The Older Adult Experiencing Sepsis

Englert, Nadine C.; Ross, Carl A.

doi:10.1097/cnq.0000000000000059

Cited by 15 publications

(17 citation statements)

References 12 publications

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“…Equally relevant is that sepsis occurs disproportionately in older adults with more than 50% of cases occurring in those aged 65 and older . In addition, the outcomes of sepsis are worst in older adults, with higher rates of mortality, organ dysfunction, cognitive impairment, permanent disabilities, and long‐term institutionalization …”

Section: Introductionmentioning

confidence: 99%

Sepsis in Older Adults in Long‐Term Care Facilities: Challenges in Diagnosis and Management

Yoshikawa

Reyes

Ouslander

2019

J American Geriatrics Society

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Despite the current understanding of the pathophysiology of sepsis and advances in its treatment, the rate of sepsis is increasing globally. Sepsis is a common cause of hospitalization in older adults, and infections are among the most common diagnoses among residents transferred to the hospital from long‐term care facilities (LTCFs). LTCFs and hospitals are facing financial and regulatory requirements to reduce potentially preventable emergency department visits, hospitalizations, and hospital readmissions due to infections and other causes. In addition, the human and financial costs of these events are substantial. Current criteria for early identification of sepsis have low sensitivity and specificity among LTCF residents. Early diagnosis must focus on changes in clinical, mental, and functional status, and vital signs including pulse oximetry. Laboratory data can increase the suspicion of sepsis, but the availability of testing and timing of results limits its usefulness in most LTCFs.While new diagnostic criteria for sepsis are being developed and validated in the LTCF setting, clinical practice and decision support tools are available to guide management. Most LTFCs do not have the capabilities to manage sepsis based on current guidelines despite availability of qualified nursing staff and clinicians. Thus excluding circumstances in which a resident's desire is palliative or hospice care without transfer to a hospital, most LTCFs will continue to transfer residents with severe infections at risk for evolving into sepsis to an acute hospital setting. J Am Geriatr Soc 67:2234–2239, 2019

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Section: Introductionmentioning

confidence: 99%

Sepsis in Older Adults in Long‐Term Care Facilities: Challenges in Diagnosis and Management

Yoshikawa

Reyes

Ouslander

2019

J American Geriatrics Society

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“…The later comprise the use of invasive devices (intravascular catheters, endotracheal tubes, indwelling bladder catheters, etc. ), immobilization and exposition to nosocomial flora [2,3]. …”

Section: Introductionmentioning

confidence: 99%

The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis

et al. 2016

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The continuous development of resuscitation techniques and intensive care reduced the mortality rate induced by the initial shock in burn patients and, currently, infections (especially sepsis) are the main causes of mortality of these patients. The misuse of antimicrobial agents is strongly related to antimicrobial and adverse patient outcomes, development of microbial resistance and increased healthcare-related costs. To overcome these risks, antimicrobial stewardship is mandatory and biomarkers are useful to avoid unnecessary medical prescription, to monitor antimicrobial therapy and to support the decision of its stop. Among a large array of laboratory tests, procalcitonin (PCT) emerged as the leading biomarker to accurately and time-effectively indicate the presence of systemic infection. In the presence of systemic infection, PCT blood levels undergo a sudden and dramatic increase, following the course of the infection, and quickly subside after the control of the septic process. This work is a meta-analysis on PCT performance as a biomarker for sepsis. This meta–analysis showed that overall pooled area under the curve (AUC) is 0.83 (95% CI = 0.76 to 0.90); the estimated cut-off is 1.47 ng/mL. The overall sepsis effect in PCT levels is significant and strong (Cohen's d is 2.1 and 95% CI = 1.1 to 3.2). This meta–analysis showed PCT may be considered as a biomarker with a strong diagnostic ability to discriminate between the septic from the non-septic burn patients. Thus, this work encourages the determination of PCT levels in clinical practice for the management of these patients, in order to timely identify the susceptibility to sepsis and to initiate the antimicrobial therapy, improving the patients’ outcomes.

