Sepsis

Definition

Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.

Description

Sepsis is also called bacteremia. Closely related terms include septicemia and septic syndrome. In the general population, the incidence of sepsis is two people in 10,000. The number of deaths from sepsis each year has almost doubled in the United States since 1980 because more patients are developing the condition. There are three major factors responsible for this increase: a rise in the number of organ transplants and other surgical procedures that require suppressing the patient's immune system; the greater number of elderly people in the population; and the overuse of antibiotics to treat infectious illnesses, resulting in the development of drug-resistant bacteria.

Causes and symptoms

Sepsis can originate anywhere bacteria can gain entry to the body; common sites include the genitourinary tract, the liver and its bile ducts, the gastrointestinal tract, and the lungs. Broken or ulcerated skin can also provide access to bacteria commonly present in the environment. Invasive medical procedures, including dental work, can introduce bacteria or permit them to accumulate in the body. Entry points and equipment left in place for any length of time present a particular risk. Heart valve replacement, catheters, ostomy sites, intravenous (IV) or arterial lines, surgical wounds, or surgical drains are examples. IV drug users are at high risk as well.

People with inefficient immune systems, HIV infection, spinal cord injuries, or blood disorders are at particular risk for sepsis and have a higher death rate (up to 60%); in people who have no underlying chronic disease, the death rate is far lower (about 5%). The growing problem of antibiotic resistance has increased the incidence of sepsis, partly because ordinary preventive measures (such as prophylactic antibiotics) are less effective.

Cancer patients are at an increased risk of developing sepsis because chemotherapy and other forms of treatment for cancer weaken their immune systems.

The most common symptom of sepsis is fever, often accompanied by chills or shaking, or other flu-like symptoms. A history of any recent invasive procedure or dental work should raise the suspicion of sepsis and medical help should be sought.

Diagnosis

The presence of sepsis is indicated by blood tests showing particularly high or low white blood cell counts. The causative agent is determined by blood culture.

In some cases the doctor may order imaging studies to rule out pneumonia, or to determine whether the sepsis has developed from a ruptured appendix or other leakage from the digestive tract into the abdomen.

Treatment

Identifying the specific causative agent ultimately determines how sepsis is treated. However, time is of the essence, so a broad-spectrum antibiotic or multiple antibiotics will be administered until blood cultures reveal the culprit and treatment can be made specific to the organism. Intravenous antibiotic therapy is usually necessary and is administered in the hospital. The patient's chances of survival are increased by rapid admission to an intensive care unit followed by aggressive treatment with antibiotics.

KEY TERMS

Bacteremia— The medical term for sepsis.

Prophylactic— Referring to medications or other treatments given to prevent disease.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Bacteremia and Septic Shock." Section 13, Chapter 156 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Cunha, Burke A., MD. "Sepsis, Bacterial." eMedicine September 29, 2004. 〈http://www.emedicine.com/med/topic3163.htm〉.

Koranyi, K. I., and M. A. Ranalli. "Mycobacterium aurum Bacteremia in an Immunocompromised Child." Pediatric Infectious Diseases Journal 22 (December 2003): 1108-1109.

Larche, J., E. Azoulay, F. Fieux, et al. "Improved Survival of Critically Ill Cancer Patients with Septic Shock." Intensive Care Medicine 29 (October 2003): 1688-1695.

Paphitou, N. I., and K. V. Rolston. "Catheter-Related Bacteremia Caused by Agrobacterium radiobacter in a Cancer Patient: Case Report and Literature Review." Infection 31 (December 2003): 421-424.

Petrosillo, N., L. Pagani, G. Ippolito, et al. "Nosocomial Infections in HIV-Positive Patients: An Overview." Infection 31, Supplement 2 (December 2003): 28-34.

Wall, B. M., T. Mangold, K. M. Huch, et al. "Bacteremia in the Chronic Spinal Cord Injury Population: Risk Factors for Mortality." Journal of Spinal Cord Medicine 26 (Fall 2003): 248-253.

ORGANIZATIONS

American College of Epidemiology. 1500 Sunday Drive, Suite 102, Raleigh, NC 27607. (919) 861-5573. 〈http://www.acepidemiology.org〉.

American Public Health Association (APHA). 800 I Street NW, Washington, DC 20001-3710. (202) 777-APHA. 〈http://www.apha.org〉.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. 〈http://www.cdc.gov〉.

OTHER

"Supportive Care for Patients—Fever, Chills, and Sweats." National Cancer Institute Cancer Net 16 April 16, 2001. 〈http://cancernet.nci.nih.gov/coping.html〉.

Sepsis

What Is Sepsis?

How Common Is Sepsis?

