Sepsis is a life-threatening condition that arises when the body's response to an infection causes injury to its own tissues and organs. Your body’s defence (the immune system), protects you from many illnesses and infections, but it’s also possible for it to go into overdrive in response to an infection.
Sepsis develops when the chemicals the immune system releases into the bloodstream to fight an infection cause inflammation throughout the entire body instead. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail. Severe cases of sepsis can lead to septic shock, which is a medical emergency.
If sepsis progresses to septic shock, blood pressure drops dramatically, and may lead to death.
Anyone can develop sepsis, but it's most common and most dangerous in older adults or those with weakened immune systems. Sepsis is also more common among males than females.
Blood poisoning is a nonspecific term used mainly by nonmedical individuals that usually refers to the medical condition known as sepsis. Blood poisoning is not a medical term and does not appear in many medical dictionaries or scientific publications. However, when it is used by laypersons, the correct medical term that most closely matches its intended meaning is sepsis. Many medical authors consider the terms blood poisoning and sepsis to be interchangeable, but the trend in the medical literature is to use the precise term sepsis.
Sepsis itself is not considered to be contagious. Sepsis spreads within a person’s body from the original source of infection to other organs through the bloodstream.
What Causes Sepsis?
Sepsis is caused by an immune response triggered by an infection. Most commonly, the infection is bacterial, but it may also be from fungi, viruses, or parasites. Common locations for the primary infection include lungs, brain, urinary tract, skin, bloodstream and abdominal organs.
Although some people have a higher risk of infection, anyone can get sepsis. People who are at risk include those who:
Are very old, sometimes from 65 or older
Are very young, mostly children younger than one
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
Have severe trauma
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.
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 occurs when you have one or more of the following signs, which indicate an organ may be failing:
Significantly decreased urine output
Abrupt change in mental status
Decrease in platelet count
Patches of discoloured skin
Abnormal heart pumping function
Chills due to fall in body temperature
Symptoms of septic shock include the symptoms of severe sepsis, plus extremely low blood pressure that doesn't adequately respond to simple fluid replacement.
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 over 50 percent. Also, an episode of severe sepsis may place one at higher risk of future infections.
When to see a doctor
Most often sepsis occurs in people who are hospitalized. People in the intensive care unit are especially vulnerable to developing infections, which can then lead to sepsis. If you get an infection or you develop signs and symptoms of sepsis after surgery, hospitalization or an infection, seek medical care immediately.
How is Sepsis Diagnosed?
Sepsis is often diagnosed based on simple measurements such as your temperature, heart rate and breathing rate.
You may need to give a blood test, since diagnosing sepsis can sometimes be difficult because its signs and symptoms can be caused by other disorders.
Depending on your symptoms and the results of your blood test, your doctor may order other tests, including:
a urine test (to check for bacteria in your urine)
a wound secretion test (to check an open wound for an infection)
a mucus secretion test (to identify germs responsible for an infection)
If your doctor can’t determine the source of an infection using the above tests, your doctor may order an internal view of your body using one of the following:
X-rays to view the lungs
computed tomography (CT) scans to view possible infections in the appendix, pancreas, or bowel area
ultrasounds to view infections in the gallbladder or ovaries
magnetic resonance imaging (MRI), which can identify soft tissue infections
Sepsis can quickly progress to septic shock and death if it is left untreated. Early, aggressive treatment boosts your chances of surviving sepsis. People with severe sepsis require close monitoring and treatment in a hospital intensive care unit. If you have severe sepsis or septic shock, lifesaving measures may be needed to stabilize breathing and heart function.
A number of medications are used in treating sepsis. They include:
Antibiotics. Treatment with antibiotics should begin immediately, within the first six hours or earlier. Initially you'll receive broad-spectrum antibiotics, which are effective against a variety of bacteria. The antibiotics are administered intravenously (IV).
After learning the results of blood tests, your doctor may switch to a different antibiotic that's more appropriate against the particular bacteria causing the infection.
Vasopressors. If your blood pressure remains too low even after receiving intravenous fluids, you may be given a vasopressor medication, which constricts blood vessels and helps to increase blood pressure.
Other medications you may receive include low doses of corticosteroids, insulin to help maintain stable blood sugar levels, drugs that modify the immune system responses, and painkillers or sedatives.
People with severe sepsis usually receive supportive care including oxygen and large amounts of intravenous fluids. Depending on your condition, you may need to have a machine help you breathe or another to provide dialysis for kidney failure.
Surgery may be needed to remove sources of infection, such as collections of pus (abscesses).
Neonatal Sepsis (Sepsis Associated with Newborns)
Neonatal sepsis is when your baby gets a blood infection within the first month of life. Neonatal sepsis is classified based on the timing of the infection, according to whether the infection was contracted during the birth process (early onset) or after birth (late onset). This helps the doctor decide what kind of treatment to administer. Low birth weight and premature babies are more susceptible to late onset sepsis because their immune systems are immature.
Neonatal sepsis is one of the leading causes, if not a leading cause currently of infant death. But with early diagnosis and treatment, the baby will recover completely and have no other problems. With maternal universal screening and proper neonatal testing the risk of neonatal sepsis has decreased significantly.
Seniors and Sepsis
Since our immune system weakens as we age, seniors can be at risk for sepsis. In a 2006 study, people over the age of 65 made up nearly 70 percent of sepsis cases. In addition, chronic illness, such as diabetes, kidney disease, cancer, high blood pressure, and HIV are commonly found with those who have sepsis. The most common types of infections to cause sepsis in seniors are respiratory like pneumonia or genitourinary like a urinary tract infection. Other infections can come with infected skin due to pressure sores or skin tearing. While these infections might not be noticed for a while, confusion or disorientation is a common symptom to look for when identifying an infection in seniors.
Your recovery from sepsis depends on the severity of your condition and any pre-existing conditions you might have. Many people who survive will recover completely. However, others will report lasting effects. The UK Sepsis Trust says it can take up to 18 months before survivors start to feel like their normal self. The Sepsis Alliance says that around 50 percent of sepsis survivors deal with post-sepsis syndrome (PSS). The alliance says this condition includes long-term effects such as:
disabling muscle and joint pains
lowered cognitive functioning
Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, from severe sepsis as high as 50%, and from septic shock as high as 80%. The number of cases worldwide is unknown as there is little data from the developing world. Estimates suggest sepsis affects millions of people a year. In the developed world approximately 0.2 to 3 people per 1000 are affected by sepsis yearly. Rates of disease have been increasing. The elderly have the worst prognosis.
One can reduce his/her risk of developing sepsis, by doing things that prevent the spread of infection. These include:
Staying up to date on your vaccinations.
Practicing good hygiene. This means practicing proper wound care, hand washing, and bathing regularly.
Getting immediate care if you develop signs of infection. Every minute counts when it comes to sepsis treatment. The sooner you get treatment, the better the outcome.