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“…It is known that the incidence of sepsis and the rate of hospitalization due to sepsis increase with age. Englart et al reported that there was an increase in hospitalization rates due to sepsis between the years 1997 and 2011 and that this increase was 3 times higher in the ages between 65 and 84 and 2 times higher in ages ≥85 (9). Angus et al demonstrated that the incidence of sepsis was 0.2/1000 in the pediatric age group and 26.2/1000 in individuals ≥85 years of age, which was almost 100 times higher compared to that found in children (10).…”

Section: Discussionmentioning

confidence: 99%

Sepsis and Septic Shock: Outcomes in Elderly and Very Elderly Critically Ill Patients

Candemir¹,

İnci²,

Aygencel³

et al. 2019

tybd

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ÖZ Amaç: Sepsis-septik şok gelişimi ile yaşın ilişkisi özellikle erişkinlerde açık değildir. Yaşlı ve çok yaşlı hastalarda sepsis ve septik şokun insidans, prognoz ve mortalitesi ile ilgili az sayıda çalışma bulunmaktadır. Bu çalışma ile yaşlı ve çok yaşlı yoğun bakım ünitesi(YBÜ) hastalarında yaşın sepsis ve septik şokun sonuçları üzerine etkisini göstermeyi amaçladık. Gereç ve Yöntem: Bu çalışma yoğun bakım ünitemizde yapılan retrospektif gözlemsel bir çalışma olup 200 yaşlı ve çok yaşlı sepsis-septik şok hastası çalışmaya alınmıştır. Bulgular: Sepsis-septik şok ilişkili mortalite oranı 61.5%(123 hasta)di. En sık enfeksiyon odağı akciğer(% 56.5, 113 hasta) ve üriner sistemdi(35%, 70 hasta). Yaşlı(61.2%, 82 hasta) ve çok yaşlı hastalar(62.1%, 41 hasta) arasında mortalite açısından anlamlı fark yoktu. YBÜ kabülünde Sıralı Organ Yetmezliği skoru(SOFA) (1.195 OR ve 1.052-1.358% 95 CI, p = 0.006) ve invazif mekanik ventilasyon gereksinimi (4.330 OR ve 1.529 -12.258% 95 CI, p = 0.006), YBÜ takibinin sonunda böbrek yetmezliği gelişmesi(6.457 OR ve 1.795-23.233% 95 CI, p = 0.004) ve oral yoldan beslenme yetersizliği (0.064 OR ve 0.018 -0.226 95% CI, p = 0.0001) YB mortalitesi için bağımsız risk faktörleri olarak bulundu. SONUÇ: Sonuç olarak,bu çalışmada yaşlı ve çok yaşlı hastalar arasında sepsis-septik şoka bağlı mortalite oranları açısından anlamlı fark yoktu. Ancak yoğun bakım ünitesine kabulu sırasında organ hasarı varlığı ve takipte komplikasyon gelişimi mortaliteyi etkilemekteydi.ABSTRACT Objective: The relationship between age and the development and outcome of sepsis and septic shock is unclear, especially in adults. There are few studies about the incidence, prognosis and mortality rates of sepsis in elderly and very elderly patients. In this study, we aimed to determine the effect of age on the outcome of sepsis and septic shock in elderly and very elderly intensive care unit (ICU) patients. Materials and Methods: This study was a retrospective observational study conducted in our medical ICU. Two hundred elderly and very elderly patients with sepsis and septic shock were included in this study. Results: The mortality rate related to sepsis and septic shock was 61.5% (123 patients). The most common site of infection was lung (56.5%, 113 patients), followed by urinary tract (35%, 70 patients). There was no significant difference between the elderly (61.2%, 82 patients) and the very elderly (62.1%, 41 patients) patients in terms of ICU mortality related to sepsis and septic shock (p>0.05). Sequential Organ Failure Assessment (SOFA) score on ICU admission (1.195 OR and 1.052-1.358 95%CI, p=0.006), requirement of invasive mechanical ventilation on ICU admission (4.330 OR and 1.529 -12.258 95% CI, p=0.006), renal impairment at the end of the ICU follow-up (6.457 OR and 1.795-23.233 95% CI, p=0.004) and the disability to feed orally in ICU (0.064 OR and 0.018-0.226 95% CI, p= 0.0001) were found as independent risk factors for ICU mortality. Conclusion: According to our study, there was no significant difference bet...

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The Older Adult Experiencing Sepsis

Cited by 15 publications

References 12 publications

Sepsis in Older Adults in Long‐Term Care Facilities: Challenges in Diagnosis and Management

Sepsis in Older Adults in Long‐Term Care Facilities: Challenges in Diagnosis and Management

The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis

Sepsis and Septic Shock: Outcomes in Elderly and Very Elderly Critically Ill Patients

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