Beware of sepsis: the last "cold" for the elderly

This is the 5123rd article of Da Yi Xiao Hu

"Doctor, my dad just had diarrhea, why can't he be saved?" At 4 a.m., the family members asked the doctor desperately at the door of the ICU. They couldn't accept that their father, who was still normal two days ago, was struggling between life and death. Let's recall what happened.

Three days ago, a 65-year-old man had diarrhea and fever, with a maximum temperature of 39.5℃, but his general condition was still good. His family thought it was just a fever, so they bought some antipyretics. During these three days, the old man took antipyretics when he had a fever, and he sweated a lot after the fever subsided. One morning ago, the family couldn't wake the old man up, so 120 rushed him to the hospital. After admission, the blood pressure was 85/45 mmHg, the heart rate was 135 beats/min, and the procalcitonin was 12 ng/ml. The doctor's preliminary diagnosis: sepsis, septic shock. A critical illness notice was issued and the patient was transferred to the ICU for further treatment.

Eight hours after admission, the doctor informed: "The patient's blood culture shows: Gram-negative bacillus infection, bacteria spread throughout the body along the bloodstream, and the lactic acid level is very high. He is currently receiving active treatment, but his condition is still unstable and he may need emergency treatment at any time." 12 hours after admission, the doctor informed again: "Your father's blood culture is positive for Klebsiella pneumoniae. The bacteria are extremely virulent and have affected multiple organs. His condition continues to deteriorate and his life is in danger at any time..."

1. What is Klebsiella pneumoniae

Klebsiella pneumoniae is a common Gram-negative bacillus that colonizes various mucosal surfaces of the human body, including the upper respiratory tract and intestines. It generally does not cause any symptomatic diseases. When the host immune system cannot control the growth of pathogens, colonized bacteria may cause infection. After evolution, Klebsiella pneumoniae gradually evolved and formed two different clonal groups. One is the classic Klebsiella pneumoniae, which is multidrug-resistant and even carbapenem-resistant, and is generally common in hospital infections; the other is highly toxic and is more common in community infections. Highly toxic Klebsiella pneumoniae has a strong pathogenicity, and its disability and mortality rates are higher. Highly toxic Klebsiella pneumoniae is more likely to cause liver abscesses, hematogenous lung abscesses, or brain abscesses.

2. What is sepsis in the elderly?

Elderly individuals are particularly susceptible to sepsis due to factors such as pre-existing comorbidities, impaired immune function, muscle loss, age-related reduced physiological reserves, malnutrition, and polypharmacy. However, the diagnosis of sepsis in elderly individuals is challenging due to its atypical presentation and fewer symptoms, and timely identification is essential for proper management and prevention of adverse outcomes. In elderly individuals, life-threatening infections may manifest through various behavioral changes, such as sudden confusion, sensory impairment, psychomotor agitation or lethargy, loss of appetite, dehydration, dizziness, falls, and incontinence. Physical symptoms may be the only symptoms. Although fever is a common manifestation of infection, it is not present in some elderly patients with infection. On the other hand, due to the low basal body temperature of the elderly and the impaired ability to regulate body temperature, the traditional definition of fever may not be applicable, and the use of some drugs will further inhibit the inflammatory response. Therefore, infections in the elderly often have no specific manifestations and are easily overlooked.

3. Early identification of sepsis in the elderly?

Sepsis in the elderly is a serious medical emergency. Early recognition and treatment are crucial. Timely medical intervention can save lives. Here are some key points to help you identify and treat elderly patients with sepsis.

S (for slurred speech or confusion) : If a person has slurred speech, confusion, or confusion, this could be a sign of sepsis.

E (for extreme pain in the muscles or joints) : If the patient experiences extreme pain in the muscles or joints, this may be a sign that the infection is getting worse.

P (for passing no urine in a day) : If the patient has not urinated for a day, this may be a sign of impaired kidney function and requires immediate medical attention.

Quick Recognition Tips : If a person becomes seriously ill from an infection, seek medical help, especially if you have never seen the person so unwell.

Seek professional medical help : If sepsis is suspected, seek medical attention immediately.

Author: Emergency Department, The Second Affiliated Hospital of Xi'an Jiaotong University

Supervisor: Chief Physician Pei Honghong

Written by: Yang Ni, attending physician