Sepsis
Sepsis is a serious medical condition characterized by a systemic inflammatory response to infection, affecting all body systems. It can arise from various infections, including bacterial, viral, fungal, or parasitic sources, often beginning in areas such as the lungs, abdomen, urinary tract, and skin. The World Health Organization has highlighted the global severity of sepsis, reporting nearly fifty million cases and around eleven million deaths annually, particularly impacting vulnerable populations like young children and the elderly. Risk factors include age, pre-existing health conditions, and socioeconomic disparities, with men and marginalized groups showing higher susceptibility. Symptoms typically include fever, chills, rapid heart rate, and low blood pressure, indicating a critical need for early diagnosis and intervention. Treatment methods involve antibiotics and supportive care, yet the prognosis can vary, with survivors potentially facing long-term effects like organ dysfunction or mental health challenges. Prevention strategies emphasize hygiene, timely medical consultation, and appropriate vaccination.
Sepsis
- ANATOMY OR SYSTEM AFFECTED: All
Definition
Sepsis is a systemic inflammatory response to infection. The World Health Organization (WHO), which released its first report in 2020 on the epidemiology and global extent of sepsis, was by that point citing data indicating that nearly fifty million cases of, and around eleven million deaths from, sepsis were occurring across the world every year. While many of the cases were occurring in young children, the overall number of cases had been rising due to aging populations, higher rates of illness and medical procedures, and improved diagnostics and reporting. In the past, the term “septicemia” (or “blood poisoning”) was often used interchangeably with sepsis, but that practice has fallen out of favor because the disease description, “blood poisoning,” is considered imprecise.
Causes
Sepsis often begins when there is an infection in the body, whether bacterial, viral, fungal, or parasitic. In this situation, the body frequently has trouble delivering oxygen to all the organs and cells that need it. The lungs, abdomen, urinary tract, skin, brain, and bone are common starting points for sepsis. Sepsis can also affect the intestine, where bacteria thrive, and already-infected areas after surgery. A foreign object (such as a catheter or drainage tube) inserted into the body can also cause sepsis.
Risk Factors
Sepsis has become more common, especially among hospitalized persons. People at higher risk include older people, young children, neonatal patients, immunocompromised persons, and persons who use injectable drugs. The widespread use of antibiotics encourages the growth of drug-resistant microorganisms. There is a higher incidence of sepsis when a person is already weakened by a condition such as malnutrition, alcoholism, liver disease, diabetes, a malignant neoplasm (cancer), organ transplantation, bone marrow transplantation, or human immunodeficiency virus (HIV) infection.
Of persons with end-stage renal disease, a significant percentage will die of sepsis. Sepsis also causes high rates of mortality in persons undergoing dialysis and in renal transplant recipients. Systemic inflammatory response syndrome and acute respiratory distress syndrome are closely related to sepsis.
Men are more susceptible than women to developing sepsis. People from marginalized groups also appear to be at greater risk of developing sepsis as well. Among persons who already have sepsis, Black people are more likely to die than White people. Preliminary studies have identified socioeconomic status, educational level, genetics, the number of other chronic diseases a person has, tobacco or alcohol use, nutritional status, and when and where a patient develops sepsis (i.e., before, during, or after hospitalization) as areas for further research into what effect race has on the disease progression and mortality of people with sepsis. Similar factors may affect risk by gender as well. The WHO additionally noted regional disparities throughout the world, with higher rates of incidence and death in lower- and middle-income countries.
Symptoms
Symptoms of sepsis include shaking, chills, fever, weakness, rapid heart rate, rapid breathing, low blood pressure, decreased urine output, nausea, vomiting, and diarrhea. Sepsis can cause infections that attack crucial body systems, such as the lining of the brain, the sac around the heart, the bones, or the large joints. Sepsis can also bring about impaired intestinal function.
Sepsis can attack the endothelium, the thin layer of cells within the blood vessels, which affects circulation, the heart, and, ultimately, the organs of the body. Multiple organ failure is a common effect of sepsis. Apoptosis, also known as suicide of the cells, is closely linked to multiple organ failure and sepsis.
