Sepsis

Overview

Sepsis is a serious condition in which the body responds improperly to an infection. The infection-fighting processes turn on the body, causing the organs to work poorly.

Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can damage the lungs, kidneys, liver and other organs. When the damage is severe, it can lead to death.

Early treatment of sepsis improves chances for survival.

Symptoms

Symptoms of sepsis

Symptoms of sepsis may include:

• Change in mental status.
• Fast, shallow breathing.
• Sweating for no clear reason.
• Feeling lightheaded.
• Shivering.
• Symptoms specific to the type of infection, such as painful urination from a urinary tract infection or worsening cough from pneumonia.

Symptoms of sepsis are not specific. They can vary from person to person, and sepsis may appear differently in children than in adults.

Symptoms of septic shock

Sepsis may progress to septic shock. Septic shock is a severe drop in blood pressure. Progression to septic shock raises the risk of death. Symptoms of septic shock include:

• Not being able to stand up.
• Strong sleepiness or hard time staying awake.
• Major change in mental status, such as extreme confusion.

When to see a doctor

Any infection could lead to sepsis. Go to a health care provider if you have symptoms of sepsis or an infection or wound that isn't getting better.

Symptoms such as confusion or fast breathing need emergency care.

Causes

Any type of infection can lead to sepsis. This includes bacterial, viral or fungal infections. Those that more commonly cause sepsis include infections of:

• Lungs, such as pneumonia.
• Kidney, bladder and other parts of the urinary system.
• Digestive system.
• Bloodstream.
• Catheter sites.
• Wounds or burns.

Risk factors

Some factors that increase the risk infection will lead to sepsis include:

• People over age 65.
• Infancy.
• People with lower immune response, such as those being treated for cancer or people with HIV.
• People with chronic diseases, such as diabetes, kidney disease or COPD.
• Admission to intensive care unit or longer hospital stays.
• Devices that go in the body, such as catheters in the vein, called intravenous, or breathing tubes.
• Treatment with antibiotics in the last 90 days.
• A condition that requires treatment with corticosteroids, which can lower immune response.

Complications

As sepsis worsens, vital organs, such as the brain, heart and kidneys, don't get as much blood as they should. Sepsis may cause atypical blood clotting. The resulting small clots or burst blood vessels may damage or destroy tissues.

Most people recover from mild sepsis, but the mortality rate for septic shock is about 30% to 40%. Also, an episode of severe sepsis raises the risk for future infections.

Diagnosis

Doctors often order several tests to try to pinpoint underlying infection.

Blood tests

Blood samples are used to test for:

• Evidence of infection.
• Blood-clotting problems.
• Abnormal liver or kidney function.
• Lower levels of oxygen than the body needs.
• Electrolyte imbalances.

Other lab tests

Other lab tests to find the source of the infection might include samples of:

• Urine.
• Liquid from the wound.
• Mucus and saliva from the respiratory tract.

Imaging tests

If the site of infection is not readily found, your health care provider may order more tests. Some examples of imaging tests are:

• X-ray. X-rays can show infections in your lungs.
• Ultrasound. This machine uses sound waves to produce real-time images on a video screen. Ultrasound can show infections in the gallbladder and kidneys.
• Computerized tomography (CT). This machine takes X-rays from a variety of angles and combines them to show cross-sectional slices of the inside of the body. Infections in the liver, pancreas or other abdominal organs are easier to see on CT scans.
• Magnetic resonance imaging (MRI). This machine uses radio waves and a strong magnet to produce cross-sectional or 3D images. It may be helpful in seeing soft tissue or bone infections.

Treatment

Early, thorough treatment raises the likelihood of recovery. People who have sepsis need close monitoring and treatment in a hospital intensive care unit. This is because people with sepsis may need lifesaving measures to stabilize breathing and heart action.

Medications

Different medications are used in treating sepsis and septic shock. They include:

• Antibiotics. Treatment with antibiotics begins as soon as possible. Broad-spectrum antibiotics, which are effective against a variety of bacteria, are often used first. When blood tests results show which germ is causing the infection, the first antibiotic may get switched out for a second one. This second one targets the germ causing the infection.
• Fluids added to veins. The use of intravenous fluids begins as soon as possible.
• Vasopressors. Vasopressors narrow blood vessels and help increase blood pressure. A vasopressor medication may be used if blood pressure is too low even after receiving fluids.

Other medications may be used, such as insulin for blood sugar levels, or painkillers.

Supportive care

People who have sepsis often get supportive care that includes oxygen. Some people may need a machine help them breathe. If a person's kidneys don't work as well because of the infection, the person may need dialysis.

Surgery

Surgery may help to remove sources of infection, such as pus, infected tissues or dead tissues.