Given the rapidly expanding elderly population with their associated immune senescence and frailty ( 5), the mortality rates associated with sepsis are expected to increase dramatically over the next 2 decades ( 6). Moreover, sepsis and septic shock are major healthcare problems, affecting millions of people worldwide each year, with the increasing cost of sepsis-associated medical care now estimated at $17 billion annually in the United States ( 4). It is associated with significant morbidity and mortality ( 1– 3) that increase markedly when septic shock becomes established. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection.
In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients (2) the risk factors associated with a worse prognosis (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.
The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates.
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