Sepsis Evaluation and Management in Geriatric Patients

Clinical Presentation and Risk Factors

The American Geriatrics Society recommends that geriatric patients with fever, altered mental status, and tachypnea be evaluated for sepsis, as these symptoms are common presentations of sepsis in this population, with tachypnea >25 breaths/min being 90% sensitive and 95% specific for pneumonia 1, 2
Patients with diabetes mellitus are predisposed to skin infections and urinary tract infections, increasing their risk of sepsis 1, 2, 3
The presence of a neurogenic bladder increases the risk of bacteremia, particularly if an indwelling catheter is present, with a 39-fold increased risk 3
Altered mental status and developmental delay increase the risk of aspiration pneumonia 1, 2, 3

The American College of Physicians recommends a systematic evaluation targeting the most common infection sources in long-term care residents, including respiratory rate, mental status, hydration status, skin examination, and chest examination 3
Initial laboratory tests should include a complete blood count with differential, comprehensive metabolic panel, inflammatory markers, lactate, urinalysis with culture, and blood cultures 4, 5
Imaging studies, such as chest radiograph, should be ordered based on clinical presentation and risk factors 3

The American Geriatrics Society recommends initiating sepsis bundle immediately, including supplemental oxygen, IV access and fluid resuscitation, blood cultures, and empiric broad-spectrum antibiotics within 1 hour 4
Empiric antibiotics should be adjusted based on local antibiogram and patient's previous cultures from long-term care facility 3
Critical medication adjustments, such as continuing prednisone and adjusting diabetes management, should be made to address underlying conditions 1, 4

The Centers for Disease Control and Prevention recommends implementing infection prevention strategies, including pneumonia prevention, UTI prevention, and skin infection prevention, to reduce future infection risk 3
Long-term care facilities should establish clear protocols for temperature monitoring, early recognition of atypical presentations, and rapid notification protocols for certified nursing assistants to alert advanced practice providers 1, 2, 3