Video:Sepsis

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Definition

Sepsis is a life-threatening condition, that arises when the body's response to infection causes injury to its own tissues and organs.[1]

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Symptoms

Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[2]

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More specific symptoms

There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection.[3]

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Young and old

In the very young, old, and people with a weakened immune systems, there may be no symptoms of a specific infection. The body temperature can also be low or normal, rather than high.[3]

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Symptoms of severe sepsis

Severe sepsis, is sepsis that is causing poor organ function, or insufficient blood flow to the body.[4] Insufficient blood flow can manifest as either low blood pressure, high blood lactate, or low urine output.[4]

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Septic shock

Septic shock is low blood pressure due to sepsis, that does not improve after fluid replacement.[4]

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Causes

Sepsis is caused by an inflammatory immune response, triggered by an infection.[3][5]

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Microbiology

Most commonly, the infection is bacterial, but it may also be fungal, viral, or protozoan.[3] Common locations for the primary infection include the lungs, brain, urinary tract, skin, and abdominal organs.[3]

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Risk factors

Risk factors include very young age, older age, and a weakened immune system from conditions such as cancer, diabetes, major trauma, or burns.[2]

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Diagnosis

An older method of diagnosis was based on the patient meeting at least two criteria from the systemic inflammatory response syndrome (called SIRS), because of a presumed infection.[3]

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Modern diagnosis

In 2016, SIRS was replaced with a shortened sequential organ failure assessment score (called the SOFA score). With the quick SOFA, if the patient has any two of, increased breathing rate, change in their level of consciousness, or low blood pressure, then they meet the criteria.[1]

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Blood cultures

Blood cultures are recommended, preferably, before antibiotics are started, however, proof of infection in the blood is not required for the diagnosis.[3]

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Medical imaging

Medical imaging should be used to look for the possible location of infection.[4]

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Differential diagnosis

Other potential causes of similar signs and symptoms include, anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism.[3]

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Treatment

Sepsis is usually treated with intravenous fluids, and antibiotics.[2][6]

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Antibiotics

Typically, antibiotics are given as soon as possible,[2] with high level care such as in an intensive care unit.[2]

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Fluid replacement and blood pressure

If fluid replacement is not enough to maintain blood pressure, medications that raise blood pressure may be used.[2] Mechanical ventilation and dialysis may be needed, to support the function of the lungs and kidneys.[2]

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Monitoring blood pressure

To guide treatment, a central venous catheter, and an arterial catheter may be placed for access to the bloodstream.[4] Other measurements such as cardiac output, and superior vena cava oxygen saturation may be used.[4]

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Risks of sepsis

People with sepsis need preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent such interventions.[4] Some might benefit from tight control of blood sugar levels with insulin.[4]

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Steroid use

The use of corticosteroids is controversial.[7] Although, a 2015 Cochrane review found low-quality evidence of benefit,[8] as did a 2019 review in JAMA.[9]

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Prognosis

Disease severity partly determines the outcome.[10] 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%.[10]

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Epidemiology

Millions are affected by sepsis each year, with a rate of 0.2-3 people per thousand, per year in the developed world[10][11]. But the global burden of disease is unknown since little data exists from the developing world[10].

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Change in rate of disease

It is believed that rates of disease have been increasing[4], and that sepsis is more common among males than females.[3]

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History

The medical condition has been described since the time of Hippocrates.[12] The terms "septicemia" and "blood poisoning" have been used in various ways, and are no longer recommended.[12][13]

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References

  1. 1.0 1.1 Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. (February 2016). "The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 315 (8): 801–10. doi:10.1001/jama.2016.0287. PMC 4968574. PMID 26903338.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 "Sepsis Questions and Answers". cdc.gov. Centers for Disease Control and Prevention (CDC). 22 May 2014. Archived from the original on 4 December 2014. Retrieved 28 November 2014.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Jui, Jonathan; et al. (American College of Emergency Physicians) (2011). "Ch. 146: Septic Shock". In Tintinalli, Judith E.; Stapczynski, J. Stephan; Ma, O. John; Cline, David M.; Cydulka, Rita K.; Meckler, Garth D. (eds.). Tintinalli's Emergency Medicine: A Comprehensive Study Guide (7th ed.). New York: McGraw-Hill. pp. 1003–14. Archived from the original on 15 January 2014. Retrieved 11 December 2012 – via AccessMedicine.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. (February 2013). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012" (PDF). Critical Care Medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. PMID 23353941. Archived from the original (PDF) on 2 February 2015.
  5. Deutschman CS, Tracey KJ (April 2014). "Sepsis: current dogma and new perspectives". Immunity. 40 (4): 463–75. doi:10.1016/j.immuni.2014.04.001. PMID 24745331.
  6. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. (March 2017). "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016". Intensive Care Medicine. 43 (3): 304–377. doi:10.1097/CCM.0000000000002255. PMID 28101605.open access
  7. Patel GP, Balk RA (January 2012). "Systemic steroids in severe sepsis and septic shock". American Journal of Respiratory and Critical Care Medicine. 185 (2): 133–9. doi:10.1164/rccm.201011-1897CI. PMID 21680949.
  8. Annane D, Bellissant E, Bollaert PE, Briegel J, Keh D, Kupfer Y (December 2015). "Corticosteroids for treating sepsis". The Cochrane Database of Systematic Reviews. 12 (12): CD002243. doi:10.1002/14651858.CD002243.pub3. PMID 26633262.
  9. Fang, F; Zhang, Y; Tang, J; Lunsford, LD; Li, T; Tang, R; He, J; Xu, P; Faramand, A; Xu, J; You, C (21 December 2018). "Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis". JAMA Internal Medicine. 179 (2): 213–223. doi:10.1001/jamainternmed.2018.5849. PMID 30575845.
  10. 10.0 10.1 10.2 10.3 Jawad I, Lukšić I, Rafnsson SB (June 2012). "Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality". Journal of Global Health. 2 (1): 010404. doi:10.7189/jogh.01.010404. PMC 3484761. PMID 23198133.
  11. Martin GS (June 2012). "Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes". Expert Review of Anti-Infective Therapy. 10 (6): 701–6. doi:10.1586/eri.12.50. PMC 3488423. PMID 22734959.
  12. 12.0 12.1 Angus DC, van der Poll T (August 2013). "Severe sepsis and septic shock". The New England Journal of Medicine. 369 (9): 840–51. doi:10.1056/NEJMra1208623. PMID 23984731. Lay summary (30 August 2013). Cite uses deprecated parameter |layurl= (help)
  13. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. (June 1992). "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine". Chest. 101 (6): 1644–55. doi:10.1378/chest.101.6.1644. PMID 1303622. Septicemia... has been used... in a variety of ways... We therefore suggest that this term be eliminated from current usage.