Is Sepsis Contagious?

What Are the Signs and Symptoms of the Disease?

How Do Doctors Make the Diagnosis?

Can Sepsis Be Treated?

What Are the Complications of the Disease?

How Is Sepsis Prevented?

Resources

Sepsis is a serious systemic infection caused by bacteria in the bloodstream.

KEYWORDS

for searching the Internet and other reference sources

Bacteremia

Group B streptococcus

Septic shock

Streptococcus pneumoniae

What Is Sepsis?

Sepsis is caused most commonly by bacteria in the bloodstream, a condition known as bacteremia (bak-tuh-REE-me-uh). These bacteria produce toxins* that provoke a response by the body’s immune system. The effect of the toxins combined with the response of the immune system brings about the disease. Bacteremia may resolve on its own or it can lead to sepsis if the bacteria are not removed by the immune system. Although bacteremia and sepsis frequently coexist, each can be present without the other. The bacteria may come from a local infection, like pneumonia* or a urinary tract* infection, or they may come from the nose, skin, or intestines*, where bacteria live without causing problems unless they enter the bloodstream. The most common sources of infection that lead to sepsis are the lungs, skin, intestine, urinary tract, and gall bladder*.

*toxins

are poisons that harm the body.

*pneumonia

(nu-MO-nyah) is inflammation of the lung.

*urinary tract

(YOOR-ih-nair-e TRAKT) is the system of organs and channels that makes urine and removes it from the body. It consists of the urethra, bladder, ureters, and kidneys.

*intestines

are the muscular tubes that food passes through during digestion after it exits the stomach.

*gall bladder

is a small pear-shaped organ on the right side of the abdomen that stores bile, a liquid that helps the body digest fat.

Sepsis is most dangerous to people with weak immune systems, such as infants, the elderly, people with HIV/AIDS or cancer, or those who have undergone organ transplantation. In infants younger than 3 months, any fever may be a sign of sepsis or another serious infection. Doctors advise immediate evaluation of these infants and prompt treatment with antibiotics if sepsis is suspected. Group B streptococcus (strep-tuh-KAH-kus) bacteria passed from mother to baby during birth are a major cause of sepsis in infants. Streptococcus pneumoniae (strep-tuh-KAH-kus nu-MO-nye) and Neisseria meningitidis (nye-SEER-e-uh meh-nin-JIH-tih-dis) bacteria are associated with sepsis in older children and in adults. Sepsis in adults most often is seen after surgery or another medical procedure in the hospital, but it may occur outside the hospital, particularly associated with urinary tract infection.

How Common Is Sepsis?

Sepsis is not very common. According to the U.S. National Library of Medicine, sepsis develops in about 2 of every 10,000 people in the general population. In infants, sepsis occurs in fewer than 1 to 2 per 1,000 live births. Sepsis is a complication in about 2 of every 100 hospitalizations, where related intravenous (IV) lines, surgical wounds or drains, and bedsores* can be entry points for bacteria.

*bedsores ,

also called pressure sores, are skin sores caused by prolonged pressure on the skin and typically are seen in people who are confined by illness or paralysis to beds or wheelchairs.

Is Sepsis Contagious?

Sepsis itself is not contagious, but the infectious agents that can cause sepsis can be transmitted from person to person. For example, in newborns, group B streptococcus organisms can spread from mother to baby during delivery.

What Are the Signs and Symptoms of the Disease?

Early symptoms of sepsis may include fever, shaking chills, rapid breathing and heartbeat, confusion, delirium*, and rash. As the infection spreads, a person’s blood pressure drops, leading to a condition known as shock*. Body organs that have important functions, including the liver, lungs, and kidneys, may begin to shut down. The blood-clotting* system also may be affected. Sepsis in young children may be more difficult to diagnose at first, because it has fewer obvious symptoms. Children may have a fever or changing temperature, a change in heart rate, or difficulty breathing. They also might be irritable or sluggish, and they may lose interest in eating.

*delirium

(dih-LEER-e-um) is a condition in which a person is confused, is unable to think clearly, and has a reduced level of consciousness.

*shock

is a serious condition in which blood pressure is very low and not enough blood flows to the body’s organs and tissues. Untreated, shock may result in death.

*clotting

is the body’s way of thickening blood to stop bleeding.

How Do Doctors Make the Diagnosis?

A diagnosis of sepsis is made based on a person’s symptoms. Blood tests are performed to identify the bacteria and to look for a low platelet* count (an indicator of the blood-clotting problems seen with sepsis) and an abnormally low or high white blood cell count (both can occur with sepsis). Other tests can help show damage to vital organs, such as the kidneys.

