Sepsis is a medical emergency that becomes fatal or life-changing for many of the people who develop this "blood poisoning."
Sepsis is the result of a massive immune response to bacterial infection that gets into the blood. It often leads to organ failure or injury, and the critical condition often leads to death. The key point with sepsis, however, is that the starting point is an infection.
Estimates for the number of people hospitalized in the US for sepsis each year top a million, and sepsis is in the top 10 of all the diseases leading to mortality in America.1
The condition featured across the media in the UK in early 2016 because sepsis, and septicemia infection leading to it, do have medical interventions that can often prove lifesaving and may reduce lifelong complications - if the condition is caught early enough.
In the case of baby William Mead, however, early signs of sepsis could have been spotted, as could his underlying septicemia. As a result, his tragic death in December 2014 may have been avoidable.
Rise in cases in the US prompts calls for better diagnosis
The report into baby William's care has wider implications, making a number of recommendations. One of which is that, in England, the helpline for non-urgent medical advice (111) needs to build in better sensitivity for flagging up the signs of sepsis, ensuring that the alarm is raised for urgent medical attention (999).2
Sepsis is most dangerous in the young and old, among other vulnerable groups, and in the US, the total number of cases has been rising.
Some infections can lead to septicemia. This can lead to sepsis. Sepsis can get severe. Life-threatening septic shock can follow.
There were around 600,000 people admitted to hospital for sepsis in America in 2000, according to hospital data analyzed by the US Centers for Disease Control and Prevention (CDC), a statistic that went on to breach 1.1 million in 2008.1 Cases in the UK have also been rising, following a similar trend.3
Why sepsis should be presenting more of a threat is thought to be due to a number of factors, including antibiotic resistance and aging populations. In addition to living longer, we are also sustaining more chronic health conditions.
However, another factor behind increasing numbers of hospital cases could also be that the problem is getting picked up and reported more and more, in spite of the improvements being called for.1
Appropriate public awareness needs to be raised about what symptoms signal an emergency. There is still some way to go in medical advances and care to improve diagnosis of sepsis and to help the fight to prevent and treat it.
The Surviving Sepsis Campaign, for example, is a pan-US/Europe effort to improve our chances against severe sepsis and septic shock. This awareness campaign has already been shown to reduce hospital death rates due to sepsis.4
Fast facts on sepsis
Here are some key points about sepsis. More detail and supporting information is in the article.
- Sepsis is a medical emergency and a complication from infection
- Usually bacterial, an infection leading to sepsis has gotten into the blood. The immune system launches a massive response to the poisons released by the microbes (hence the terms septicemia and "blood poisoning")
- The symptoms of sepsis can be tricky to spot and may be mistaken for other serious illnesses
- Getting urgent medical treatment - with antibiotics, and other treatment dependent on the severity of the condition - is key to the chances of surviving sepsis
- Sepsis can lead to a severe condition that threatens damage to the organs or even their complete failure
- Septic shock is the most dangerous stage of the condition - an immediately life-threatening condition that results from persistently low blood pressure caused by sepsis
- The very young and older people are among the groups of people at greatest risk of sepsis and also the worsening severities of the condition. So, too, are people with weakened immune systems
- Prevention includes anyone with an infection being alert to the early symptoms of sepsis - particularly vulnerable people - and observing simple measures of infection control such as handwashing.
What is sepsis?
Sepsis is part of a cascade of worsening conditions. Answering what sepsis is and what causes sepsis depends on the specific part of the disease process in question.
Sepsis is a specific condition in itself, but it follows on from a blood infection called septicemia. This explains why the terms sepsis and septicemia are often used together. The blood should be sterile of bacteria (and another term for when these microbes get into the circulation is "bacteremia").5
The blood infection can lead to the blood poisoning and inflammatory danger of sepsis. Septicemia leads to sepsis in this way because:6
- Poisons are released by the septicemia - released by the bacteria infecting the blood
- The immune system mounts a massive inflammatory response to these poisons - sepsis.
Most infections leading to sepsis are bacterial.
The current definition of sepsis is based on relatively recent developments in the scientific understanding of the condition. The disease process is also not fully understood, with treatment still proving highly challenging.7
Previous descriptions of sepsis were more focused on the infection rather than the inflammatory danger in response to it.
