What is sepsis

Sepsis (also known as septicemia or blood poisoning) is a serious blood infection caused by bacteria/virus/fungus and your body’s extreme immune response to that infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. Sepsis is a medical emergency and can be fatal if not treated quickly. If you suspect you or someone else has sepsis, call your local emergency number for an ambulance.

Sepsis is life-threatening and without timely treatment can rapidly cause tissue damage, multi-organ failure and death — time matters. Research shows that rapid, effective sepsis treatment, which includes giving antibiotics, maintaining blood flow to organs, and treating the source of infection, can save lives.

Sepsis happens when an infection you already have in your skin, lungs, urinary tract or somewhere else – triggers a chain reaction throughout your body leading to septic shock where your blood pressure drops dramatically, which may lead to death. Septic shock is a life-threatening condition that happens when blood pressure drops to a dangerously low level after an infection. This reduces the amount of blood and oxygen that reaches the body’s organs, stopping them working properly.

Anyone can develop sepsis, but it’s most common and most dangerous in older adults or those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival.

If you or your loved one suspects sepsis or has an infection that’s not getting better or is getting worse, get medical care IMMEDIATELY when an infection is not getting better or if it gets worse.

Bacteria in the blood may infect other organs, causing inflammation of the:

• lining of the brain (meningitis)
• abdomen (peritonitis)
• inner layer of the heart (endocarditis)
• joints (septic arthritis).

Sepsis can also lead to septic shock.

What is the difference between an infection and sepsis?

An infection occurs when germs enter a person’s body and multiply, causing illness, organ and tissue damage, or disease.

If that infection isn’t stopped, it can cause a life-threatening condition called sepsis.

Who is at risk of sepsis?

Anyone can get an infection, and almost any infection can lead to sepsis. Certain people are at higher risk:

• Adults 65 or older.
• People with chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease
• People with weakened immune systems
• Children younger than one

Sepsis Stages

Many doctors view sepsis as a three-stage syndrome, starting with sepsis and progressing through severe sepsis to septic shock. The goal is to treat sepsis during its early stage, before it becomes more dangerous.

Sepsis

To be diagnosed with sepsis, you must exhibit at least two of the following symptoms, plus a probable or confirmed infection:

• Body temperature above 101 °F (38.3 °C) or below 96.8 °F (36 °C)
• Heart rate higher than 90 beats a minute
• Respiratory rate higher than 20 breaths a minute

Severe sepsis

Your diagnosis will be upgraded to severe sepsis if you also exhibit at least one of the following signs and symptoms, which indicate an organ may be failing:

• Significantly decreased urine output
• Abrupt change in mental status
• Decrease in platelet count
• Difficulty breathing
• Abnormal heart pumping function
• Abdominal pain

Septic shock

To be diagnosed with septic shock, you must have the signs and symptoms of severe sepsis — plus extremely low blood pressure that doesn’t adequately respond to simple fluid replacement.

Sepsis complications

Sepsis ranges from less to more severe. As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis can also cause blood clots to form in your organs and in your arms, legs, fingers and toes — leading to varying degrees of organ failure and tissue death (gangrene).

Most people recover from mild sepsis, but the mortality rate for septic shock is nearly 50 percent. Also, an episode of severe sepsis may place you at higher risk of future infections.

Sepsis causes

What causes sepsis

Sepsis can start with any bacterial, viral or fungal infection. The most likely is bacterial infection in the bladder, or in the chest, or even on the skin. But the infection worsens and spreads through the blood. The body’s immune reaction can make things worse, not better, and it can cause a sudden, untreatable drop in blood pressure called septic shock.

Four types of infections that are often linked with sepsis are:

1. Lungs (pneumonia)
2. Kidney (urinary tract infection)
3. Skin infections, such as cellulitis – this can be caused by an intravenous catheter that’s been inserted through the skin to give fluids or medication
4. Gut

Sepsis may also develop when you’re already in hospital. For example, you’re more likely to develop sepsis if:

• you’ve recently had surgery
• you’ve had a urinary catheter fitted
• you have to stay in hospital for a long time.

Other sources of infection include:

• appendicitis
• an infection of the thin layer of tissue that lines the inside of the abdomen (peritonitis)
• an infection of the bladder, urethra or kidneys (urinary tract infection)
• an infection of the gallbladder (cholecystitis) or bile ducts (cholangitis)
• infections after surgery
• infections of the brain and nervous system – such as meningitis or encephalitis
• flu (in some cases)
• bone infection (osteomyelitis)
• heart infection (endocarditis)

Sometimes the specific infection and source of sepsis can’t be identified.

The most frequently identified germs that cause infections that develop into sepsis include:

• Staphylococcus aureus (staph)
• Escherichia coli (E. coli)
• Some types of Streptococcus

The incidence of sepsis appears to be increasing in the United States. The causes of this increase may include:

• Aging population. Americans are living longer, which is swelling the ranks of the highest risk age group — people older than 65.
• Drug-resistant bacteria. Many types of bacteria can resist the effects of antibiotics that once killed them. These antibiotic-resistant bacteria are often the root cause of the infections that trigger sepsis.
• Weakened immune systems. More Americans are living with weakened immune systems, caused by HIV, cancer treatments or transplant drugs.

