What Is Sepsis?
Sepsis is a life-threatening condition in which the body is fighting a severe infection that has spread via the bloodstream. If a patient becomes "septic," they will likely have low blood pressure leading to poor circulation and lack of blood perfusion of vital tissues and organs. This condition is termed "shock" and is sometimes referred to as septic shock when an infection is the cause of shock to distinguish it from shock due to blood loss or from other causes. This condition can develop either as a result of the body's own defense system or from toxic substances made by the infecting agent. Survival rates for sepsis depend on the patient's underlying medical conditions, how quickly the diagnosis is made, the organism that causes the infection, and the patient's age.
People at Risk for Sepsis
- People whose immune systems (the body's defense against infections) are not functioning well because of an illness (such as diabetes or AIDS) or because of medical treatments that weaken the immune system (such as chemotherapy for cancer or steroids for a number of medical conditions) are more prone to develop sepsis. It is important to remember that even healthy people can become septic.
- Very young babies, because their immune systems are not completely developed, may get sepsis if they become infected and are not treated in a timely manner. Often, if they develop signs of an infection such as fever, infants must receive antibiotics and be admitted to the hospital. Sepsis in the very young is often more difficult to diagnose because the typical signs of sepsis (fever, change in behavior) may not be present or may be more difficult to ascertain.
- The elderly population, especially those with other medical illnesses such as diabetes, may be at increased risk as well.
- Hospitalized patients are at risk to develop sepsis from infections due to intravenous lines, catheters, surgical wounds, and/or bedsores.
The number of people dying from sepsis has increased in the past 20 years. This is most likely due to the increased number of patients who suffer from sepsis. The number of patients who develop sepsis has increased for many reasons. Since 1999, the rapid rise of sepsis mortality seen in previous decades has slowed.
- There has been a large increase in sepsis because doctors have started treating cancer patients and organ-transplant patients, among others, with strong medications that weaken the immune system. In the past, these patients would have died due to complications of their disease. As we get better at treating the underlying illness, patients survive longer but then sometimes die due to the complications of the therapy.
- As our aging population increases, the number of elderly people with weak immune systems has grown.
- Advances in medical care have increased the survival of acute events (severe trauma, severe strokes), which often lead to a delayed death due to sepsis.
- Increased antibiotic use has resulted in many more resistant strains of bacteria, making the treatment of sepsis more difficult in some cases because there is no effective antibiotic.
What Causes Sepsis?
Many different microbes can cause sepsis. Although bacteria are most commonly the cause, viruses and fungi can also cause sepsis. Infections in the lungs (pneumonia), bladder and kidneys (urinary tract infections), skin (cellulitis), abdomen (such as appendicitis), and other areas (such as meningitis) can spread and lead to sepsis. Infections that develop after surgery can also lead to sepsis.
What Are Sepsis Risk Factors?
- Very young people and elderly people
- Anyone who is taking immunosuppressive medications (such as transplant recipients)
- People who are being treated with cancer chemotherapy drugs or radiation
- People who have had their spleen surgically removed (the spleen helps fight certain infections)
- People taking steroids (especially over the long term)
- People with longstanding diabetes, AIDS, or cirrhosis
- Someone who has very large burns or severe injuries
- People with infections such as
Low Blood Pressure
If low blood pressure is the normal state for a patient, then there will be no symptoms.
If low blood pressure is symptomatic, then the patient may feel:
- dizzy and weak,
- short of breath, or
- have chest pain.
The symptoms will depend upon which organ in the body is lacking adequate blood flow.
What Are Sepsis Symptoms and Signs?
- If a person has sepsis, they often will have fever. Sometimes, though, the body temperature may be normal or even low.
- The individual may also have chills and severe shaking.
- The heart may be beating very fast, and breathing may be rapid. Low blood pressure is often observed in septic patients.
- Confusion, disorientation, and agitation may be seen as well as dizziness.
- Decreased urination (due to poor kidney perfusion or dehydration)
- Some patients who have sepsis develop a rash on their skin. The rash may be a reddish discoloration or small dark red dots seen throughout the body.
- Those with sepsis may also develop pain in the joints of the wrists, elbows, back, hips, knees, and ankles.
When Should Someone Seek Medical Care for Sepsis?
When to Call the Doctor
A person should call the doctor if anyone has signs and symptoms of sepsis. If any of the following are true about the patient's medical history, they need to be especially vigilant regarding possible sepsis symptoms if the person
- is being treated with cancer chemotherapy or radiation,
- is taking immunosuppressive medications (for example after an organ transplant),
- has diabetes,
- has AIDS, or
- is very young or very old.
When to Go to the Hospital
- Anyone suspected of having sepsis should go to a hospital.
- If a child younger than 2 months of age has fever, lethargy, poor feeding, a change in normal behavior, or an unusual rash, call the doctor and proceed to the hospital.
- If someone has confusion, dizziness, fast heartbeat, fast breathing, fever, chills, rash, or dizziness, call the doctor immediately or go to the hospital's emergency department.
What Tests Do Health Care Professionals Use to Assess and Diagnose Sepsis?
