sepsis/mrsa

[NurseNature]

What makes an infection go septic? Why don't all scrapes/scratches/wounds go septic? My guess is that it is dependent on one's immune system, but that's all i have to go on. I saw that most of the pt's in the wound care center had mrsa in their deep, open wounds. Many of the pt's were really worried when they heard mrsa was in their wound b/c of all the recent publicity on it. I wasn't sure how to best answer their concerns. I knew that if it wasn't systemic then it was only a worry as to how quickly the wound would heal or if it would require amputation eventually b/c of complications with the healing process. I am very interested in sepsis causes and and results. Are most infections s/s similar if septic? Sorry, lots of questions on this topic and I am very interested. I want to know what to tell my pt's in next weeks clinicals. I was finding it difficult to quickly research and as you all know... not a lot of time to do so while in last year of nursing school. Thanks all!

[fultzymom]

An infection can go septic if the person has a depressed immune system. But also if the infection is let go too long before it is caught and treated, that can cause a person to get septic. If a person is going to get MRSA they would have to be in direct contact with it. That is why it is so important to do good handwashing between patients so that you do not pass it from an infected person to someone else.

I also had many people who asked me if I had heard of the new "superbug" that they found. I had to enlighten them that it is not a new bug and you are only going to get it if you had direct contact with it and you have an open wound. For the most people, healthy people with closed skin are not going to get it, unless it is respiratory MRSA, then you have to implement other precautions.

[leslie :-D]

localized infections, left untreated, can eventually cause sepsis.

most do not, because wounds are visible and allow closer monitoring.

untreated uti's, pneumonias can be trickier.

many don't present w/textbook s/s, and many pts are afebrile.

esp the elderly.

often, a late sign of sepsis, is a decreased temp...95-97.

ulcers/wounds, scratches, etc, have a much higher incidence of earlier tx.

leslie

[CaseManager1947]

Patients become septic, or develop sepsis to be more accurate, due to bacterial, fungal or parasitic infection(malaria) within the blood stream. For obvious reasons our blood is a perfect culture media and supports bacterial growth easily.This can come from an external source (cut, scratch, infected needle) that contains bacteria. It can also develop due to UTI and pneumonia that has either been 1.) untreated, 2) improperly treated (wrong abx, eg). or 3.) undertreated (too short a course, nonadherence to rx). Immune compromise is not necessary, but comes along with the very young and the very old, as well as obvious reasons (HIVetc.) One main cause which is often not noted is from invasive lines. I had a gentleman on Psych once, who had blown his renals due to Lithium tox , had central dialysis catheter, and his main sx was HYPOTENSION! On further study, had elevated wbc. We sent to the unit, with hypotensive shock due to line sepsis.

Failure to diagnose can also result in horrendous situations. One guy came in to ER with what was diagnosed as a "sprain". He had swelling and erythema in the ankle. Was sent home on Lortab or some such. Came back in 2 weeks later with leg swollen to the knee, had to have bilateral fasciotomy, vac, and skin graft. Nearly lost his leg!!