Risk Factors
The very young (under one year) and older people (over 75 years) or people who are very frail.
People who have impaired immune systems because of illness or drugs, including:
- Being treated for cancer with chemotherapy
- Those who have impaired immune function (for example, diabetes, have had a splenectomy, or sickle cell disease)
- Taking long-term steroids
- Taking immunosuppressant drugs to treat non-malignant disorders such as rheumatoid arthritis
- Have had surgery or other invasive procedures in the past six weeks
- Any breach of skin integrity (for example, cuts, burns, blisters or skin infections)
- Misuse drugs intravenously
- Indwelling lines or catheters
Women who are pregnant, have given birth or had a termination of pregnancy or miscarriage in the past six weeks are in a high-risk group for sepsis. In particular, women in this group who have:
- Impaired immune systems because of illness or drugs
- Gestational diabetes or diabetes or other comorbidities
- Taking long-term steroids
- Needed invasive procedures (for example, caesarean section, forceps delivery, removal of retained products of conception)
- Prolonged rupture of membranes
- Been in close contact with people with group A streptococcal infection, e.g. scarlet fever
- Continued vaginal bleeding or an offensive vaginal discharge
For neonates, risk factors include:
- Invasive group B streptococcal infection in a previous baby
- Maternal group B streptococcal colonisation, bacteriuria or infection in the current pregnancy
- Premature rupture of membranes
- Preterm birth following spontaneous labour (before 37 weeks’ gestation)
- Suspected or confirmed rupture of membranes for more than 18 hours in a preterm birth
- Intrapartum fever higher than 38°C or confirmed or suspected chorioamnionitis
- Parenteral antibiotic treatment is given to the woman for confirmed or suspected invasive bacterial infection at any time during labour or in the 24-hour period before and after the birth (this does not refer to intrapartum antibiotic prophylaxis)
- Suspected or confirmed infection in another baby in the case of a multiple pregnancy
(Adapted from NICE, 2016; The Sepsis Trust, 2019)
Although patients with these risk factors are more predisposed to developing sepsis, it is key not to rely just on risk factors alone. (NICE, 2016) also recommend the application of clinical acumen to ‘think sepsis’ and ask, does this person look unwell, are they deteriorating unexpectedly, or are they failing to improve as expected?
It is especially important to listen to concerns of colleagues, the patient, their family, carers or advocates. There may well be subtle cues that indicate changes/deterioration in health, such as ‘they are not normally like this’ and ‘I’ve never seen them so unwell’ (The Sepsis Trust, 2019).