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Sepsis Management: Importance of the Pathogen

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Handbook of Sepsis

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Abstract

The nature of the pathogen responsible for initiating the septic process has a major impact on the host: pathogen interaction and the ultimate outcome for the patient. Potential pathogens must first evade an impressive array of innate and adaptive host defense mechanisms to invade and disseminate within a previously healthy human. Such a pathogen-derived pathophysiologic feat is only possible if the invasive microorganism expresses an array of virulence factors capable of overwhelming the host. However, considerably less virulent microorganisms can still successfully disseminate within patients who manifest a number of immune defects and comorbid conditions which functionally impair antimicrobial defenses and disrupt microbial clearance capacities. Pathogens can injure the host by at least three different mechanisms: (1) rapidly replicate and overwhelm the host by an uncontrolled microbial burden or load of organisms, (2) express toxins that directly or indirectly induce cellular injury, or (3) induce collateral damage to normal host tissues through generation of an excessive and damaging host inflammatory response to the presence of pathogen-associated molecular pattern (PAMP) substances. In this chapter we will examine these mechanisms in detail and emphasize the need to rapidly initiate antimicrobial therapies with antibiotics and source control strategies to limit pathogen damage in septic patients. Treatment has become much more difficult by the spread of antibiotic resistance genes among bacterial as well as viral, fungal, and even protozoan pathogens that can cause sepsis.

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Authors and Affiliations

  1. Infectious Diseases, University of Missouri-Kansas City, Kansas City, MO, USA

    Russell J. McCulloh M.D.

  2. Ocean State Clinical Coordinating Center of Rhode Island Hospital, Providence, RI, USA

    Russell J. McCulloh M.D. & Steven M. Opal M.D.

  3. Infectious Disease Division, Alpert Medical School of Brown University, Providence, RI, USA

    Steven M. Opal M.D.

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  1. University of Amsterdam, Amsterdam, The Netherlands

    W. Joost Wiersinga

  2. University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Christopher W. Seymour

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McCulloh, R.J., Opal, S.M. (2018). Sepsis Management: Importance of the Pathogen. In: Wiersinga, W., Seymour, C. (eds) Handbook of Sepsis. Springer, Cham. https://doi.org/10.1007/978-3-319-73506-1_11

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