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Sepsis

Definition

Sepsis is a severe illness in which the bloodstream is overwhelmed by bacteria.

Alternative Names

Systemic inflammatory response syndrome (SIRS)

Causes

Sepsis is caused by a bacterial infection that can begin anywhere in the body. Common places where an infection might start include:

• The bowel (usually seen with peritonitis)
• The kidneys (upper urinary tract infection or pyelonephritis)
• The lining of the brain (meningitis)
• The liver or the gall bladder
• The lungs (bacterial pneumonia)
• The skin (cellulitis)

In children, sepsis may accompany infection of the bone (osteomyelitis). In hospitalized patients, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as bedsores (decubitus ulcers).

Symptoms

In sepsis, blood pressure drops, resulting in shock. Major organs and body systems, including the kidneys, liver, lungs, and central nervous system, stop working properly.

A change in mental status and hyperventilation may be the earliest signs of sepsis.

In general, symptoms of sepsis can include:

• Chills
• Confusion or delirium
• Decreased urine output
• Fever or low body temperature (hypothermia)
• Hyperventilation
• Lightheadedness due to low blood pressure
• Rapid heart beat
• Shaking
• Skin rash
• Warm skin

Exams and Tests

The infection is often confirmed by a blood test. However, a blood test may not reveal infection in people who have been receiving antibiotics.

Other tests that may be done include:

• Blood gases
• Kidney function tests
• Platelet count
• White blood cell count
• Blood differential
• Fibrin degradation products
• Peripheral smear

Treatment

If you have sepsis, you will be admitted to a hospital, usually the intensive care unit (ICU). Antibiotics are given through a vein (intravenously).

Oxygen, fluids given through a vein, and medications that increase blood pressure may be needed. Dialysis may be necessary if there is kidney failure. A breathing machine (mechanical ventilation) is necessary if there is lung failure.

For some patients, treatment with powerful anti-inflammatory medications called corticosteroids or recombinant human activated protein C may be helpful.

Outlook (Prognosis)

Sepsis is often life threatening, especially in people with a weakened immune system or with a chronic illness.

Possible Complications

• Death
• Disseminated intravascular coagulation
• Problems with blood flow to vital organs (brain, heart, kidneys)
• Septic shock

Prevention

The risk of sepsis can be reduced, especially in children, by following the recommended immunization schedule. Careful hand-washing procedures and care of medical equipment can help prevent hospital-related infections that lead to sepsis.

References

Russell JA. Shock syndromes related to sepsis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 109.

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