Definition & Overview
Sepsis, also called systemic inflammatory response syndrome, is a severe blood infection that can quickly lead to the failure of several vital organs including the liver, lungs, and kidney. It develops when the body detects severe infection and initiates a full-body inflammatory response. The inflammation then results in blood clotting that blocks blood flow in various arteries, depriving vital organs much-needed nutrients and oxygen. It also leads to the death of tissues in the arms, toes, fingers, and legs. In severe cases, the condition leads to the sudden drop in blood pressure. This is referred to as septic shock, which is the most common cause of death in intensive care units in the United States.
Meanwhile, the infection that triggers the body’s inflammatory response can be caused by virus and bacteria, which can penetrate the body through a simple wound or may stem from other serious medical conditions such as meningitis, pneumonia, appendicitis, or a urinary tract infection.
According to the Centers for Disease Control and Prevention (CDC), the number of sepsis cases in the United States is steadily increasing (at least one million cases are reported each year) due to the aging population, antibiotic resistance, and increase in the number of people with compromised immune systems, which include those who were diagnosed with AIDS or HIV and those who are getting organ transplants and other invasive procedures.
Cause of Condition
Sepsis develops due to the overwhelming immune response to infection, with pneumonia, abdominal infection, bloodstream infection, and kidney infection being the most common causes in the majority of reported cases. However, the condition can also result from wounds that infectious agents can use as a gateway to enter the body. Other common places where an infection might start include:
- The lining of the brain
- Lungs (bacterial pneumonia)
Patients who are staying in the hospital for any reason have the highest risk of developing an infection. For these people, the common sites of infection include surgical wounds, intravenous lines, surgical drains, and pressure ulcers or bedsores.
Although sepsis can affect anybody of any age, certain groups of people are at a higher risk. These include:
- People with compromised immune systems such as those battling AIDS or HIV
- People who are undergoing autoimmune therapy
- People who have had invasive surgical procedures
- Very young and very old individuals, particularly if they have existing medical conditions
- People with diabetes
- People who have chronic meningitis, pneumonia, appendicitis, or a urinary tract infection
- People being treated in an intensive care unit
- People whose treatment to unrelated medical conditions include the use of intravenous catheters or breathing tubes
The symptoms of sepsis, which are mainly triggered by the chemicals that the body releases as immune response, include:
- Delirium or confusion
- Hypothermia (low body temperature)
- Rapid heartbeat, pulse, and breathing
- Skin rash
- Warm skin
- Decreased urination
- Nausea and vomiting
- Extreme pain
- Shortness of breath
- Sleepy, difficult to rouse
Who to See & Types of Treatments Available
Patients who display at least some of the symptoms listed above, particularly those who meet the risk factors (have compromised immune system, had undergone invasive surgical procedures, or have other medical conditions such as diabetes, among others) and those with known infection should immediately call their doctor. Since sepsis is a life-threatening condition, getting immediate medical attention is crucial. Every minute counts, especially since the infection can spread pretty quickly.
To diagnose the condition, various tests such as blood, urine, wound secretion, and mucus secretion tests will be performed. The blood will then be checked for infection and clotting problems. The doctor will also determine if there’s a decreased amount of oxygen in the body or an electrolytes imbalance. This is followed by the assessment of the kidney’s function.
If the above tests yield inconclusive results, imaging tests will be conducted. These include x-rays for the lungs, CT scans for the bowel area, appendix, and pancreas, and ultrasounds for the ovaries or gallbladder. If soft tissue infection is suspected, the doctor will also order an MRI.
As the mortality rate for septic shock is nearly 50%, doctors strive to provide prompt and aggressive treatment once a patient has been diagnosed with sepsis. Life-saving measures are immediately taken to stabilize heart function and breathing, and patients are cared for in a hospital intensive care unit.
Treatment of sepsis aims to clear the infection, keep the vital organs from failing, and prevent blood pressure from dropping.
To treat the condition, a broad-spectrum of antibiotics is administered intravenously. This treatment protocol is initiated even before the infectious agent is identified. The antibiotics may be altered once the results of all tests confirm the particular bacteria causing the infection. Vasopressor medication will also be administered to increase blood pressure. Depending on the severity of the case and the patient’s unique circumstances, corticosteroids, insulin, painkillers, and drugs that modify the immune system responses may also be provided. Kidney dialysis or even surgery may also be performed to drain or clear an infection.
Sepsis can be very aggressive and up to 50% of patients die from it. On the other hand, those who survive the condition face a higher risk of permanent organ damage or organ failure.
- Optimal Management of Septic Shock
- Stephen J. Fitch, MD; James R. Gossage, MD
- Vol 111 / No 3 / March 2002 / Postgraduate Medicine
- National Institute of General Medical Sciences: "Sepsis Fact Sheet."