Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ The older and more recent definitions of terms related to sepsis are given in Table 46-1. Sepsis-3 redefined sepsis by combining sepsis and severe sepsis from the Sepsis-2 guideline. ++Table Graphic Jump LocationTABLE 46-1Comparison of Definitions from Sepsis-2 and Sepsis-3 GuidelinesView Table|Favorite Table|Download (.pdf) TABLE 46-1 Comparison of Definitions from Sepsis-2 and Sepsis-3 Guidelines Sepsis-2 Guideline (2012) Sepsis-3 Guideline (2016) Systemic inflammatory response syndrome (SIRS) to infectious or noninfectious insults: Two or more of the following: Temperature >38°C or <36°C Heart rate >90 beats/minute Respiratory rate >20 breaths/minute WBC >12,000/mm3 (12 × 109/L) or <4000 cells/mm3 (4 × 109/L) or >10% (0.10) immature bands Sepsis: SIRS + probable or documented infection Severe sepsis: Sepsis + one or more organ dysfunction or hypoperfusion Septic shock: Sepsis + refractory hypotension despite fluid resuscitation (30 mL/kg) or serum lactate >1 mmol/L Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection Acute change in total SOFA score ≥2 points Septic shock: Sepsis + persistent hypotension requiring vasopressor use and serum lactate >2 mmol/L despite adequate fluid resuscitation SOFA, sequential organ failure assessment; WBC, white blood cell. +++ ETIOLOGY AND PATHOPHYSIOLOGY ++ Patients at risk for infection who are predisposed to sepsis include advanced or very young age; preexisting conditions including heart failure, diabetes, chronic obstructive pulmonary disease, cirrhosis, alcohol dependence, and end-stage renal disease; and other immunosuppressive diseases such as neoplasm and human immunodeficiency virus (HIV) disease. The most common anatomic source of infection that leads to sepsis is the lung (40%–42%), followed by intra-abdominal space (31%–34%) and genitourinary tract (11%–15%). The microorganisms isolated from blood cultures of patients with sepsis or septic shock include gram-negative organisms in 44%–59% of patients, gram-positive bacteria in 37%–52%, anaerobic organisms in 5%, and fungi in 4%–10%. Escherichia coli is by far the most commonly isolated gram-negative microorganism in sepsis (55%–60%), followed by Klebsiella species, Proteus species, Enterobacter species, and Pseudomonas aeruginosa. Mortality increases significantly with increasing severity of sepsis (3.5% for sepsis, 9.9% in severe sepsis, and 29% in septic shock), especially in presence of P. aeruginosa. The most common gram-positive organisms are Staphylococcus aureus, followed by coagulase-negative Staphylococci, Enterococcus species, and Streptococcus pneumoniae. Candida species (particularly Candida albicans) are common fungal etiologic agents of bloodstream infections. The 30-day mortality rate for sepsis due to candidemia is 54%. The pathophysiologic focus of gram-negative sepsis has been on the lipopolysaccharide (endotoxin) component of the gram-negative cell wall membrane. Lipid A is a part of the endotoxin molecule from the gram-negative bacterial cell wall that is highly immunoreactive and is responsible for most of the toxic effects. In gram-positive sepsis, the exotoxin peptidoglycan on the cell wall surface appears to exhibit proinflammatory activity. Sepsis involves a complex interaction of proinflammatory (eg, tumor necrosis factor-α [TNF-α]; interleukin [IL]-1, IL-6, IL-12) and anti-inflammatory ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPharmacy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPharmacy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options