Sepsis

Septicemia, Bacteremia

What is sepsis?

Sepsis is the presence of disease-causing organisms (usually bacteria), or the toxins they produce, in the bloodstream. This can result in inflammatory responses of blood vessel dilation, leakage of fluid into tissues, and decline in heart output. This can progress to a severe drop in blood pressure (septic shock), resulting in cell damage and multiple organ failure of the heart, liver, lungs, brain and kidneys. Failure in any of these organs can be fatal. Septic shock is fatal in 60% to 70% of all cases, even with modern therapeutic measures.

Puncture wounds, deep cuts, burns, an infected surgical incision, gangrene of the bowel or any tissue, or the use of intravenous tubes or bladder catheters can be a path for organisms to enter the blood. The immune status of the individual may influence the course of disease.

How is it diagnosed?

History is usually of fever and chills, with shortness of breath and a feeling of apprehension. There might be more specific symptoms pointing to the site of infection (e. g. , abdominal pain if there is gangrene of the intestine), but localizing symptoms might be absent. There could be a history of having recently undergone surgery, or having a known, severe infection. The history could be of a recent puncture wound, deep cut, or a burn. The individual might have a bladder catheter or an intravenous tube, increasing the risk of sepsis. Mental confusion can be reported in the elderly, by their caregivers.

Physical exam usually confirms the fever. Examination might suggest the source of infection. If septic shock develops, blood pressure drops and heart rate rises. The lungs will have abnormal breath sounds indicating fluid accumulation, rapid, shallow breathing, sudden high fever and chills, cold hands and feet or a bluish tinge to the skin, decreased urine output, prostration, rapid heartbeat, and changes in mental state reflected as confusion, agitation, disorientation or coma.

Tests: Blood cultures often can identify the organism causing sepsis. A blood count can show nonspecific signs of infection. A blood gas analysis will probably show a low oxygen content in the blood (hypoxemia).

How is sepsis treated?

Treatment of sepsis is with intravenous antibiotics directed at the infecting organism. If the source of sepsis is an abscess or dead tissue, surgery is required to drain or remove it. Less commonly, sepsis is caused by a fungal infection, and can be treated with antifungal medication. If an individual is taking immunosuppressant medications, they should be stopped. When signs of septic shock appear, hospitalization in an intensive care unit is essential. Intravenous antibiotics are used to treat the infection and intravenous fluids are administered to restore fluid volume. The circulation may need support with medications. Mechanical respiration may be required to support adequate oxygen supply to the tissues.

Medications

Information Brand Generic Label Rating
Order Metronidazole Flagyl Metronidazole Off-Label
Levaquin without prescription Levaquin Levofloxacin Off-Label
Principen Principen Ampicillin
Cleocin Clindamycin

What might complicate it?

Generalized clotting of the blood (disseminated intravascular coagulation) is a dire complication. Organ failure associated with septic shock will complicate the disease. Multiple organ failure (heart, lungs, kidneys, or liver) is usually fatal.

Predicted outcome

The predicted outcome for sepsis is variable. If the infection is detected early, it is treatable and the prognosis is good. If septic shock and/or organ failure develop, the prognosis is poor. Septic shock has a high fatality rate.

Alternatives

Other causes of shock may be from blood loss, severe vomiting or diarrhea, depressant drug use, heart failure, or severe pancreatitis.

Appropriate specialists

Infectious disease specialist, cardiologist, internist, gastroenterologist, neurologist, hepatologist, and nephrologist.

Last updated 17 November 2011


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