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  • The definitions of terms related to sepsis are given in Table 45–1. Physiologically similar systemic inflammatory response syndrome can be seen even in the absence of identifiable infection.

TABLE 45–1Definitions Related to Sepsis


  • The sites of infections that most frequently lead to sepsis are the respiratory tract (39%–50%), urinary tract (5%–37%), and intra-abdominal space (8%–16%). Sepsis may be caused by gram-negative (50%–62% of sepsis) or gram-positive bacteria (37%–47%), as well as by fungi (5%) or other microorganisms.

  • Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa are the most commonly isolated gram-negative pathogens in sepsis. Other common gram-negative pathogens are Serratia spp., Enterobacter spp., and Proteus spp. P. aeruginosa is the most frequent cause of sepsis fatality. Common gram-positive pathogens are Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci, and Enterococcus species.

  • Candida species (particularly Candida albicans) are common fungal etiologic agents of bloodstream infections. The 30-day mortality rate for sepsis due to candidemia was 54%.

  • The pathophysiologic focus of gram-negative sepsis has been on the lipopolysaccharide (endotoxin) component of the gram-negative cell wall. Lipid A is a part of the endotoxin molecule from the gram-negative bacterial cell wall that is highly immunoreactive ...

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