Screening and Diagnosis
Because sepsis is so lethal, early diagnosis is crucial. Some of the signs are a temperature above 101° or below 96° Fahrenheit, a heart rate above ninety beats per minute, or a breathing rate faster than twenty beats per minute. Additional signs include having a white blood cell count greater than 12,000 cubic millimeters or having pus-forming or other pathogenic organisms. Blood cultures are drawn to determine the source of the infection. Diagnostic tests may also be performed on wound secretions or on cerebrospinal fluid. Imaging scans may be done too.
A number of factors can complicate diagnosis. Doctors often do not see persons with sepsis until those persons are in the later stages of illness and tend to have several complex diseases. Sepsis may be one component of a larger disease process, such as systemic inflammatory response syndrome or multiple organ dysfunction syndrome.
If there is damage to vital organs, the diagnosis becomes severe sepsis. The most serious form of sepsis is septic shock, with the complication of low blood pressure (hypotension) that does not respond to standard treatment.
Treatment and Therapy
Because sepsis spreads so quickly, treatment may start before the results of blood cultures are available. More potent antibiotics are available, covering a broader spectrum, and antifungal agents may be used if the infection is thought to be fungal rather than bacterial in origin. Immunosuppressive agents may also be used. Other treatments include insulin, painkillers, sedatives, and surgery. One strategy is to attempt invasive treatment of inflammatory, infectious, and neoplastic diseases. Studies have also been conducted to determine the effects of low-dose corticosteroids given over an extended period, with mixed results in terms of benefits and harms.
Respiratory failure is treated with gas exchange and oxygen. To treat liver failure, therapy involves stimulating beta 2 receptors. For cardiac dysfunction, the patient is treated with volume therapy and vasoactive drugs. Ventilator support is used for neurological problems.
Prevention and Outcomes
The best protection against sepsis is frequent handwashing, staying current on immunizations, and seeking prompt care for infections. Skin that has redness, swelling, or pus should be examined by a doctor. In hospitals, the best prevention is identifying sepsis early and treating it with the correct antibiotic, a protocol that will help to reduce organ dysfunction. In many cases, however, sepsis strikes persons who are already vulnerable.
Those who survive sepsis or septic shock may experience temporary depression, anxiety, confusion, loss of appetite, aches and pains, fatigue, weight loss, insomnia, or shortness of breath. Most survivors of sepsis regain renal function over time; however, those with pre-existing renal problems may need ongoing dialysis. More rarely, survivors experience long-term neurocognitive impairments, struggle with insomnia, have ongoing organ dysfunction, or require amputation of a limb.
Bibliography
Angus, Derek C., and Tom van der Poll. “Sepsis and Septic Shock.” New England Journal of Medicine, vol. 369, 2013, pp. 840–51.
Baue, Arthur, et al., editors. Sepsis and Organ Dysfunction: Epidemiology and Scoring Systems: Pathophysiology and Therapy. Springer, 1998.
Bone, R. C., et al. “Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis.” Chest, vol. 101, 1992, pp. 1644–55.
Dellinger, R. Phillip, et al. “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008.” Critical Care Medicine, vol. 36, 2008, pp. 296–327.
Evans, Timothy, and Mitchell P. Fink, editors. Mechanisms of Organ Dysfunction in Critical Illness. Springer, 2002.
Makic, Mary Beth Flynn, and Lauren T. Morata, editors. Sole's Introduction to Critical Care Nursing. 9th ed., Elsevier, 2024.
Mayr, Florian B., et al. “Infection Rate and Acute Organ Dysfunction Risk as Explanations for Racial Difference in Severe Sepsis.” Journal of the American Medical Association, vol. 24, 2010, pp. 2495–503.
Sarnak, Mark J., and Bertrand L. Jaber. “Mortality Caused by Sepsis in Patients with End-Stage Renal Disease Compared with the General Population.” Kidney International, vol. 58, 2000, pp. 1758–64.
"Sepsis." National Institute of General Medical Sciences, July 2024, nigms.nih.gov/education/fact-sheets/Pages/sepsis.aspx. Accessed 18 Sept. 2024.
"Sepsis." World Health Organization, 3 May 2024, www.who.int/news-room/fact-sheets/detail/sepsis. Accessed 18 Sept. 2024.
Valley, Thomas S., and Colin R. Cooke. “The Epidemiology of Sepsis: Questioning Our Understanding of the Role of Race.” Critical Care, vol. 19, 2015, p. 347.
Zucker-Franklin, D., et al. Atlas of Blood Cells: Function and Pathology. 3rd ed., Lea & Febiger, 2003.