The modern approach - since the early 1990s - has been to characterize sepsis in terms of the body's responses to the infection. Go back to the time of the ancient Greeks, however, and they referred to sepsis as rot, decay or putrefaction.8
One definitive and simple definition has recently been set for the public by leaders in the field of infectious diseases and sepsis. In 2010, as part of an effort to raise awareness of the "pandemic" of this medical emergency, the Global Sepsis Alliance produced the following:9
"Sepsis is a life-threatening condition that arises when the body's response to an infection injures its own tissues and organs."
Who gets sepsis and the infections leading to it?
Sepsis is possible in anyone with an infection that develops a complication, but the people most at risk of sepsis are the very young and the old, and anyone with these risk factors:10
- A weakened immune system
- Chronic illness, including the examples of diabetes, kidney or liver disease, AIDS and cancer
- A severe wound, including severe burns.
Vulnerability to sepsis is becoming more widespread. This is thought to be for a number of reasons, including more people having the risk factors above, and:1
- More opportunities for infections to become complicated - more people are having invasive procedures and organ transplants, and more are taking immunosuppressive drugs and chemotherapies
- Rising antibiotic resistance - medicine has been failing to keep up adequately with the strategies that microbes continually evolve against drugs that would otherwise control infections.
Recent development in sepsis from MNT news
This study, published by two journals in June 2015 - the International Journal of Sports Medicine and Exercise Immunology Reviews - found blood markers of sepsis in people doing exercise over a prolonged period of time, showing that the extreme exercise "causes the gut wall to change," triggering a sepsis-like immune response.
A new study shows that protecting blood vessels from the damage caused by sepsis could be a way to successfully treat a condition that poses a major challenge in the intensive care unit.
The blood infection of septicemia is usually, but not always, caused by Gram-negative bacteria.6 People with good immune systems who nonetheless get sepsis usually have a septicemia with relatively common bacteria. In people with compromised immunity, however, less common microbes can get into the blood.11
Symptoms of sepsis
The most important step for patients or people around them suspecting sepsis is that they:11-13
- Do not attempt to make a home diagnosis
- Instead, get medical help as soon as possible - the symptoms of sepsis from a bad infection are serious
- The symptoms can signal other conditions that would also need medical help.
The signs and symptoms of sepsis following a bad infection are often subtle and can be mistaken for those of other serious conditions. However, sepsis typically involves the following main features in someone who has had a recent infection, and symptoms can come on quickly.
Get urgent medical help - go to the emergency department whenever sepsis is suspected. It often produces:11,14
Uncomplicated viral infections such as cold or flu are not sepsis. The child with sepsis is, instead, seriously ill and may show a drop in alertness along with other symptoms such as fast pulse and breathing.
- Fever (high temperature, pyrexia), and there may be 'chills' and shivering
- Fast heart rate/pulse (tachycardia)
- Rapid rate of breathing (tachypnea)
- Unusual levels of sweating (diaphoresis).
It is particularly important to call for urgent medical help if sepsis has reached a late stage - severe sepsis or septic shock.
Call an ambulance whenever sepsis is suspected and there is:10-14
- Dizziness or feelings of faintness
- Confusion or a drop in alertness, or any other unusual change in mental state, including a feeling of doom or real fear of death
- Slurred speech
- Diarrhea, nausea or vomiting
- Severe muscle pain and extreme general discomfort
- Difficulty breathing - shortness of breath
- Low urine output (not needing to urinate for a whole day, for example)
- Skin that is cold, clammy and pale, or discolored or mottled
- Skin that is cool and pale at the extremities, signaling poor blood supply (poor perfusion)
- Loss of consciousness.
Get medical help for anyone whether the skin feels unusually warm or cold, because either can happen with sepsis.11-13 There can be either fever or low body temperature (pyrexia or hypothermia).15
The elderly and very young are particularly vulnerable to sepsis after an infection and also more vulnerable to the worsening of any sepsis condition.
When calling for medical help, going to the emergency department, or speaking to doctors and nurses, it is important to mention any recent infection, surgical procedure, or if the patient has a compromised immune system such as from drug treatment or certain conditions.11-13
Such a medical history is more likely to mean there has been an infection that would alert the health care professionals to the diagnosis of sepsis if they see the typical features.
On the next page, we look at tests and diagnosis for sepsis along with treatment and prevention.