In the hospital, the doctor may conduct various tests. These tests will either be geared toward the patient's specific symptoms (for example, a chest X-ray if the patient is suspected of having pneumonia) or many different tests if the source of the sepsis is not known.
- Blood work may be done by inserting a needle into a vein in the patient's hand or arm and drawing blood into several tubes. This blood may be analyzed to see if the patient has an elevation in the white blood cell counts.
- Blood may also be sent to the lab to be placed on a medium where bacteria will grow if they are present in the blood. This is called a blood culture. Results from this test usually take over 24 hours (the time required to look for bacterial growth). Lab technicians may also look for bacteria in the blood under the microscope on slides.
- Samples may be taken of sputum (mucus), urine, spinal fluid, or abscess contents to look for the presence of infectious organisms.
- To obtain urine that is not contaminated and to measure the amount of urine being produced, a flexible rubber tube may be placed into the bladder (catheter).
- Spinal fluid may be obtained from the lower back (spinal tap or lumbar puncture) to evaluate if there is an infection in the brain or fluid surrounding the brain and spinal cord. After the skin is cleaned and numbed, a hollow needle is placed between the bones of the spine into the canal containing the spinal cord. Because the needle is placed lower than the location where the cord ends, there is little danger of injuring the nerves of the spinal cord. When the needle is in the correct spot, the doctor will let the fluid drip into tubes. The sample of fluid is sent to the lab for testing.
- Other tests may include a chest X-ray to look for pneumonia or a CT scan to see if there is infection in the abdomen.
- A dye (contrast) might be injected into a vein during a CT scan to help highlight certain organs in the abdomen.
- The CT scan is a series of X-rays taken from different angles very quickly and put together by the computer to show an image of the internal organs.
- Usually, a radiologist reads the results and notifies the patient's doctor.
- In the hospital, the patient may be placed on a cardiac monitor, which will show the patient's heart rate and rhythm.
- Similarly, the patient is usually placed on a pulse oximeter which indicates the amount of oxygen in the blood.
- If the patient is a young child who is ill and being evaluated for sepsis, he or she will get similar tests and treatment.
What Is the Treatment for Sepsis?
- The patient will likely be administered oxygen, either by a tube that is placed near the nose or through a clear plastic mask.
- Depending on the results of the tests, the doctor may order medications. These medications may include antibiotics given intravenously (given directly into the vein). Initially, the antibiotics may be those that kill many different bacteria because the exact kind of infection the patient has is not known. Once the blood culture results show the identity of the bacteria, the doctor may select a different antibiotic that kills the specific organism responsible for the infection.
- The doctor may also order IV salt solution (saline) and medications to increase the blood pressure if it is too low.
- Your health care professional will likely admit the patient to the hospital at least until the blood culture results are known. If the patient is very ill and with low blood pressure, the doctor may admit the patient to the intensive care unit (ICU) and may consult specialist doctors to help in the management of the illness.
- If results show an infection in the abdomen, either drainage of the infection by the placement of tubes or surgery may be necessary.
- Research to discover new treatments for sepsis has failed over the past 20-30 years. Many medications that were thought to be helpful were proven to have no benefit in clinical trials. However, scientists are working diligently to discover medications that will modify the body's aggressive immune response to microbes, which leads to sepsis. Depending on the hospital where the patient receives treatment, different sepsis treatment protocols might be in place.
Are There Home Remedies for Sepsis?
Sepsis is a medical emergency. If a person has sepsis, treatment is usually given in the hospital and often in an intensive care unit.
Is Sepsis Contagious?
Depending on where the infection started and the organism causing the sepsis, the patient could be contagious (for example, if the infection started in the lung or with certain forms of brain infections).
What Specialists Treat Sepsis?
Many specialists are usually involved in the care of a septic patient. If the patient is in the intensive-care unit, an intensivist, pulmonologist, or internist will often be the primary caretaker. As septic patients have an underlying infection, frequently an infectious-disease specialist will be involved in the care, as well.
What Is the Prognosis of Sepsis?
The prognosis of sepsis depends on age, previous health history, overall health status, how quickly the diagnosis is made, and the type of organism causing the sepsis.
- For elderly people with many illnesses or for those whose immune system is not working well because of illness or certain medications and sepsis is advanced, the mortality rate (death rate) may be as high as 80%.
- On the other hand, for healthy people with no prior illness, the mortality rate may be low, at around 5%.
- The overall mortality rate from sepsis is approximately 40%. It is important to remember that the prognosis also depends on any delay in diagnosis and treatment. The earlier the treatment is started, the better the outcome will be.
Is It Possible to Prevent Sepsis?
- It's possible to prevent some forms of sepsis, and the severity of the episode may be decreased.
- The risk of sepsis can be reduced in children by following recommended immunization schedules.
- Hospital related infections leading to sepsis can be decreased by strictly following hand washing and hygiene protocols.
Reviewed on 9/11/2017
Al-Khafaji, Ali H. "Multiple Organ Dysfunction Syndrome in Sepsis." Medscape. Mar. 7, 2017. <http://emedicine.medscape.com/article/169640-overview>.
Donovan, C., and J. Blewitt. "An Overview of Meningitis and Meningococcal Septicaemia." Emerg Nurse. 17.7 Nov. 2009: 30-6; quiz 37.