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Myriad bacteria, viruses, fungi, and parasites can cause SIRS. Among the bacterial causes of sepsis, some age-related patterns are observed.

  • Early-onset neonatal sepsis: Streptococcus agalactiae, Escherichia coli, Haemophilus influenzae, and Listeria monocytogenes are the most frequent organisms encountered.
  • Late-onset neonatal sepsis: Coagulase-negative Staphylococcus, Staphylococcus aureus, E coli, Klebsiella species, Pseudomonas aeruginosa, Enterobacter species, Candida species, S agalactiae, Serratia species, Acinetobacter species, and various anaerobes are some of the most commonly involved organisms.
  • Sepsis in infancy
    • Streptococcus pneumoniae and Neisseria meningitidis predominate in the United States and the developed world because conjugate H influenzae type b (Hib) vaccination has essentially eliminated disease caused by that organism.
    • Hib, S pneumoniae, N meningitidis, and Salmonella species are the most frequent causes of bacterial sepsis among most infants worldwide.
    • In regions where malaria occurs, Plasmodium falciparum is a frequent cause of SIRS in infancy.
  • Sepsis in childhood: The same pathogens cause SIRS in childhood, although the presence of encapsulated organisms generally becomes less frequent as a child's immune response to polysaccharide antigens improves with age.
  • Special considerations: Underlying conditions predispose to infection with particular pathogens.
    • Acquired immunodeficiency syndrome (AIDS) predisposes to SIRS from various usual and unusual pathogens, particularly pneumococcus.
    • Children with hemoglobin SS disease have a 400-fold increased risk of sepsis due to pneumococcus and Salmonella, among other pathogens.
    • Congenital heart disease is a risk factor for endocarditis and SIRS.
    • Genitourinary anomalies often increase the risk of urosepsis.
    • Infants and children with significant burns are at risk for SIRS, caused by skin flora and nosocomial gram-negative pathogens in particular.
    • Splenic dysfunction or absence, as well as complement, immunoglobulin, and properdin deficiency, predispose to sepsis due to encapsulated organisms.

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