charging, attraction and fixation on the surface of erythrocytes, oxidation and killing by the oxygen released from erythrocytes [33 ].
Sepsis causing bacteria produce hemolysins . Erythrocytes are the main bactericidal cells in the bloodstream and hemolysins are necessary for bacterial survival in the bloodstream. If the speed of bacterial growth in the tissue is limited by host immune reactions, bacteria produce a capsule, slime layer and biofilm for surviving host attacks. After entering the bloodstream, bacterial capsule and slime layer prevent triboelectric charging and fixation on the surface of erythrocytes. If bacteria rapidly proliferate in the tissue, they are short of time to produce a capsule and slime layer and after entering the bloodstream, they are caught and fixed on the surface of erythrocytes. If bacteria survive oxidation on the surface of erythrocytes, they produce hemolysins that destroy erythrocytes or provide bacterial penetration into the inner space of erythrocytes. Hemolysins are important for the development of sepsis to advanced
stages.
Unfortunately, infection places people in the hospital and infection is developed in the hospital. Two ways to contract sepsis are through hospital-caused infection, like in Amy Widener’s case, and through an infection caused by outside sources, for example a urinary tract infection in an elderly person. Everyone is capable of getting sepsis however cases appear most often in children under one year of age and in elderly older than sixty-five years. This is due to the body’s immune system being weaker in these demographics than in a person that has a built-up and strong immune system (“Sepsis Questions and Answers”). Sepsis occurs because of infection so the immune system plays a large role in the body’s defense mechanism. When people with already compromised immune systems develop an infection or are in an environment that infection is likely to occur, for example an unsanitary procedure in a hospital, then the body’s chances of being able to fight the infection off are greatly
According to the Clinical Excellence Commission (2014), approximately 6,000 deaths per annum are caused by sepsis in Australia alone. These mortality figures are higher than breast cancer (2,864) and prostate cancer (3,235) combined (Cancer Australia, 2014). Despite advances in modern medicine and increased understanding of the need for timely recognition and intervention (Dellinger et al, 2013), sepsis remains the primary cause of death from infection worldwide (McClelland, 2014). Studies undertaken by The Sepsis Alliance (2014) and Schmidt et al, (2014) state that 40% of patients diagnosed with severe sepsis do not survive.
Antimicrobial therapy is the cornerstone sepsis treatment, and the therapeutic goal should be centered around administration of effective IV antibiotics within 60 minutes of septic shock or severe sepsis (without shock) recognition. The initial antimicrobial therapy should be empiric and focused on having activity against all expected pathogens (bacterial, fungal, viral), based on each individual patient situation. Daily reassessment of antimicrobial therapy should be performed, with de escalation in mind; procalcitonin levels can be of use to direct discontinuation in patients with no evidence of infection following initial septic
Studies have shown pertactin, a 69kDa non fimbrial outer membrane protein, facilitates attachment of the bacteria to ciliated respiratory cells. Experiments conducted on humans to test the role of pertactin have shown no significant effect except with the results from Bassinet (4). Furthermore, filamentous haemagglutinin confers infection by attaching to the host cells in the lower respiratory tract. It is about 2nm wide, and 50n...
However with septic shock the symptoms may be worse as the patient may experience tachyeordia and tachypnae, leucocytosis which is a high count of white blood cells, change in metal state for example confusion and hyperglycaemia which is a deficiency of glucose in the bloodstream. The diagnosis for sepsis and septic shock involve using blood cultures which is where bacteria is detected in blood which may have spread from a different part of the body. Blood cultures are taken mostly to be done on new-borns and young children who have the symptoms of sepsis. If the blood culture tests positive there is a bacterial or fungal infection which needs to be treated immediately as it is life-threatening. Also cytokines are used as they can destroy the infection however there is a problem with this diagnosis as excessive production can cause tissue and organ
Daniels (2011) said that sepsis is one of the leading causes of death in hospital patient worldwide and severe sepsis causes around 37,000 deaths in the UK every year. Czura (2011) has defined it as a life-threatening condition that arises when the body’s response to infection injures its own tissues and organs and sepsis can be present in any patient and in any clinical setting. Based on the learner’s reading, she became aware of the importance of identifying the early inflammatory markers such as temperature less than 36 degrees or more than 38.3 degrees, heart rate greater than 90 beats per minute (bpm), respiratory rate greater than 20 breaths/minute, altered mental state, white cell count lesser than 4g/l or greater than 12g/l and blood glucose greater than 7.7 millimoles for non-diabetic patients. Presence of any two of these will follow further test and if sepsis is indicated then commence the sepsis six care bundle within the hour, contact the doctor and critical care outreach team. The sepsis six care bundle which was developed by Daniels et al (2010) has shown to improve delivery of reliable care across a range of clinical settings which is now used in many UK
Renal and hepatic function tests include creatinine test, blood urea nitrogen (BUN) test, alkaline phosphatase (ALP) test, bilirubin test, and others. Urinalysis includes urine osmolality tests and urine culture tests. The sooner one’s sepsis is diagnosed and managed, the better the chances are one has to survive. There are three identifiable stages of sepsis. The three stages are, in order, sepsis, severe sepsis, and septic shock. The stage of sepsis is achieved when an infection enters the bloodstream and enacts inflammatory responses throughout the body. This stage is not as life threatening as the next two stages but should be assessed and treated for as soon as possible. The stage of severe sepsis is achieved when an infection disrupts the flow of blood to the brain or renal organs resulting towards organ failure. There can be an occurrence of gangrene in the arms, legs, fingers, and toes exhibiting tissue death caused by blood clots. If treatment is not given quickly in this stage then septic shock is bound to occur. The stage of septic shock is achieved when the overall blood pressure drops drastically leading to respiratory, cardiac, or organ failure and likely death This stage demands
Sepsis has gained much focus as a major global health problem. Since 2003, an international team of experts came together to form the Surviving Sepsis Campaign (SSC), in the attempts to combat an effectively treat sepsis. Although, diagnostics and protocols have been developed to identify high risk patients, the need for human clinical assessment is still necessary to ensure a proper diagnosis is made and appropriate treatment is initiated in a timely manner. The use of a highly efficient and experienced team, such as, the electronic Intensive Care unit (eICU) could close the gap from diagnosis to treatment.