Risk factors for sepsis

Sepsis is more common and more dangerous if you:

• Are very young or very old
• Have a compromised immune system
• Are already very sick, often in a hospital’s intensive care unit
• Have wounds or injuries, such as burns
• Have invasive devices, such as intravenous catheters or breathing tubes

What causes the symptoms of sepsis?

Usually, your immune system keeps an infection limited to one place. This is known as a localized infection.

Your body produces white blood cells, which travel to the site of the infection to destroy the germs causing infection.

A series of biological processes occur, such as tissue swelling, which helps fight the infection and prevents it spreading. This process is known as inflammation.

If your immune system is weak or an infection is particularly severe, it can quickly spread through the blood into other parts of the body. This causes the immune system to go into overdrive, and the inflammation affects the entire body.

This can cause more problems than the initial infection, as widespread inflammation damages tissue and interferes with blood flow.

The interruption in blood flow leads to a dangerous drop in blood pressure, which stops oxygen reaching your organs and tissues.

People at risk of developing sepsis

Everybody is potentially at risk of developing sepsis from minor infections. However, some people are more vulnerable, including people who:

• have a medical condition that weakens their immune system – such as HIV or leukaemia
• are receiving medical treatment that weakens their immune system – such as chemotherapy or long-term steroids
• are very young or very old
• are pregnant
• have a long-term health condition – such as diabetes
• have just had surgery, or have wounds or injuries as a result of an accident
• are on mechanical ventilation – where a machine is used to help you breathe
• have drips or catheters attached to their skin
• are genetically prone to infections

Sepsis is a particular risk for people already in hospital because of another serious illness.

Bacterial infections that can be caught in hospital, such as MRSA (Methicillin-resistant Staphylococcus aureus), tend to be more serious, as these bacteria have often developed a resistance to many commonly used antibiotics.

Sepsis signs and symptoms

There is no single symptom of sepsis.

The symptoms of sepsis vary. They may include:

• fever
• chills
• rapid breathing and heart rate
• tiredness
• clammy or sweaty skin
• headaches.

If sepsis gets worse, symptoms may include:

• confusion
• nausea and vomiting
• difficulty breathing
• mottled skin
• a sudden drop in blood pressure.

Get medical help immediately if you suspect sepsis, or if your infection is not getting better or is getting worse.

Symptoms of septic shock may develop if sepsis is left untreated. These can include:

• lightheadedness (dizziness)
• a change in mental state – such as confusion or disorientation
• diarrhea
• feeling sick and vomiting
• slurred speech
• severe muscle pain
• severe shortness of breath
• producing less urine – for example, not peeing for a day
• cold, clammy and pale or mottled skin
• loss of consciousness

Signs and symptoms of sepsis in children under 5

• looks mottled, bluish or pale
• is very lethargic or difficult to wake
• feels abnormally cold to touch
• is breathing very fast
• has a rash that does not fade when you press it
• has a fit or convulsion

If your child has any of the symptoms listed above and below, is getting worse or is sicker than you’d expect (even if their temperature falls), trust your instincts and seek medical advice urgently.

Temperature

• temperature over 100.4 °F (38 °C) in babies under three months
• temperature over 102.2 °F  (39 °C) in babies aged three to six months
• any high temperature in a child who cannot be encouraged to show interest in anything
• low temperature (below 96.8 ° F or 36 °C – check three times in a 10-minute period)

Breathing

• finding it much harder to breathe than normal – looks like hard work
• making “grunting” noises with every breath
• can’t say more than a few words at once (for older children who normally talk)
• breathing that obviously “pauses”

Toilet/nappies

• not had a wee or wet nappy for 12 hours

Eating and drinking

• new baby under one month old with no interest in feeding
• not drinking for more than eight hours (when awake)
• bile-stained (green), bloody or black vomit/sick

Activity and body

• soft spot on a baby’s head is bulging
• eyes look “sunken”
• child cannot be encouraged to show interest in anything
• baby is floppy
• weak, “whining” or continuous crying in a younger child
• older child who’s confused
• not responding or very irritable
• stiff neck, especially when trying to look up and down

Sepsis signs and symptoms in older children and adults

Early symptoms of sepsis may include:

• a high temperature (fever) or low body temperature
• chills and shivering
• a fast heartbeat
• fast breathing

In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after.

These can include:

• feeling dizzy or faint
• a change in mental state – such as confusion or disorientation
• diarrhea
• nausea and vomiting
• slurred speech
• severe muscle pain
• severe breathlessness
• less urine production than normal – for example, not urinating for a day
• cold, clammy and pale or mottled skin
• loss of consciousness

When to get medical help

Seek medical advice urgently if you’ve recently had an infection or injury and you have possible early signs of sepsis.

If sepsis is suspected, you’ll usually be referred to hospital for further diagnosis and treatment.

