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Definition
Septicaemia or sepsis is defined as a suspected or proven infection plus a systemic inflammatory response syndrome, characterized by fever, tachycardia (fast heartbeat), tachypnea (rapid breathing), and leukocytosis. Severe sepsis is defined as sepsis with major organ dysfunction, including hypotension (low blood pressure), hypoxemia (low blood oxygen), oliguria (low urine output) and obtundation (confusion). Septic shock is defined as severe sepsis with hypotension, despite adequate fluid resuscitation. Septic shock and multi-organ dysfunction are the most common causes of death in patients with sepsis.
Summary
- Refers to the disseminated inflammatory response elicited by microbial infections.
- Sepsis is the culmination of complex interactions between the infecting microorganism and the host, leading to immune, inflammatory, and coagulation responses.
- It can lead to low blood pressure, organ failure and death.
- It is a medical emergency that should receive immediate attention.
- Sepsis occurs more commonly in patients who are immunosuppressed, including those with HIV infection, the elderly and patients with co-morbidities like diabetes and cancer.
What is sepsis?
Sepsis is the body’s response to invasion by foreign microbial infections. These microbes can be viruses, bacteria or fungi. They gain access to the host body through the lung, abdomen, skin central nervous system or urinary tract. Sepsis is a serious condition and can progress rapidly, leading to low blood pressure, organ failure and death.
What are the symptoms?
Sepsis is identified by a systemic response consisting of at least 2 of the following in the presence of an identified microbe:
- increased heart rate (>90/min)
- increased respiratory rate(>20/min) or PaCO2 <32 mm Hg or use of mechanical ventilation
- increased temperature (>38°C) or decreased temperature(<36°C)
- increased white-cell count (>12,000/mm3) or decreased white-cell count (<4000/mm3).
Associated features include:
- loss of appetite
- mood changes: unresponsive, agitated, and lethargic
- fever and chills
- rash or hemorrhagic lesions in the skin.
What are the causes?
Sepsis is a life-threatening infection that can arise from a microbial infection, usually through a lung, abdomen or urinary tract infection, central nervous system (meningitis) or bone (osteomyelitis). The bacteria Staphylococcus aureus, Streptococcus pneumoniae and Escherichia coli are the most frequent causes of sepsis. In immunosuppressed patients, Gram negative bacteria may also be responsible.
How is a diagnosis made?
Diagnosis is confirmed by the identification of a foreign pathogen in the presence of a systemic inflammatory response syndrome, e.g., fever, tachycardia, tachypnea, and leukocytosis. This process will include a thorough medical examination coupled with appropriate diagnostic investigations. A physical exam will show signs of infection, low blood pressure and fever. Blood or urine tests can show the presence of bacteria.
How is it treated?
Sepsis is a medical emergency that should receive immediate attention from a doctor or hospital. Judicious use of appropriate broad-spectrum antibiotics will be given to fight infection before the microbe is identified. Afterwards specific antibiotics will be administered, based on the identification of the microbe.
Rapid diagnosis (within the first 6 hours) and expeditious treatment are critical, since early, goal directed therapy can be very effective. This includes fluid administration, administration of the appropriate antibiotics as soon as possible and oxygen administration.
Multiple approaches are necessary in the treatment of sepsis, including the appropriate monitoring of the acutely ill patient, preferably in a high care environment.
Prevention
Appropriate treatment of wounds and infections can prevent sepsis. Administration of vaccinations for pneumonia and influenza are highly beneficial. Early consultation with medical doctors might prevent the rapid progression of the illness, which often results in a fatal outcome.
Risk factors
Sepsis occurs more commonly in patients who are immunosuppressed, including those with HIV infection, the elderly and patients with co-morbidities like diabetes and cancer.
Reviewed by Dr H. Neethling, MBChB, M.Med (Int).
Reviewed by Dr Ismail Kalla, Full Time Senior Consultant in the Department of Pulmonology and Critical;
