Managing sepsis--a common cause of geriatric death.

Consider where the patient acquired the infection--in the community or the hospital. Gram-negative sepsis that develops after admission to a hospital or extended-care facility is likely to be caused by multiply-resistant organisms. Lack of fever does not reliably exclude sepsis in elderly patients. Among 27 afebrile patients found to have bacteremia-fungemia, diagnosis was made in one-third only after blood cultures were drawn, and almost one-half were already receiving antibiotics.