Sepsis

Medically reviewed by Steven Kim, MD and Debra Sullivan, PhD, MSN, CNE, COIee on February 23, 2017Written by Krista O'Connell and Valencia Higuera

What is sepsis?

Sepsis is a life-threatening illness caused by your body’s response to an infection. Your immune system protects you from many illnesses and infections, but it’s also possible for it to go into overdrive in response to an infection.

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 million cases of sepsis each year, according to the Centers for Disease Control and Prevention (CDC) . This type of infection kills more than 258,000 Americans a year.

Symptoms What are the symptoms of sepsis?

There are three stages of sepsis: sepsis, severe sepsis, and septic shock. Sepsis can happen while you’re still in the hospital recovering from a procedure, but this isn’t always the case. It’s important to seek immediate medical attention if you have any of the below symptoms. The earlier you seek treatment, the greater your chances of survival.

Sepsis

Symptoms of sepsis include:

  • a fever above 101ºF or a temperature below 96.8ºF
  • heart rate higher than 90 beats per minute
  • breathing rate higher than 20 breaths per minute
  • probable or confirmed infection

You must have two of these symptoms before a doctor can diagnose sepsis.

Severe sepsis

Severe sepsis occurs when there’s organ failure. You must have one or more of the following signs to be diagnosed with severe sepsis:

Septic shock

Symptoms of septic shock include the symptoms of severe sepsis, plus a very low blood pressure .

Effects The serious effects of sepsis

Although sepsis is potentially life-threatening, the illness ranges from mild to severe. There's a higher rate of recovery in mild cases. Septic shock has a 50 percent mortality rate, according to the Mayo Clinic . Having a case of severe sepsis increases your risk of a future infection.

Severe sepsis or septic shock can also cause complications. Small blood clots can form throughout your body. These clots block the flow of blood and oxygen to vital organs and other parts of your body. This increases the risk of organ failure and tissue death ( gangrene ).

Causes What causes sepsis?

Any infection can trigger sepsis, but the following types of infections are more likely to cause sepsis:

According to the CDC , the number of sepsis cases in the United States increases every year. In fact, the NIH reports that sepsis causes more U.S. deaths than prostate cancer, breast cancer, and AIDS combined. Possible reasons for the increase include:

Risks Who is at risk for sepsis?

Although some people have a higher risk of infection, anyone can get sepsis. People who are at risk include:

  • young children and seniors
  • people with weaker immune systems, such as those with HIV or those in chemotherapy treatment for cancer
  • people being treated in an intensive care unit (ICU)
  • people exposed to invasive devices, such as intravenous catheters or breathing tubes

Newborns Newborns and sepsis

Neonatal sepsis is when your baby gets a blood infection within the first month of life. Neonatal sepsis is classified based on the timing of the infection, according to whether the infection was contracted during the birth process (early onset) or after birth (late onset). This helps the doctor decide what kind of treatment to administer. Low birth weight and premature babies are more susceptible to late onset sepsis because their immune systems are immature. While symptoms can be subtle and nonspecific some signs include:

  • listlessness
  • not breastfeeding well
  • low body temperature
  • apnea (temporary stopping of breathing)
  • fever
  • pale color
  • poor skin circulation with cool extremities
  • abdominal swelling
  • vomiting
  • diarrhea
  • seizures
  • jitteriness
  • yellowing of the skin and whites of the eyes ( jaundice )
  • problems feeding

Neonatal sepsis is still a leading cause of infant death, but with early diagnosis and treatment, the baby will recover completely and have no other problems. With maternal universal screening and proper neonatal testing the risk of neonatal sepsis has decreased significantly.

SeniorsSeniors and sepsis

Since our immune system weakens as we age, seniors can be at risk for sepsis. In one 2006 study , people over the age of 65 made up nearly 70 percent of sepsis cases. In addition, chronic illness, such as diabetes , kidney disease , cancer, high blood pressure , and HIV are commonly found with those who have sepsis. The most common types of infections to cause sepsis in seniors are respiratory like pneumonia or genitourinary like a urinary tract infection . Other infections can come with infected skin due to pressure sores or skin tearing. While these infections might not be noticed for a while, confusion or disorientation is a common symptom to look for when identifying an infection in seniors.

SpreadingIs sepsis contagious?

Sepsis is not contagious. However, the pathogens that caused the original infection that lead to sepsis can be contagious. Sepsis spreads within a person’s body from the original source of infection to other organs through the bloodstream.

