Sepsis

An Overview

Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death. Almost any type of infection can lead to sepsis. Infections that lead to sepsis most often start in the lung, urinary tract, skin or gastrointestinal tract.
Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have in your skin, lungs, urinary tract, or somewhere else triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure and death.

Sepsis develops when the chemicals the immune system releases into the bloodstream to fight an infection cause inflammation throughout the entire body instead. Severe cases of sepsis can lead to septic shock, which is a medical emergency. There are more than 1.5 million cases of sepsis each year.

Signs and symptoms of sepsis

To be diagnosed with sepsis, you must have a probable or confirmed infection and all of the following signs:
• Change in mental status
• Systolic blood pressure — the first number in a blood pressure reading — less than or equal to 100 millimeters of mercury (mm Hg)
• Respiratory rate higher than or equal to 22 breaths a minute.
• A fever, chills, and shivering
• A rapid pulse also known as tachycardia
• Difficulty breathing
• Clammy or sweaty skin
• Extreme pain or discomfort
• Redness and swelling around a wound
• Confusion, reduced alertness, and other changes in the person’s mental state
• A feeling of doom or sudden fear of death
• Slurred speech
• Diarrhea, nausea, or vomiting
• Severe pain and extreme general discomfort
• Shortness of breath
• Loss of consciousness

Septic shock is a severe drop in blood pressure that results in highly abnormal problems with how cells work and produce energy. Progression to septic shock increases the risk of death. Signs of progression to septic shock include:
• The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
• High levels of lactic acid in your blood (serum lactate). Having too much lactic acid in your blood means that your cells aren’t using oxygen properly.

Causes of sepsis

• bacterial infections
• fungal infections
• viral infections, including COVID-19
• Lungs, such as pneumonia
• Kidney, bladder and other parts of the urinary system
• Digestive system
• Bloodstream (bacteremia)
• Catheter sites
• Wounds or burns
• The pathogen may enter the body through a wound or during or after surgery.

Diagnosis

Blood tests
Blood samples are used to test for:
• Evidence of infection
• Clotting problems
• Abnormal liver or kidney function
• Impaired oxygen availability
• Electrolyte imbalances
Other lab tests
Other lab tests to identify the source of the infection might include samples of:
• Urine
• Wound secretions
• Respiratory secretions
Imaging tests
If the site of infection is not readily found, your doctor may order one or more of the following imaging tests:
• X-ray. X-rays can identify infections in your lungs.
• Ultrasound. This technology uses sound waves to produce real-time images on a video monitor. Ultrasound may be particularly useful to check for infections in your gallbladder and kidneys.
• Computerized tomography (CT). This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your body’s internal structures. Infections in your liver, pancreas or other abdominal organs are easier to see on CT scans.
• Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet to produce cross-sectional or 3D images of the internal structures of your body. MRIs may be helpful in identifying soft tissue or bone infections.

Treatments

• Antibiotics. Treatment with antibiotics begins as soon as possible. Broad-spectrum antibiotics, which are effective against a variety of bacteria, are usually used first. After learning the results of blood tests, your doctor may switch to a different antibiotic that’s targeted to fight the particular bacteria causing the infection.
• Intravenous fluids. The use of intravenous fluids begins as soon as possible.
• Vasopressors. If your blood pressure remains too low even after receiving intravenous fluids, you may be given a vasopressor medication. This drug constricts blood vessels and helps increase blood pressure.
A doctor will provide rapid treatment for sepsis, including:
• reating the cause of the infection
• administering antibiotics, if the infection is bacterial
• providing oxygen and intravenous fluids to ensure blood flow to the organs
• providing a means of assisted breathing, if appropriate
• scheduling surgery, if necessary, to remove damaged tissue
Sepsis often requires treatment in a hospital, and some people need intensive care.
Older people, in particular, may also need treatment to:
• prevent pressure ulcers
• prevent deep vein thrombosis
• control glucose levels
Some severe cases of sepsis or septic shock do not respond to all disease-directed therapies. In these instances, healthcare professionals may need to provide end-of-life care.
Sepsis in newborns
Sepsis can develop within 24 hours of birth, and in newborns, the issue is called neonatal sepsis. A baby is considered a neonate up to 90 days after delivery.
There is a higher risk of neonatal sepsis if:
• The person had a group B streptococcal infection during pregnancy.
• Delivery is preterm.
• The water breaks more than 24 hours before delivery.
Late-onset neonatal sepsis starts 24 hours or more after delivery. It can stem from a bacterial, viral, or fungal infection.
There is a higher risk of late-onset sepsis if the infant spends time in the hospital to receive treatment for another problem or comes into contact with someone who has an infection.
Signs and symptoms of neonatal sepsis include:
• changes in body temperature
• breathing problems
• diarrhea and vomiting
• a swollen abdomen
• low blood sugar
• jaundice
• a slow heart rate

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