*platelets

(PLATE-lets) are tiny disk-shaped particles within the blood that play an important role in clotting.

Can Sepsis Be Treated?

As soon as a diagnosis of sepsis is suspected, treatment with intravenous antibiotics begins. Patients with sepsis are hospitalized in an intensive care unit, where they may be given oxygen, intravenous fluids, and medication to stabilize blood pressure, treat other symptoms, and kill the bacteria responsible for the condition. Dialysis* may be necessary if the patient’s kidneys fail. If respiratory failure* occurs, patients usually are placed on a respirator, a machine that aids their breathing until they can breathe again on their own. If the patient survives, recovery from sepsis can take weeks.

*dialysis

(dye-AL-uh-sis) is a process that removes waste, toxins (poisons), and extra fluid from the blood; usually it is done when a person’s kidneys are unable to perform these functions normally.

*respiratory failure

is a condition in which breathing and oxygen delivery to the body is dangerously altered. This may result from infection, nerve or muscle damage, poisoning, or other causes.

What Are the Complications of the Disease?

Septic shock* may occur in patients with sepsis. Disseminated intravascular coagulation is a complication associated with sepsis in which the body’s blood-clotting system is out of control; this can lead to serious internal bleeding. This complication usually improves when the cause of sepsis is treated. Sepsis can be fatal, depending on the infectious agent and on the age and overall health of the patient. Quick diagnosis and treatment can improve outcomes and save lives.

*septic shock

is shock due to overwhelming infection and is characterized by decreased blood pressure, internal bleeding, heart failure, and, in some cases, death.

How Is Sepsis Prevented?

Sepsis may not be preventable in many cases, but an early response to symptoms may stop a bacterial infection from progressing to sepsis. This is particularly important with regard to people with weak immune systems. Among hospitalized patients, efforts are made to limit the use of intravenous and urinary catheters*, which are both common entry points for sepsis-causing bacteria. Following a recommended vaccination* schedule for children can lessen their risk of contracting certain infections that might lead to sepsis. Immunization against Streptococcus pneumoniae is recommended for infants and for adults and children at high risk due to age or medical problems. This vaccine is highly effective in preventing pneumonia and sepsis caused by this organism.

*catheters

(KAH-thuh-ters) are small plastic tubes placed through a body opening into an organ (such as the bladder) or through the skin directly into a blood vessel. They are used to give fluids to or drain fluids from a person.

*vaccination

(vak-sih-NAY-shun), also called immunization, is giving, usually by an injection, a preparation of killed or weakened germs, or a part of a germ or product it produces, to prevent or lessen the severity of the disease caused by that germ.

Pregnant women typically are tested to determine whether they are carrying group B streptococcus bacteria in their vagina*. Treating these women with antibiotics during pregnancy may reduce the risk of passing the bacterium from mother to child. People with medical conditions, such as sickle-cell disease*, that put them at greater risk for developing serious bacterial infections are prescribed antibiotics to decrease the chance that sepsis can develop.

*vagina

(vah-JY-nah) is the canal, or passageway, in a woman that leads from the uterus to the outside of the body.

*sickle-cell disease

is a hereditary condition in which the red blood cells, which are usually round, take on an abnormal crescent shape and have a decreased ability to carry oxygen throughout the body.

See also

Pneumonia

Skin and Soft Tissue Infections

Streptococcal Infections

Urinary Tract Infections

Vaccination (Immunization)

Resources

Organization

U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894. The National Library of Medicine has a website packed with information on diseases (including sepsis) and public health, consumer resources, dictionaries and encyclopedias of medical terms, and directories of doctors and helpful organizations.

Telephone 888-346-3656 http://www.nlm.nih.gov

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of children’s health. It contains articles on a variety of health topics, including sepsis.

http://www.KidsHealth.org

sep·sis / ˈsepsis/ • n. Med. the presence in tissues of harmful bacteria and their toxins, typically through infection of a wound. ORIGIN: late 19th cent.: modern Latin, from Greek sēpsis, from sēpein ‘make rotten.’

sepsis Infection of the soft tissues or blood by pathogenic microorganisms, arising usually after these have entered the body through a skin wound. It results in destruction of the tissues by the pathogens or their toxins.

sepsis Destruction of body tissue by disease-causing (pathogenic) bacteria or their toxins. Local or widespread inflammation may occur, possibly followed by necrosis, the death of tissue. Treatment is with antibiotics.

sepsis putrefaction. XIX. — modL. — Gr. sēpsis, f. sḗpein rot, putrefy.
So septic XVII. — L. — Gr. sēptikǒs.

sepsis (sep-sis) n. the putrefactive destruction of tissues by disease-causing bacteria or their toxins.

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