Sepsis and Infection Control

Sepsis is a life-threatening syndrome caused by a dysregulated host response to infection that produces acute organ dysfunction. It is not synonymous with bacteraemia: a patient can be septic without a positive blood culture, and a positive blood culture does not by itself establish sepsis. The clinical question is not simply, “Does this patient have an infection?” It is, “Has the infection triggered physiological deterioration?” An acute increase in the Sequential Organ Failure Assessment (SOFA) score of at least 2 points identifies clinically important organ dysfunction. SOFA incorporates respiratory function, coagulation, liver function, cardiovascular status, neurological status, and renal function. For rapid bedside recognition, a quick SOFA (qSOFA) score of at least 2 is a high-risk signal. The three findings are altered mentation, systolic blood pressure of 100 mm Hg or less, and respiratory rate of 22 breaths/min or greater. A low qSOFA should not reassure you or delay assessment; sepsis may be present before these findings accumulate. Sepsis can begin with a familiar infection—pneumonia, urinary infection, abdominal infection, skin or soft-tissue infection, an infected device, or an infected wound—and...