Blood Poisoning Health Article

Definition

Blood poisoning, also known as septicemia or sepsis, occurs when the bloodstream becomes infected by bacteria (i.e., staphylococci, streptococci) or fungi introduced through a wound, abscess, or other injury. Septicemia may also originate from a localized infection in the body.

Description

Over 600,000 cases of septicemia occur in the United States each year, and approximately two-thirds of these cases are diagnosed in hospitalized patients. Septicemia is an extremely dangerous disorder because it spreads rapidly throughout the body. If bacteria continue to multiply in the bloodstream and the condition progresses to septic shock, blood pressure plummets and organ systems begin to shut down. Septic shock leads to multiple-organ dysfunction syndrome (MODS), and may result in death. Although the mortality rate of patients with sepsis has dropped from 31% in 1979 to 17.4% in 1999, over 100,000 sepsis patients die in the United States each year. Men are more likely than women to develop sepsis, and the prevalence rate among African Americans is twice the rate seen in Caucasians.

Causes & symptoms

A septic infection can originate in any wound, including burns, cuts, punctures, scrapes, abscesses, or a soft tissue infection. It can also start as a specific infection such as a sinus infection or appendicitis. Invasive surgical procedures and medical devices, such as catheters, vascular access grafts, and intravenous lines, also carry a risk of introducing bacteria to the bloodstream if not properly cleaned and cared for. A large percentage of septicemia patients contract the infection in a hospital setting.

Septicemia symptoms include:

• elevated white blood cell count
• fever and chills
• rapid breathing
• sudden drop in blood pressure
• tachycardia (a rapid, pounding heartbeat)
• confusion and possible loss of consciousness
• warm, flushed skin
• skin irregularities, such as subcutaneous red lines, swelling, bleeding under the skin, or necrosis (tissue death)

Septic shock can occur when septicemia is not treated adequately or quickly enough. Symptoms of septic shock include:

• a severe drop in blood pressure (systolic pressure less than 90 mmHG and/or less than 40 mmHG of the patient's baseline blood pressure)
• organ dysfunction (such as renal, or kidney, failure) due to reduced blood flow to the organ systems
• loss of consciousness

There are some known risk factors for developing septicemia. These include:

• Having a chronic disorder or disease. The body has a difficult time fighting infection if the immune system is already weakened.
• Use of immunosuppressive drugs. These drugs also weaken the immune system.
• Taking intravenous medications or drugs. Needles can introduce infectious organisms into the bloodstream if not used in a sterile manner.

Diagnosis

There is no specific laboratory test for early diagnosis of septicemia. Blood cultures can sometimes determine the presence of bacteria in the bloodstream once the infection has spread; however, blood cultures require 24 hours or longer to incubate. Given the rapidly progressing nature of septicemia, cultures are more effective for confirming the diagnosis and narrowing the choice of antibiotics for treatment, as treatment usually must begin before the cultures are complete. In some cases, septicemia patients may have negative blood cultures. Further analysis of blood samples by a trained hematologist may be required to make a diagnosis. If the infection is thought to have spread from a wound or injury, tissue samples from that site may also be analyzed. Such other body fluids as urine and sputum may be cultured for organisms.

Treatment

Septicemia is a potentially fatal, rapidly progressing disease. Any individual who suspects they may have septicemia should seek emergency medical care immediately.

Allopathic treatment

Septicemia is treated with a course of intravenous antibiotics. The type of antibiotic used depends on the infectious agent. Blood cultures, wound cultures, and other diagnostic tests will help the healthcare provider determine which medication will be most effective. Abscesses or other sites of infection are drained of pus and fluids with a catheter. Blood pressure medications and fluids are administered to stabilize blood pressure. In cases where the patient is suffering from significant respiratory distress, a ventilator may be required. Further organ support such as dialysis may be administered if the patient progresses to septic shock.

A very promising new treatment for sepsis, activated human protein C, was shown to cut the mortality rate of patients with severe sepsis by 6.1% in the first 28 days after treatment. The drug, also known as drotrecogin alfa, was approved by the FDA in the fall of 2001. It is being marketed under the trade name Xigris. Xigris cannot, however, be given to patients at high risk for active bleeding, including those who have just had surgery, have been diagnosed with an aneurysm or gastrointestinal bleeding, or are being treated with warfarin or platelet inhibitors.