SEPSIS

Sepsis (Blood Infection)

 Sepsis Overview
 Sepsis Causes
 Sepsis Symptoms
 When to Seek Medical Care
 Exams and Tests
 Sepsis Treatment
 Self-Care at Home
 Medical Treatment
 Next Steps
 Outlook
 Pictures of Sepsis
 Synonyms and Keywords
 Authors and Editors

Sepsis Overview

Sepsis is a condition in which the body is fighting a severe infection that has spread via the
bloodstream. If a patient becomes "septic," they will likely be in a state of low blood pressure termed
"shock." This condition can develop either as a result of the body's own defense system or from toxic
substances made by the infecting agent (such as a bacteria,virus, or fungus).

People at risk for sepsis

 People whose immune systems (the body's defense against microbes) are not functioning well
because of an illness (such as cancer or AIDS) or because of medical treatments (such
as chemotherapy for cancer or steroids for a number of medical conditions) that weaken
the immune system are more prone to develop sepsis. It is important to remember that even
healthy people can suffer from sepsis.

 Because their immune systems are not completely developed, very young babies may get
sepsis if they become infected and are not treated in a timely manner. Often, if they develop
signs of an infection such as fever, infants have to receiveantibiotics and be admitted to the
hospital. Sepsis in the very young is often more difficult to diagnose because the typical signs
of sepsis (fever, change in behavior) may not be present or may be more difficult to ascertain.
 The elderly population, especially those with other medical illnesses such asdiabetes, may be
at increased risk as well.

The number of people dying from sepsis has almost doubled in the past 20 years. This is most likely due
to the increased number of patients who suffer from sepsis.

 There has been a large increase in sepsis because doctors have started treating cancer
patients and organ transplant patients, among others, with strong medications that weaken the
immune system.

 Also, because of our aging population, the number of elderly people with weak immune
systems has grown.
 Finally, because of the increased and often inappropriate use of antibiotics to treat illnesses
caused by viruses and not bacteria, many strains of bacteria have become resistant to
antibiotics, making the treatment of sepsis more difficult in some cases.
Sepsis Causes

Many different microbes can cause sepsis. Although bacteria are most commonly the cause, viruses
and fungi can also cause sepsis. Infections in the lungs (pneumonia), bladder and kidneys (urinary tract
infections), skin (cellulitis), abdomen (such as appendicitis), and other organs (such as meningitis) can
spread and lead to sepsis. Infections that develop after surgery can also lead to sepsis.

Who is at risk for sepsis?

 Very young people and elderly people

 Anyone who is taking immunosuppressive medications (such as transplant recipients ).

 People who are being treated with chemotherapy drugs or radiation
 Patients who have no spleen
 Patients taking steroids (especially over the long-term)
 People with long-standing diabetes, AIDS, or cirrhosis
 Someone who has very large burns or severe injuries
 People with infections such as the following:
o Pneumonia
o Meningitis
o Cellulitis
o Urinary tract infection
o Ruptured appendix

Sepsis Symptoms

 If a patient has sepsis, they often will have fever. Sometimes, though, the body temperature
may be normal or even low.

 The patient may also have chills and severe shaking.

 The patient's heart may be beating very fast and breathing rapidly.

 Confusion, disorientation, and agitation may be seen as well as dizziness and decreased
urination.

 Some patients who have sepsis develop arash on their skin. The rash may be a reddish
discoloration or small dark red dots throughout the body.

 You may also develop pain in the joints at your wrists, elbows, back, hips, knees, and ankles.

When to Seek Medical Care

When to call the doctor

A person should call the doctor if they, or a loved one has signs and symptoms of sepsis. If any of the
following are true about the patient's medical history they need to be especially vigilant regarding
possible sepsis symptoms if the patient:

 is being treated with chemotherapy or radiation;

 has had an organ transplant;

 has diabetes;

 has AIDS; or
  is are concerned that the patient may have sepsis and develops fever or chills or any other
signs and symptoms.

When to go to the hospital

 If a child younger than 60 days has fever, lethargy, poor feeding, a change in normal behavior,
or an unusual rash, call the doctor and proceed to the hospital.

 If you have a family member with confusion, dizziness, fast heartbeat, fast breathing, fever,
chills, rash, or dizziness, call your doctor immediately or go to the hospital's emergency
department.

When to Seek Medical Care

When to call the doctor

A person should call the doctor if they, or a loved one has signs and symptoms of sepsis. If any of the
following are true about the patient's medical history they need to be especially vigilant regarding
possible sepsis symptoms if the patient:

 is being treated with chemotherapy or radiation;

 has had an organ transplant;

 has diabetes;

 has AIDS; or

 is are concerned that the patient may have sepsis and develops fever or chills or any other
signs and symptoms.

When to go to the hospital

 If a child younger than 60 days has fever, lethargy, poor feeding, a change in normal behavior,
or an unusual rash, call the doctor and proceed to the hospital.

