Sepsis

Definition
Sepsis is a potentially life-threatening complication of an infection. It often occurs when the infection spreads into the bloodstream. The activation of the immune system in response to infection triggers a chain reaction leading to uncontrolled inflammation and clots in the microcirculation of multiple organs. Patients with sepsis have increased risk of death as a result of complications from multiple organ dysfunction and failure of the circulatory system due to sudden drop in blood pressure (septic shock). Sepsis is a medical emergency that requires urgent inhospital care, preferably in the intensive care unit.

Epidemiology
The risk of sepsis is higher in:

  • Persons with weakened immune systems
  • Elderly persons or the very young such as infants
  • Persons with underlying chronic illnesses (diabetes, AIDS, cancer, liver or kidney disease)
  • Severe physical injuries (open fractures or severe burns)
  • Have invasive devices such as catheters

Sepsis occurring in previously healthy persons usually involves a highly virulent organism (such as Staphylococcus aureus and Streptococcus pyogenes) which may produce a toxin.

The mortality rate for severe sepsis and septic shock may be up to 50%. Prompt, early antibiotic treatment and skilled organ support in the intensive care unit is critical for therapeutic success.

Sepsis may spread from different sources of infection within the body. These types of infections include:

  • Skin and soft tissue infections
  • Pneumonia
  • Urinary tract infections involving the kidneys
  • Abdominal infections (usually in the biliary tract or involving perforation of the abdominal organs)
  • Healthcare-associated infections (pneumonia or involving central lines, catheters, prosthetic devices, surgical sites)

Clinical

  • Fever and chills
  • Confusion or disorientation
  • Rapid breathing
  • Increased heart rate
  • Hot or cold clammy skin
  • Symptoms referable to the site of infection

Diagnostic Tests
Patients with sepsis often exhibit at least 2 of the following:

  • Body temperature above 38.3 C or below 36.0 C
  • Heart rate more than 90 beats per minute (bpm)
  • Breathing rate more than 20 breaths a minute
  • Symptoms referable to a probable or confirmed infection

Other symptoms referable to possible organ dysfunction:

  • Significant decrease in urine output
  • Abrupt change in mental status
  • Difficulty breathing
  • Abnormal heart function with low blood pressure
  • Abdominal pain and distension

Septic shock is diagnosed if there are signs of severe sepsis and extremely low blood pressure that does not respond to simple fluid replacement.

Tests that may help with diagnosis of sepsis depend on the suspected source of infection and include:

  • Blood, urine, sputum cultures
  • Bacterial cultures from other sites (from catheters, central lines, phlegm or discharge from a wound)
  • Blood counts, general biochemistry, coagulation profile
  • Chest X-Rays
  • Abdominal ultrasound
  • Computerized Tomography (CT) of affected organs if appropriate
  • Magnetic Resonance Imaging (MRI) of affected organs if appropriate

Treatment
Having prompt aggressive treatment increases chances of recovering from sepsis. Severe sepsis or septic shock requires close monitoring and treatment in an Intensive Care Unit (ICU) where doctors will treat the infection, sustain and support the vital organs especially the blood pressure. Antibiotics, supplemental oxygen and intravenous fluids are required for treatment of sepsis. Mechanical ventilation and kidney dialysis may be required. Surgery may be needed to control or remove the source of infection.

Prevention
Vaccinations against infections such as pneumonia and meningitis can help prevent acquiring such infections and hence sepsis from these sources. Wounds or burns should be kept clean to prevent infection. If there are any invasive devices such as catheters or central lines, they must be checked regularly and kept clean.

If there is a suspected infection, early assessment and treatment should be sought.

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