Diagnosis How is sepsis diagnosed?

If you have symptoms of sepsis, your doctor will order tests to make a diagnosis and determine the severity of your infection.

One of the first tests is a blood test. Your blood is checked for complications like:

  • infection
  • clotting problems
  • abnormal liver or kidney function
  • decreased amount of oxygen
  • an imbalance in minerals called electrolytes that affect the amount of water in your body as well as the acidity of your blood

Depending on your symptoms and the results of your blood test, your doctor may order other tests, including:

  • a urine test (to check for bacteria in your urine)
  • a wound secretion test (to check an open wound for an infection)
  • a mucus secretion test (to identify germs responsible for an infection)

If your doctor can’t determine the source of an infection using the above tests, your doctor may order an internal view of your body using one of the following:

  • X-rays to view the lungs
  • computed tomography (CT) scans to view possible infections in the appendix, pancreas, or bowel area
  • ultrasounds to view infections in the gallbladder or ovaries
  • magnetic resonance imaging (MRI), which can identify soft tissue infections

CriteriaSepsis criteria

There are two tools, or sets of criteria, doctors use to determine the severity of your condition. One is the systemic inflammatory response syndrome (SIRS). SIRS is defined when you meet two or more of the following criteria:

  • fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
  • heart rate of more than 90 beats per minute
  • respiratory rate of more than 20 breaths per minute or arterial carbon dioxide tension (PaCO 2) of less than 32 mm Hg
  • abnormal white blood cell count

Another tool is the quick sequential organ failure assessment (qSOFA). It uses the results of three criteria:

  • low blood pressure reading
  • high respiratory rate (greater than 22 breaths per minute)
  • Glasgow coma scale score of less than 15. (This scale is used to determine your level of consciousness.)

A positive qSOFA is determined if two or more of the above measurements are abnormal. Some physicians prefer using qSOFA because unlike the SIRS criteria, qSOFA does not require laboratory tests. The results of either of these assessments will help your doctor determine care.

Treatment How is sepsis treated?

Sepsis can quickly progress to septic shock and death if it is left untreated. Doctors use a number of medications to treat sepsis, including:

  • antibiotics via IV to fight infection
  • vasoactive medications to increase blood pressure
  • insulin to stabilize blood sugar
  • corticosteroids to reduce inflammation
  • painkillers

Severe sepsis may also require large amounts of IV fluids and a respirator for breathing. Dialysis might be necessary if the kidneys are affected. Kidneys help filter harmful wastes, salt, and excess water from the blood. In dialysis, a machine performs these functions.

In some cases, surgery may be needed to remove the source of an infection. This includes draining a pus-filled abscess or removing infected tissue.

RecoveryCan you recover from sepsis?

Your recovery from sepsis depends on the severity of your condition and any pre-existing conditions you might have. Many people who survive will recover completely. However, others will report lasting effects. The UK Sepsis Trust says it can take up to 18 months before survivors start to feel like their normal self. The Sepsis Alliance says that around 50 percent of sepsis survivors deal with post-sepsis syndrome (PSS). The alliance says this condition includes long-term effects such as:

  • damaged organs
  • insomnia
  • nightmares
  • disabling muscle and joint pains
  • fatigue
  • poor concentration
  • lowered cognitive functioning
  • lowered self-esteem

Severe cases of sepsis can lead to death. Of the million Americans that are effected year, it’s been estimated that between 28 and 50 percent of these people die.

PreventionSepsis prevention

By doing things that prevent the spread of infection, you can reduce your risk of developing sepsis. These include:

  1. Staying up to date on your vaccinations. Getting vaccinated for the flu , pneumonia , and other infections.
  2. Practicing good hygiene. This means practicing proper wound care , hand washing, and bathing regularly.
  3. Getting immediate care if you develop signs of infection. Every minute counts when it comes to sepsis treatment. The sooner you get treatment, the better the outcome.

Outlook Outlook

It’s important to remember that sepsis is a medical emergency. Every minute and hour counts, especially since the infection can spread quickly. There’s no one symptom of sepsis, but rather it has a combination of symptoms. Get immediate medical attention if you suspect that you have sepsis, especially if you have a known infection.

  • Medically reviewed by Steven Kim, MD and Debra Sullivan, PhD, MSN, CNE, COIee on February 23, 2017Written by Krista O'Connell and Valencia Higuera