According to Shiel (2018) nosocomial infections are infections that have been caught in a hospital and are potentially caused by organisms that are resistant to antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics and may be acquired during hospitalisation. A nosocomial infection is specifically one which was not present or incubating prior to the patient’s admission and occurs within 72 hours after hospitalisation (https://www.medicinenet.com/script/main/art.asp?articlekey+4590).
The Clostridium difficile bacterium is now recognised as the chief cause of nosocomial diarrhoea in the United States and Europe.
Infection and Sepsis
Infection is caused by the invasion and multiplication of microorganisms such as bacteria, viruses and parasites that are not normally present within the body. When an infection causes no symptoms it is termed ‘subclinical’; when it causes no symptoms it is called ‘clinically apparent’. An infection may remain localised, or it may spread through the blood or lymphatic vessels to become systemic (body wide). Microorganisms that live naturally in the body are not considered infections, for example, the normal intestinal flora which live within the mouth and intestine (Shiel: 2018)
Sepsis is a potentially life-threatening condition caused by the body’s response to an infection. The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body’s response to these chemicals is out of balance, triggering changes that can damage multiple organ systems.
Sepsis is most common and most dangerous in:
- Older adults
- Pregnant women
- Children younger than one year
- People who have chronic conditions, such as diabetes, kidney or lung disease, or cancer
- People who have weakened immune systems
Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves the chances for survival (Infect. Microbiol., 22 June 2017 | https://doi.org/10.3389/fcimb.2017.00263). Usually, the body responds to infection if it is localised in an area, such as a severe wound (especially burns). If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death, and by the time an infection is systemic, the patient may present with an abnormally high temperature (hyperpyrexia) or a low temperature (hypothermia) and one or more of the following symptoms: rapid heart rate (tachycardia), rapid breathing, an abnormally high or low number of white blood cells (Leucopenia and leukocytosis).
Many infections cause these symptoms however, in the case of sepsis, organs begin to malfunction and blood flow to certain parts of the body becomes inadequate. When the blood pressure remains low despite intensive treatment with intravenous fluids, septic shock is diagnosed. Septic shock can lead to dangerously low blood pressure and abnormalities in cellular metabolism. Toxins are produced by certain bacteria which cause cells to release substances which, trigger inflammation (cytokines) and assist in the immune system fight infection however, they may have harmful effects, such as:
- Causing blood vessels to dilate, decreasing the blood pressure, and
- Causing blood clots in tiny blood vessels inside the organs.
If sepsis worsens to the point of end-organ dysfunction (kidney failure, liver dysfunction, altered mental status, or heart damage), then the condition is called severe sepsis. Once severe sepsis worsens to the point where blood pressure can no longer be maintained with intravenous fluids alone, then the criterion has been met for septic shock (Melis; Fichera, & Ferguson (2006). Arch Surg. 141 (7): 701–4. doi:10.1001/archsurg.141.7.701. PMID 16847244)
Treatment primarily consists of the following:
- Giving intravenous fluids
- Early antibiotic administration
- Early goal directed therapy
- Rapid source identification and control
- Support of major organ dysfunction