 If you have a family member with confusion, dizziness, fast heartbeat, fast breathing, fever,
chills, rash, or dizziness, call your doctor immediately or go to the hospital's emergency
department.

Exams and Tests

In the hospital, the doctor may conduct various tests.

 Blood work may be done by inserting a needle into a vein in the patient's hand or arm and
drawing blood into several tubes. This blood may be analyzed to see if the patient has an
elevation in the white blood cells.

 Blood may also be sent to the lab to be placed on a medium where bacteria will grow if they
are present in the blood. This is called a blood culture. Results from this test usually take over
24 hours. Lab technicians may also look for bacteria in the blood under the microscope on
slides.

 Samples may be taken of sputum(mucus), urine, spinal fluid, or abscesscontents to look for the
presence of infectious organisms.
o To obtain clean urine and to measure the amount of urine the patient produces, a
flexible rubber tube may be placed in their bladder (catheter).
 o Spinal fluid may be obtained from the lower back (spinal tap). After the skin is cleaned
and numbed, a hollow needle is placed between the bones of the spine into the canal
containing the spinal cord. Because the needle is placed lower than where the cord
ends, there is little danger of injuring the nerves of the spinal cord. Sometimes the
patient may experience electrical sensations or jolts in their legs during this test
because the needle tickles the nerves as it goes in, but these sensations go away in a
matter minutes in most cases. When the needle is in the correct spot, the doctor will
let the fluid drip into tubes. These tubes are sent to the lab for testing.
o Other tests may include a chest x-ray to look for pneumonia or a CT scan to see if
there is infection in the abdomen.
 A dye might be injected into the patient's vein during a CT scan to help
highlight certain organs in the abdomen. During the injection of this dye, the
patient may feel a flushing or hot sensation or even become nauseated, but
again this feeling will last a very short time.
 The CT scan is a series of x-rays taken from different angles very quickly
and put together by the computer to show an image of the internal organs.
 Usually, a radiologist reads the results and notifies the patient's doctor.
o In the hospital, the patient may be placed on a cardiac monitor, which will show the
patient's heart rate and rhythm.
 If the patient is an young child that is ill, and being evaluated for sepsis, he or she will get
similar tests and treatment.

Sepsis Treatment

Self-Care at Home

Sepsis is a medical emergency. If a person has sepsis, treatment is usually given in the hospital and
often in an intensive care unit.

Medical Treatment

 The patient will likely be placed on oxygen, either by a tube that is placed near the nose or
through a clear plastic mask.

 Depending on the results of the tests, the doctor may order medications. These medications
may include antibiotics given by IV. Initially the antibiotics may be those that kill many different
bacteria because the exact kind of infection the patient has is not known. Once the blood
culture results show the identity of the bacteria, your doctor may select a different antibiotic that
kills the specific microbe.

 The doctor may also order IV salt solution (saline) and medications to increase the
patient's blood pressure if it is too low.

 The doctor will likely admit the patient to the hospital at least until the blood culture results are
known. If the patient is very ill with blood pressure, the doctor may admit the patient to the
intensive care unit (ICU) and may consult other doctors to help in the management of the
patient's illness.

 If results show an infection in the abdomen, either drainage of the infection by tubes or surgery
may be necessary.

 Research to discover new treatments for sepsis has failed over the past 20-30 years. Many
medications that were thought to be helpful were proven to have no benefit in clinical trials.
However, scientists are working diligently to discover medications that will modify the body's
aggressive immune response to microbes, which leads to sepsis.
Next Steps

Outlook

The prognosis depends on age, previous health history, how quickly the diagnosis is made and the
organism causing the sepsis.

 For elderly people with many illnesses or for those whose immune system is not working well
because of illness or certain medications and sepsis is advanced, the death rate may be as
high as 80%.

 On the other hand, for healthy people with no prior illness, the death rate may be low, at
around 5%.

 The overall death rate from sepsis is approximately 40%. It is important to remember that the
prognosis also depends on any delay in diagnosis and treatment. The earlier the treatment is
started, the better the outcome will be.

Pictures of Sepsis

Picture 1: Cellulitis, an infection of the skin, may lead to sepsis, particularly in elderly people and those
with diabetes or other illnesses that alter the immune system.

Media type: Photo

Picture 2: This rash, called petechia and purpuramay be a sign of bacteria in the bloodstream
(bacteremia).

Media type: Photo

Synonyms and Keywords

severe bacteremia, septicemia, septic shock, shock, low blood pressure, blood infection, severe
infection, septic, immune system, sepsis

Authors and Editors

Author: Jerry R. Balentine, DO, FACEP

Editor: Melissa Conrad Stoppler, MD

Previous contributing Authors and Editors:

Author: Selim Suner, MD, MS, Assistant Professor, Department of Surgery, Section of Emergency
Medicine, Brown Medical School.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency
Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor,
eMedicine; Thomas Rebbecchi, MD, FAAEM, Program Director, Assistant Professor, Department of
Emergency Medicine, University of Medicine and Dentistry of New Jersey.