Sepsis

Sepsis is the presence of pus-forming or other disease-causing organisms in the blood or tissues. Septicemia, commonly known as blood poisoning, is a common type of sepsis. Patients with sepsis may develop symptoms and signs that are typical of infection, or may be non-specifically unwell. Some patients who have sepsis may become extremely unwell very quickly. Many patients with sepsis require prolonged hospitalization, often on the intensive care unit. Around a third of patients who develop sepsis die despite treatment by their doctors. Recent advances in diagnosis and management have improved outcomes in many patients, but the condition remains extremely dangerous and expensive.^[1]

Other Names

Septicemia, Septic Shock, Blood Infection

Causes

Sepsis involves several different organs and systems and always involves a causative organism in the blood, but controversies exist over the contribution of individual responses and organ systems to the disease process.^[2] The most critical problems concern patients' coagulation systems, and currently, there is an approved therapy with a component of the coagulation system (activated protein C) to treat patients with severe sepsis. Patients' immune systems are affected, with some components of the immune response subject to suppression while other aspects are hyperstimulated. It is likely that no single mediator, system, pathway, or pathogen drives accounts for all of the abnormalities seen in sepsis.

Treatment

The principles of immediate treatment of sepsis are to identify the condition early, take samples of blood and other body fluids early, and then treat the underlying infection with antibioticsas soon as possible. A blood lactate level should be measured to see if the circulation is failing and if shock is developing. The patient should be given intravenous fluid to keep the blood pressure at normal or near normal levels, and should be given intravenous medication to keep the blood pressure up if adequate volumes of intravenous fluids alone are not sufficient. Any source of infection such as a central venous catheter should be removed promptly, and any collection of pus in the body, for example within the chest or abdomen, should be drained to remove ongoing infection.

Many patients with sepsis develop organ failure, and admission to the intensive care unit may be required to support failing organs.

Early treatment may prevent intensive care admission.

References

1. ↑ Wheeler AP. Recent developments in the diagnosis and management of severe sepsis. Chest. 2007 Dec;132(6):1967-76. Abstract | Full Text
2. ↑ Remick DG. Pathophysiology of sepsis. Am J Pathol. 2007 May;170(5):1435-44. Abstract | Full Text | PDF