Sepsis

When your body fights infection, it naturally releases infection-fighting chemicals into your bloodstream. Sepsis occurs when those chemicals go beyond the actual infection to trigger inflammation (swelling) in other parts of your body. Microscopic blood clots form and begin to block blood and oxygen flow to organs and tissues, such as the brain, heart and kidneys, and tissues in arms, legs, fingers and toes.

Anyone can develop sepsis, even infants, but it's most common in older adults and those with weakened immune systems. It most often occurs in people who are hospitalized. According to the Centers for Disease Control and Prevention, sepsis is the ninth leading cause of disease-related deaths. Patients in intensive care are especially vulnerable to infections that may lead to sepsis.

Many doctors view sepsis as a three-stage syndrome, starting with sepsis, progressing through severe sepsis to septic shock — the point where inflammation can damage multiple organ systems, causing them to fail. The goal is to treat sepsis during its mild stage, before it becomes more dangerous.

If you develop signs of sepsis after surgery, hospitalization or an infection, seek medical care immediately.

Prevention

Preventing infection is the best way to prevent sepsis, and infections can be reduced by proper care of all wounds. If an infection does set in, it should be treated as quickly as possible. The risk of getting an infection also drops when everyone in the healthcare environment practices proper hygiene. Washing hands with soap and water is extremely important.

At El Camino Health, our healthcare team follows highly practiced guidelines to prevent infection. From regular hand washing to close monitoring of patients for sepsis symptoms, all members of the healthcare team are dedicated to patient safety.

Symptoms

For a patient to be diagnosed with sepsis, symptoms must include two or more of the following:

• Body temperature above 101 or below 96.8 F.
• Heart rate higher than 90 beats a minute.
• Respiratory rate higher than 20 breaths a minute.
• Probable or confirmed infection based on white blood cell count.

To be diagnosed with severe sepsis, you must experience two of the above symptoms plus one of the following:

• Significantly lower urine output.
• Abrupt change in mental status.
• Decrease in blood platelet count.
• Difficulty breathing.
• Abnormal heart pumping function.
• Organ or system failure.

The signs and symptoms of septic shock include symptoms of severe sepsis, along with extremely low blood pressure that doesn't respond to fluid replacement. It requires continuous IV medication to keep blood pressure up.

Diagnosis

Because the signs of sepsis are similar to those of other disorders, your doctor may order tests to pinpoint the underlying infection.

Your doctor may use a blood test to check for:

• Evidence of infection.
• Clotting problems.
• Abnormal liver or kidney function.
• Impaired oxygen availability.
• Electrolyte imbalances.

Depending on your symptoms, your doctor may order further testing to examine your:

• Urine, to look for signs of bacteria.
• Wound secretions, to show what type of antibiotic might work best.
• Respiratory secretions, to determine the type of germ causing the infection.

To confirm the location of the infection, your doctor may use imaging exams, such as X-rays, CT, MRI or ultrasound.

Treatment

Early diagnosis and treatment are the best way to reduce complications from sepsis.

Early treatment of sepsis usually involves antibiotics and large amounts of intravenous fluids. Typically, patients with severe sepsis are closely monitored in the intensive care unit, though some patients may receive monitoring and care in another unit if their condition allows. In the case of septic shock, lifesaving measures may be needed to stabilize breathing and heart function.

Medications commonly used in treating sepsis include:

• Antibiotics - Administered intravenously.
• Vasopressors - To constrict blood vessels so blood pressure increases.

Your doctor may also administer other medications — such as low doses of corticosteroids and insulin to stabilize blood sugar levels — or prescribe painkillers, sedatives or drugs that modify your immune system responses.

People with severe sepsis or septic shock usually receive supportive care including oxygen, intravenous fluids and, if needed, breathing assistance or kidney dialysis. In some instances, treatment requires surgery to remove the source of infection, such as an abscess.