Help with a microbiology case study...

[Buckaroo93]

Case:

A middle-aged man presents to the ED with chest pain and is found to have suffered a heart attack. He has a past history of hypertension, NIDDM, and high cholesterol. Exploratory surgery shows he requires a triple bypass. This is performed on the 5th day of his hospital stay. During recovery, he develops septic shock with fever and pneumonia. MRSA has been identified from sputum samples and from the surgical incision.

I know that pneumonia can cause sepsis which can lead to septic shock but...

can sepsis cause pneumonia and thus septic shock?

1. Would the portal of entry be the incision in which case the MRSA could have gotten into the blood stream and then cause the pneumonia?

2. Would the portal of entry be the upper respiratory where it settled in the lungs thus causing the pneumonia which led to the sepsis?

3. Could it have been a combo of both?

What came first, the chicken or the egg?

Thanks,

Vinny