Sepsis

Definition

Sepsis is an illness in which the body has a severe response to bacteria or other germs.

This response may be called systemic inflammatory response syndrome (SIRS).

Causes

The symptoms of sepsis are not caused by the germs themselves. Instead, chemicals the body releases cause the response.

A bacterial infection anywhere in the body may set off the response that leads to sepsis. Common places where an infection might start include:

• The bloodstream
• The bones (common in children)
• The bowel (usually seen with peritonitis)
• The kidneys (upper urinary tract infection or pyelonephritis)
• The lining of the brain (meningitis)
• The liver or gallbladder
• The lungs (bacterial pneumonia)
• The skin (cellulitis)

For patients in the hospital, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as bedsores (decubitus ulcers).

Symptoms

In sepsis, blood pressure drops, resulting in shock. Major organs and body systems, including the kidneys, liver, lungs, and central nervous system, stop working properly because of poor blood flow.

A change in mental status and very fast breathing may be the earliest signs of sepsis.

In general, symptoms of sepsis can include:

• Chills
• Confusion or delirium
• Fever or low body temperature (hypothermia)
• Light-headedness due to low blood pressure
• Rapid heartbeat
• Shaking
• Skin rash
• Warm skin

Bruising or bleeding may also occur.

Exams and Tests

A person with sepsis will look very sick.

The infection is often confirmed by a blood test. However, a blood test may not reveal infection in people who have been receiving antibiotics. Some infections that can cause sepsis cannot be diagnosed by blood tests.

Other tests that may be done include:

• Blood differential
• Blood gases
• Kidney function tests
• Platelet count and fibrin degradation products, to check for bleeding risk
• White blood cell count  

Treatment

If you have sepsis, you will be admitted to a hospital, usually in the intensive care unit (ICU). Antibiotics are usually given through a vein (intravenously).

Oxygen and large amounts of fluids are given through a vein. Other medical treatments include:

• Medications that increase blood pressure
• Dialysis if there is kidney failure
• A breathing machine (mechanical ventilation) if there is lung failure

Outlook (Prognosis)

Sepsis is often life threatening, especially in people with a weakened immune system or a long-term (chronic) illness.

Damage caused by a drop in blood flow to vital organs such as the brain, heart, and kidneys may take time to improve. There may be long-term problems with these organs.

Not all patients survive an episode of sepsis.

Prevention

The risk of sepsis can be reduced by following the recommended immunization schedule.

In the hospital, careful hand washing and proper care of urinary catheters and IV lines can help prevent infections that lead to sepsis.

References

Russell JA. Shock syndromes related to sepsis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 108.

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