Sepsis

What is sepsis?

Sepsis is a serious condition that can result in organ damage or death. It happens when the body’s immune system has a severe response to an infection. Sepsis is a medical emergency. It needs to be treated right away.

Bacteria, viruses, and fungi can invade your body and cause disease. When your body senses one of these, the immune system responds. Your body releases certain chemicals into the blood that can help fight infection.

In some cases, the body has an abnormal and severe response to infection. This can cause inflammation around the body and damage your body’s cells. Blood clots may start to form all over the body. Some blood vessels may start to leak. Blood flow and blood pressure may start to drop. This harms the body’s organs by stopping oxygen and nutrients from reaching them. If this process isn’t stopped, organs in the body can stop working. This can lead to death.

The term sepsis is used to define any condition in which the body's organs stop working right and there is an infection. Septic shock is when sepsis occurs along with changes to the circulatory, cellular, and metabolic systems.

Sepsis is a common cause of death in hospital intensive care units. It can affect people of all ages. But children and older adults are at highest risk.

What causes sepsis?

Sepsis never happens on its own. It always starts with an infection somewhere in your body, such as:

• Lung infection
• Urinary tract infection
• Skin infection
• Abdominal infection such as from appendicitis or an infected gallbladder

Bacteria are the most common cause of these infections. Viruses, parasites, and fungi can also cause them and lead to sepsis. In some cases, the bacteria enter the body through a medical device such as a blood vessel or urinary catheter. An infection that spreads around the body through the bloodstream is more likely to cause sepsis. An infection in just one part of the body is less likely to lead to sepsis.

Sepsis is sometimes called by the nonmedical term blood poisoning. But this is misleading. Sepsis isn’t caused by poison.

Who is at risk for sepsis?

Some health problems and other conditions that affect your ability to fight infection can raise your risk for sepsis. These include:

• HIV/AIDS
• Diabetes
• Cancer
• Liver disease
• Severe burns
• Respiratory failure
• Alcoholism
• Other conditions that affect the immune system

Babies, children, and older adults also have a higher risk of developing sepsis.

Careful treatment of these health conditions may help reduce the risk of sepsis.

What are the symptoms of sepsis?

Symptoms and signs of sepsis can include:

• Fever or abnormally low temperature
• Chills
• Rash
• Confusion
• Trouble breathing
• Swelling
• Rapid heart rate and breathing rate
• Low blood pressure
• Signs of reduced blood flow to one or more organs
• Less urine

The symptoms may vary depending on the severity of the sepsis. These symptoms may be mild at first and then quickly get worse.

How is sepsis diagnosed?

To diagnose sepsis, a healthcare provider will ask about your medical history and your symptoms. Some of the symptoms of early sepsis are the same as other health problems. This can make sepsis hard to diagnose in its early stages. A full exam of the body is needed to help diagnose sepsis.

You may also have tests, such as:

• Urine tests to look for signs of infection in your urine, and check kidney function
• Blood tests to looks for signs of infection in your blood
• Imaging tests such as a chest X-ray, CT scan, or other tests to look for the site of infection

A healthcare provider will often suspect sepsis in a person with certain signs and symptoms. These include an abnormal body temperature, rapid heart and breathing rate, and abnormal white blood cell count. A healthcare provider can make an official diagnosis when there is a source of infection and abnormal signs and symptoms point to organ problems. Septic shock is diagnosed when the signs of organ dysfunction do not get better with treatment.

How is sepsis treated?

Treatment is done in a hospital’s intensive care unit (ICU). This is because sepsis treatment needs very close monitoring. Vital signs such as heart rate, blood pressure, and breathing will be constantly watched. Blood and urine tests will be done often. Your condition will be closely watched and your treatment adjusted as often as needed.

The source of the sepsis must be treated. At first, you will often be treated with one or more antibiotics that work on many types of bacteria. Results of culture and sensitivity testing can identify a specific type of bacteria and the appropriate antibiotic. Pockets of infection may need to be drained. These are called abscesses. In some cases, an infected part of the body may need to be removed with surgery.

Along with antibiotic treatment, you will also need other types of treatments to help support the body, such as:

• Extra oxygen, to keep up normal oxygen levels
• IV (intravenous) fluids, to help bring blood pressure and blood flow to organs back to normal
• A breathing tube and a ventilator, if you have trouble breathing
• Dialysis, in case of kidney failure
• Medicines to raise the blood pressure
• Other treatments to prevent problems such as deep vein thrombosis and pressure ulcers
• Insulin to keep blood sugars in the optimal range, even in you don't have a history of diabetes

Most people with mild sepsis do get better. But even with intense treatment, some people die from sepsis. Up to half of all people with severe sepsis will die from it.

What are possible complications of sepsis?

Many people survive sepsis without any lasting problems. Other people may have serious problems from sepsis, such as organ damage. Some possible complications of sepsis are:

• Kidney failure
• Tissue death (gangrene) of fingers or toes that may require amputation
• Permanent lung damage from acute respiratory distress syndrome
• Permanent brain damage, which can cause memory problems or more severe symptoms
• Later problems with your immune system, which can raise the risk for future infections
• Damage to the heart valves (endocarditis), which can lead to heart failure

When should I call my healthcare provider?

Seek care right away if you or someone else has symptoms of sepsis. Early diagnosis and treatment can help improve the chances of a good recovery. After recovery, you may be more prone to infections and other illnesses. Call or see your healthcare provider right away at the first signs of an infection or illness.

Key points about sepsis

Sepsis is a serious medical condition that can result in organ damage or death. It happens when the body’s immune system has a severe response to an infection.

• Sepsis is a medical emergency. It needs to be treated right away.
• Possible signs and symptoms of sepsis include fever, confusion, trouble breathing, rapid heart rate, and very low blood pressure.
• Sepsis is treated with antibiotics, oxygen, and IV fluids as soon as possible. Other treatments such as kidney dialysis, breathing support, or surgery may also be needed.
• Sepsis can cause serious complications. These include kidney failure, gangrene, and death.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.