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What Is Sepsis?
The word ‘SEPSIS’ is used a lot in a secondary care setting, but what do we understand about sepsis? You may have heard of the term ‘blood poisoning’ being explained to you by a nurse or doctor. But this is not an accurate description of sepsis, and the two terms should not be used interchangeably.
Blood poisoning is a serious infection in which bacteria are in the bloodstream or when there’s an infection in the bloodstream. This can happen through a number of ways, including scrapes, wounds etc. It can also happen as a bacterial infection elsewhere in the body, such as the lungs, and enters the bloodstream. This then triggers –SEPSIS. Sepsis is when your body responds deadly and overwhelmingly to an infection as a life-threatening counter. It is not an infection in and of itself.
To break it down for simpler explanation:
Your immune system usually works to fight germs (pathogens) that present in your body to prevent an infection; this includes bacteria, viruses, fungi, or parasites. Sometimes you may need extra help to fight these germs – medications! Examples of medications include antibiotics, antivirals, antifungals, and antiparasitics. When an infection triggers a chain reaction throughout your body, your immune system sometimes stops fighting the infection, and turns against itself, this is known as sepsis. Without timely treatment, sepsis can lead to septic shock, multi-organ failure, tissue damage, and ultimately death.
Don’t worry, you can’t spread sepsis to other people, but you can spread the infections that caused sepsis to other people
Who Is At Risk Of Sepsis?
Anyone who is affected by an infection as mentioned above can progress to sepsis, but there are a few categories of a vulnerable population who are at a higher risk than others:
- Pregnant Women
- Neonates / Premature neonates
- Hospitalized patients
- Patients receiving care in intensive care units
- People with HIV
- People with liver cirrhosis
- People with cancer
- People with acute or chronic kidney disease
- People with autoimmune diseases
- People without a spleen
I Know What Sepsis Is Now!…. But What Happens In Sepsis?
You are normally diagnosed with sepsis when you develop a set of signs and symptoms related to sepsis. It is not diagnosed based on the infection itself. These include:
T – Temperature
When you have an infection, your body’s temperature rises as it is trying to fight off the bacteria causing this. However, some people may have lowered body temperature, known as hypothermia. Therefore, any changes, higher or lower than normal, can be a sign of sepsis.
I – Infection
M – Mental decline – confused, drowsy, difficult to rouse
Sepsis can sometimes affect mental status. Especially in elderly patients, a sudden change in mental status such as acute delirium and worsening confusion may present.
E – Extremely ill – severe pain or discomfort, shortness of breath
Sepsis causes general discomfort in all parts of the body, and some may feel worse than others.
As sepsis progresses, there will be signs of organ failure, such as increased oxygen requirements due to difficulty breathing (lungs), oliguria or anuria (kidneys), abnormal liver enzyme tests (liver), and changes in mental status (brain). This is where we need to watch out for potential septic shock, defined as sepsis with persisting hypotension as a result of a critical reduction in blood pressure and perfusion abnormalities despite the provision of adequate fluid resuscitation. It is the most severe complication of sepsis, and most of these patients require treatment and monitoring in the Intensive Care Unit.
Signs And Symptoms Of Sepsis
Healthcare professionals look for the following signs and symptoms, as well as those listed above, to determine a diagnosis. They include:
- Elevated white blood cell count
- Elevated plasma C-reactive protein
- Elevated procalcitonin levels (PCT)
- Low blood pressure
- Low central venous or mixed venous oxygen saturation
- High cardiac output
- Low oxygen level
- Low urine output (oliguric or anuric)
- High serum creatinine
- Clotting abnormalities
- Absent bowel sounds
- Low platelets in the blood (Thrombocytopenia)
- High bilirubin levels
- High lactate in the blood (≥ 2 mmol/L)
- Decreased capillary filling or mottling
How Can We Prevent Sepsis From Happening?
Rather than preventing sepsis, there are ways to prevent microbial transmission and infection that will or can potentially evolve into sepsis.
In the community, this involves the general public utilizing effective hygiene practices such as correct handwashing technique, safe preparation of food, improving sanitation and water quality and availability, access to vaccines, etc.
In a healthcare setting, prevention of infection mainly relies on having proper infection prevention and control protocols in place, as well as educating healthcare professionals about effective hygiene practices and precautions, along with a clean, well-functioning environment and equipment.
Moreover, prevention of evolution to sepsis in both community and healthcare settings involve appropriate indication for antibiotic treatment of an infection, including antibiotic review after 48 hours for optimization, prompt seeking of medical care, and early detection of signs and symptoms applicable to sepsis. It is important to note that whilst antibiotic treatment is crucial for an infection, it is best to seek advice from a healthcare professional first, instead of self-treating with antibiotics. Antibiotic resistance is a huge problem globally and can jeopardize the clinical management of sepsis.
Referenced on 20.6.2021
- Gondongwe XD & Welch J. Sepsis: an update on identification and management. Clinical Pharmacist, CP, January 2017, Vol 9, No 1;9(1): DOI:10.1211/PJ.2017.20202083
- Sepsis Alliance. Sepsis Information Guide: Sepsis Basics. Last updated 02 June 2021. https://www.sepsis.org/sepsis-basics/what-is-sepsis/
- World Health Organization. Sepsis. August 2020. https://www.who.int/news-room/fact-sheets/detail/sepsis
- Centre for Disease Control and Prevention. What is sepsis. Last reviewed 27 January 2021. https://www.cdc.gov/sepsis/what-is-sepsis.html
- Maggio PM. Sepsis and Septic Shock. MSD Manual Professional Version, Jan 2020. https://www.msdmanuals.com/en-gb/professional/critical-care-medicine/sepsis-and-septic-shock/sepsis-and-septic-shock
- Caraballo, C., & Jaimes, F. Dysfunction in Sepsis: An Ominous Trajectory from Infection To Death. The Yale journal of biology and medicine, 2019. 92(4), 629–640.