Sepsis

Sepsis or septicemia is a life-threatening condition where the body starts to damage its tissues as a response to an infection. Sepsis might cause sepsis shock leading to a sudden drop in blood pressure, severe organ failure, or even death.

Other names #

Also known as Septic infection, Blood poisoning, Septic poisoning and Septicemia

Causes #

The most common cause of sepsis or septicemia is a bacterial infection. Other common causes of sepsis are fungal, viral, or parasitic infections in your body. The infection might occur anywhere in the body, but some of the common sites where infection could lead to sepsis include:

• The lungs: Lung infections such as pneumonia might lead to sepsis in some patients. Sepsis through the lungs can be fatal if not treated on time.

• The abdomen: An infection in the appendix (appendicitis), infection of the abdominal cavity (peritonitis), gallbladder infections, liver infections, or bowel problems might lead to mild or severe sepsis.

• The urinary tract: An infection in the kidneys or bladder can also lead to sepsis. This kind of blood infection occurs mostly in patients who have a urinary catheter to drain urine. Urosepsis might cause nausea, vomiting, pain in your lower spine, and abnormal white blood cell count (either too high or too low). Urosepsis can be life-threatening if not treated on time.

• The skin: Sometimes bacteria might penetrate the skin through open cuts or wounds. They can also enter through intravenous catheters when they are inserted into the body to give or drain fluids. Cellulitis, which is an inflammatory condition of the skin, can also lead to skin sepsis.

Symptoms #

Symptoms of sepsis #

• Fever above 101 F

• Increased heart rate

• A confirmed infection in the body

• Increased breathing rate of more than twenty breaths per minute

Symptoms of severe sepsis #

• Organ failure due to tissue damage

• Discolored skin or a hemorrhagic rash in the skin

• Bone marrow suppression leading to decreased platelet counts

• Difficulty in breathing

• Abnormal heart functions causing cardiomyopathy (heart disease leading to difficulty in pumping blood to the body)

• Reduced body temperature leading to chills

• Weakness and dizziness

• Confusion or disorientation

• Slurred speech

Symptoms of septic shock #

• Decreased urination

• Clammy and sweaty skin

• Respiratory failure

• Heart failure

Risk factors #

• Infancy: Infants are at high risk of developing sepsis because of infantile birth disorders.

• Old age: Older people are more susceptible to infections because of weaker immunity. Moreover, older people commonly suffer from diseases such as diabetes or lower respiratory infections, leading to sepsis.

• A weak immune system: A weak immune system, irrespective of age or gender can also lead to the development of sepsis. Cancer patients who take chemotherapy have a weakened immune system which increases their chances of developing sepsis.

• Uncontrolled diabetes: Patients who suffer from diabetes mellitus are at a high risk of developing sepsis. Infections are prone to get severe in these patients.

• Chronic kidney or liver ailments: Patients with chronic kidney disease who undergo regular dialysis are more likely to develop infections and sepsis.

• Hospitalized patients: Patients with extended hospital stays or who get admitted to the intensive care unit are prone to contracting an infection that might turn into sepsis.

• Insertion of invasive devices: Breathing tubes or intravenous catheters can potentially increase the risk for infection, including healthcare-acquired infections (HAIs), which can lead to sepsis.

Diagnosis #

Blood tests #

Blood tests are conducted to test the evidence of an infection, any blood clots, electrolyte imbalance, impaired liver or kidney function, and lower oxygen levels. These include:

• Complete blood count (CBC)

• Serum concentrations of electrolytes

• Liver function test

• Kidney function test

Lab tests #

Certain lab tests are conducted by collecting samples of urine, respiratory secretions, and wound secretions.

Imaging tests #

The following imaging tests are done to locate the exact source of the blood infection:

• X-ray: Lung infections are identified through x-rays.

• Ultrasound: Infections in the gallbladder and kidney are identified through ultrasound images. This procedure uses sound waves to create images of the organs on the monitor.

• Computerized tomography (CT): This procedure gives cross-sectional images of the body’s internal organs. It works by taking x-ray images from various angles and then combining them. It is an advanced form of testing and gives almost perfect images of liver, pancreas, and other abdominal organs to locate the source of the sepsis.

• Magnetic resonance imaging (MRI): This procedure is used to produce 3D images of the body’s internal organs. The technology uses sound waves and a magnet to produce images. MRI is used to identify sepsis in bones and soft tissues.

Treatment #

Antibiotics #

Broad-spectrum antibiotics are initially given as they are effective against a wide variety of bacteria. After conducting all the relevant blood tests, antibiotics targeting particular bacterias that are causing the infection are given. These antibiotics include:

• Ceftriaxone (Rocephin): It is used to control several life-threatening bacterial infections such as pneumonia, meningitis, and E. coli. It is also given to prevention of infection or sepsis after surgery.
• Meropenem (Merrem): It is an intravenous antibiotic used to treat sepsis arising out of intra-abdominal infections.
• Cefotaxime (Claforan): It is an intravenous antibiotic used to treat sepsis that may arise from a urinary tract infection, pneumonia, meningitis, or cellulitis.
• Ampicillin and sulbactam (Unasyn): This combination treats a wide spectrum of bacterial infections that might include skin sepsis.
• Levofloxacin (Levaquin): This antibiotic is used to treat bacterial infections in the kidney and prostate. It is also used to treat skin infections and pneumonia.

Intravenous fluids #

Intravenous fluids are administered as soon as possible to prevent severe sepsis or septic shock. Crystalloid fluids are the most commonly used intravenous solutions given to patients with sepsis and septic shock.

Vasopressors #

If the blood pressure doesn’t increase even after intravenous fluids, vasopressor medications are started. The function of vasopressors is to constrict the blood vessels to increase blood pressure. Norepinephrine and dopamine are the most preferred vasopressors used in the treatment of sepsis or septic shock.

Supportive care #

Supportive care includes oxygen, a machine to help breathe properly, and dialysis if the kidneys are adversely affected.

Surgery #

Surgery might be considered if the source of the infection is pus (abscesses), dead tissues (gangrene), or infected tissues. If there is a soft tissue abscess leading to sepsis, it should be drained as soon as possible.