Two of the most significant bloodborne pathogens are HBV (Hepatitis B Virus) and HIV (Human Immunodeficiency Virus). Some of the other bloodborne pathogens include Hepatitis C, Hepatitis D, and Syphilis. These are less significant and not as life threatening as the two listed above.
My disease is Streptococcal pneumonia or pneumonia is caused by the pathogen Streptococcus pneumoniae. Streptococcus pneumoniae is present in human’s normal flora, which normally doesn’t cause any problems or diseases. Sometimes though when the numbers get too low it can cause diseases or upper respiratory tract problems or infections (Todar, 2008-2012). Pneumonia caused by this pathogen has four stages. The first one is where the lungs fill with fluid. The second stage causes neutrophils and red blood cells to come to the area which are attracted by the pathogen. The third stage has the neutrophils stuffed into the alveoli in the lungs causing little bacteria to be left over. The fourth stage of this disease the remaining residue in the lungs are take out by the macrophages. Aside from these steps pneumonia follows, if the disease should persist further, it can get into the blood causing a systemic reaction resulting in the whole body being affected (Ballough). Some signs and symptoms of this disease are, “fever, malaise, cough, pleuritic chest pain, purulent or blood-tinged sputum” (Henry, 2013). Streptococcal pneumonia is spread through person-to-person contact through aerosol droplets affecting the respiratory tract causing it to get into the human body (Henry, 2013).
Capriotti & Frizzell (2016) explain that sepsis is often seen in those who have a weak immune system. These individuals are at an increased risk of developing sepsis from microorganisms that a healthy immune system would normally fight off (Capriotti et al. 2016). The elderly, infants, and immunosuppressed patients are the most at risk for developing the condition (Capriotti et al. 2016). Sepsis can be caused by any microbe, but is most often caused by bacteria (Capriotti et al. 2016). Since sepsis has such a broad reach and can develop as a secondary infection after an initial injury or illness, Capriotti & Frizzell (2016) further explain the di...
Sepsis is also called Septicemia and is a poisoning of the blood. This is an attack of bacteria into the bloodstream. Sepsis does not need blood poisoning to occur; it can affect multiple organs or the entire body without it happening. Sepsis is the body’s systematic inflammatory response to a bacterial infection (Jones, 2017). The infection can also have a wound or a chest infection or can be spread throughout the entire body. Sepsis’ definition is “a life-threatening condition that arises when the body’s response to infection injures its own tissues and organs” (McClelland, 2014). Sepsis is a leading cause of hospital admissions and can lead to death in hospital patients worldwide. The death rate associated with
Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
“ Sepsis” according to the International Surviving Sepsis Campaign, is defined as the presence of infection together with systemic manifestations of infection (Dellinger et al., 2013) In todays modern society sepsis still accounts for 15% of maternal deaths a year worldwide (Dolea & Stein, 2003). Despite medical advances, aseptic technique, and antibiotic use, sepsis is the most common cause of direct maternal death in the UK. According to the CMACE report the maternal mortality rate increased from 0.85 deaths per 100,000 maternities in 2003–05 to 1.13 deaths in 2006–08 (Harper, 2011). Puerperal sepsis has a long history within obstetrics and midwifery, and yet despite this knowledge it has become, yet again, the leading cause of direct maternal death. Therefore due to the increased maternal mortality, I have chosen to focus on the care of a woman within ...
The white blood cells destroy any unfamiliar pathogens in the bloodstream and can cause inflammation. Therefore, the inflammation causes a surplus of white blood cells to clot the wound for healing.