Sepsis etiology

The majority of sepsis cases, especially the more severe forms, have bacterial etiologies. Common bacterial species include Staphylococcus aureus. Streptococcus pneumoniae, Escherichia coli. Salmonella typhi (and other enterobacterial species). Pseudomonas species and haemolytic streptococci in children Haemophilus influenzae and Neisseria meningitidis are important whereas nosocomial episodes of sepsis are frequently caused by Staphylococcus epidermidis. Streptococcus faecalis (syn. enterococci), yeasts and anaerobes. 

In patients with sepsis treatment is indicated before an etiologic diagnosis is made. Patients presenting with severe sepsis need immediate intervention with antimicrobial agents that cover the most likely etiologies in that particular setting. 

Other etiologies need to be ruled out because many of the symptoms of serotonin syndrome overlap with those of early sepsis or neuroleptic malignant syndrome, conditions associated with significant mortality. It is critical to evaluate for sepsis and to determine that a neuroleptic has not been started or increased prior to the onset of... 

Those involved in individual health assessment are concerned with the early detection of specific organ kidney injury. With regard to acute kidney injury (AKI), biomarkers may serve several additional purposes. That is, they may determine AKI subtypes (prerenal, intrinisic renal, or postrenal), identify the etiology of AKI (ischemia, toxins, sepsis, or a combination), differentiate AKI from other forms of acute kidney disease (urinary tract infections, glomerulonephrihs, intershtial nephritis), predict the AKI severity (risk stratification for prognostication as well as guide to therapy), monitor the course of AKI, and monitor the response to AKI interventions. For chronic kidney disease (CKD), they provide both evidence and severity of exposure and may be used to assess response to removal of offend-... 

Future opportunities include rapid detection and identification of bacterial causes of sepsis and meningitis, with the ability in the latter to differentiate viral and fungal etiologies. Universal primers have been described that are conserved in all eubacteria tested and a similar situation exists for fungi and enteroviruses (B3, R6, W8). A coamplification test that combines primers for the three types of agents could prove medically useful in selecting therapy if the result can be obtained in 2 hours. 

Meaningful interpretation of eicosanoid levels in plasma or pulmonary oedema fluid during clinical sepsis or ARDS is complicated by the large number of uncontrolled variables compared with experimental sepsis or models of acute lung injury. These include diverse etiological factors precipitating sepsis and ARDS, variation in the stage of severity of these inflammatory conditions... 

Pichler J, Horn V, Macdonald S, Hill S. Sepsis and its etiology among hospitalized children less than 1 year of age with intestinal failure on parenteral nutrition. Transplant Proc 2010 42(1) 24-5. 

The incidence of Candidiasis reported in this series is disturbing because of the recent association of Candidiasis with parenteral nutrition, by Ashcraft and Leape (5). The work of MacMillan, Law and Holder, however, documents the increasing problem of Candida in the burned child (6). Because of the number of variables involved, it is difficult in this series to assess the relationship between Candidiasis and central venous nutritional supplementation. The clinician caring for this type of patient, however, should be aware of this etiologic possibility when sepsis presents and treat when present by removing catheters and giving Amphotericin B. 

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