Severe sepsis and septic shock are medical emergencies. If you think you or someone in your care has one of these conditions, go straight to the hospital’s emergency room or call your local emergency number for an ambulance.

Sepsis diagnosis

A doctor will examine the person with sepsis and will organize blood tests as well as tests of their urine. The person would also need x-rays and perhaps other scans as well.

Doctors diagnose sepsis using a number of physical findings like fever, low blood pressure, increased heart rate, and increased breathing rate. They also do lab tests that check for signs of infection and organ damage.

Tests will include:

• Taking blood cultures – to identify the type of bacteria causing sepsis
• Taking a blood sample – to assess the severity of sepsis
• Taking a urine sample. If your doctor suspects that you have a urinary tract infection, he or she may want your urine checked for signs of bacteria.
• Monitoring your urine output – to assess severity and kidney function
• Wound secretions. If you have a wound that appears infected, testing a sample of the wound’s secretions can help show what type of antibiotic might work best.
• Respiratory secretions. If you are coughing up mucus (sputum), it may be tested to determine what type of germ is causing the infection.

Many of the symptoms of sepsis, such as fever and difficulty breathing, are the same as in other conditions, making sepsis hard to diagnose in its early stages.

Imaging scans

If the site of infection is not obvious, your doctor may order one or more of the following imaging tests:

• X-ray. Using low levels of radiation, X-rays are good for visualizing problems in your lungs.
• Computerized tomography (CT). Infections in your appendix, pancreas or bowels are easier to see on CT scans. This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your body’s internal structures.
• Ultrasound. This technology uses sound waves to produce real-time images on a video monitor. Ultrasound may be particularly useful to check for infections in your gallbladder or ovaries.
• Magnetic resonance imaging (MRI). MRIs may be helpful in identifying soft tissue infections, such as abscesses within your spine. This technology uses radio waves and a strong magnet to produce cross-sectional images of your internal structures.

Sepsis treatment

Immediate treatment is important. A person with sepsis will need to be treated in hospital since it is a serious condition and can be fatal. There, they will receive antibiotics, intravenous fluids and oxygen. Other types of treatment, such as assisting breathing with a machine or kidney dialysis, may be necessary. Sometimes surgery is required to remove tissue damaged by the infection.

Antibiotics

The main treatment for sepsis, severe sepsis or septic shock is antibiotics.

If you have severe sepsis and septic shock, antibiotics will be given directly into a vein (intravenously).

Ideally, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death.

Intravenous antibiotics are usually replaced by tablets after two to four days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition.

Types of antibiotics

There won’t usually be time to wait until a specific type of infection has been identified, so broad-spectrum antibiotics are given first.

These are designed to work against a wide range of known infectious bacteria and usually cure most common infections.

Once a specific bacterium has been identified, a more focused antibiotic can be used.

Viral infections

If the sepsis is caused by a virus, antibiotics won’t work. Antibiotics are usually given anyway because it would be too dangerous to delay treatment until tests confirm the specific cause.

With a viral infection, you’ll need to wait until your immune system starts to tackle the infection, although antiviral medication may be given in some cases.

Intravenous fluids

If you have sepsis, your body needs increased amounts of fluid to prevent dehydration and kidney failure.

You’ll usually be given fluids intravenously during the first 24 to 48 hours after admission if you have severe sepsis or septic shock.

It’s important that the doctors know how much urine your kidneys are making when you have sepsis so they can spot signs of kidney failure.

If you’re admitted with severe sepsis or septic shock, you’ll usually have a catheter inserted into your bladder to monitor your urine output.

Oxygen

Your body’s oxygen demand goes up if you have sepsis.

If you’re admitted to hospital with sepsis and the level of oxygen in your blood is low, you’ll usually be given oxygen. This is either given through a mask or tubes in your nostrils.

Treating the source of infection

If a source of the infection can be identified, such as an abscess or infected wound, this will also need to be treated.

For example, any pus may need to be drained away or, in more serious cases, surgery may be needed to remove the infected tissue and repair any damage.

Increasing blood pressure

Medications called vasopressors are used if you have low blood pressure caused by sepsis.

Vasopressors are normally given intravenously while you’re in an intensive care unit (ICU). Extra fluids may also be given intravenously to help increase blood pressure.

Other treatments

You may also require additional treatments, such as:

• corticosteroids or insulin medication
• a blood transfusion
• mechanical ventilation – where a machine is used to help you breathe
• dialysis – where a machine filters your blood to copy the function of your kidneys

These treatments are mostly used in intensive care units (ICUs).

Recovering from sepsis

Some people make a full recovery fairly quickly. The amount of time it takes to fully recover from sepsis varies, depending on:

• the severity of the sepsis
• the person’s overall health
• how much time was spent in hospital
• whether treatment was needed in an intensive care unit (ICU).

Some people experience long-term physical and/or psychological problems during their recovery period, such as:

• feeling lethargic or excessively tired
• muscle weakness
• swollen limbs or joint pain
• chest pain or breathlessness

These long-term problems are known as post-sepsis syndrome. Not everyone experiences these problems.