Sepsis: Everything You Need to Know

. Chapters 0:00 Introduction 0:45 Symptoms of Sepsis 2:10 Causes of Sepsis 3:02 Diagnosis of Sepsis 3:24 Treatment of Sepsis Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs.[4] This initial stage is followed by suppression of the immune system.[8] Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[1] There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection.[2] The very young, old, and people with a weakened immune system may have no symptoms of a specific infection, and the body temperature may be low or normal instead of having a fever.[2] Severe sepsis causes poor organ function or blood flow.[9] The presence of low blood pressure, high blood lactate, or low urine output may suggest poor blood flow.[9] Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement.[9] Sepsis is caused by many organisms including bacteria, viruses and fungi.[10] Common locations for the primary infection include the lungs, brain, urinary tract, skin, and abdominal organs.[2] Risk factors include being very young or old, a weakened immune system from conditions such as cancer or diabetes, major trauma, and burns.[1] Previously, a sepsis diagnosis required the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in the setting of presumed infection.[2] In 2016, a shortened sequential organ failure assessment score (SOFA score), known as the quick SOFA score (qSOFA), replaced the SIRS system of diagnosis.[4] qSOFA criteria for sepsis include at least two of the following three: increased breathing rate, change in the level of consciousness, and low blood pressure.[4] Sepsis guidelines recommend obtaining blood cultures before starting antibiotics; however, the diagnosis does not require the blood to be infected.[2] Medical imaging is helpful when looking for the possible location of the infection.[9] Other potential causes of similar signs and symptoms include anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism.[2] Sepsis requires immediate treatment with intravenous fluids and antimicrobials.[1][5] Ongoing care often continues in an intensive care unit.[1] If an adequate trial of fluid replacement is not enough to maintain blood pressure, then the use of medications that raise blood pressure becomes necessary.[1] Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively.[1] A central venous catheter and an arterial catheter may be placed for access to the bloodstream and to guide treatment.[9] Other helpful measurements include cardiac output and superior vena cava oxygen saturation.[9] People with sepsis need preventive measures for deep vein thrombosis, stress ulcers, and pressure ulcers unless other conditions prevent such interventions.[9] Some people might benefit from tight control of blood sugar levels with insulin.[9] The use of corticosteroids is controversial, with some reviews finding benefit,[11][12] and others not.[13] Disease severity partly determines the outcome.[6] The risk of death from sepsis is as high as 30%, while for severe sepsis it is as high as 50%, and septic shock 80%.[6] Sepsis affected about 49 million people in 2017, with 11 million deaths (1 in 5 deaths worldwide).[14] In the developed world, approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about a million cases per year in the United States.[6][7] Rates of disease have been increasing.[9] Sepsis is more common among males than females.[2] However, other data show a greater prevalence of the disease among women.[15] Descriptions of sepsis date back to the time of Hippocrates.[16] The terms “septicemia“ and “blood poisoning“ have been used in various ways and are no longer recommended.[16][17]