SEPSIS

Scope of the Problem

Sepsis is the body’s severe response to an infection. Sepsis occurs when a person has an infection that triggers an extreme systemic response throughout the body. Without timely recognition and intervention, sepsis can rapidly lead to tissue damage, organ failure, and death.

Sepsis can range from mild to more severe. As sepsis worsens, blood flow to vital organs becomes impaired, leading to organ failure or tissue death. Blood clots can form in the arms, legs, fingers, and toes, resulting in gangrene and amputation.

Sepsis can progress to septic shock when the systemic infection leads to dangerously low blood pressure. Septic shock is more likely than sepsis to cause death. Most people recover from mild sepsis, but the average mortality rate for septic shock is 30%–40%. Also, an episode of severe sepsis may place the patient at higher risk for future infection.

Each year, at least 1.7 million adults in the United States develop sepsis, and on average 21% of septic patients die from sepsis (CDC, 2023k). As many as 87% of sepsis cases begin in the community, and up to 50% of sepsis survivors are left with long-term physical and/or psychological effects (Mayo Clinic, 2023; Sepsis Alliance, 2022).

In New York State, approximately 50,000 patients are impacted each year, and on average almost 30% of septic patients die from sepsis (NYS, 2019).

Causes of Sepsis

Sepsis is caused by infection—bacterial, viral, fungal, or parasitic. Anyone can get an infection, and almost any infection can lead to sepsis. The most likely include:

• Pneumonias
• Infections of the digestive system
• Infections of the urinary tract
• Bacteremia (bloodstream infections)

People who are higher risk for sepsis include:

• Adults 65 or older
• People with chronic medical conditions (e.g., diabetes, lung disease, cancer, kidney disease)
• Pregnant women
• People with weakened immune systems (e.g., human immunodeficiency virus)
• Children younger than 1 year
• Those with wounds or injuries, such as burns
• Those with invasive devices (e.g., central lines, endotracheal tubes)
• Those who previously received antibiotics or corticosteroids in the last 90 days
  (Cleveland Clinic, 2023; Mayo Clinic, 2023)

Early Recognition of Sepsis

There is no one sign or symptom of sepsis. Rather, sepsis can be recognized by a combination of symptoms, including any of the following:

• Tachycardia
• Fever usually >101 °F, shivering, or feeling very cold
• Change in mental status
• Rapid, shallow breathing
• Lightheadedness
• Symptoms specific to source of infection (i.e., dysuria, worsening cough)

Symptoms of Septic Shock

Septic shock is a later, often final, stage of sepsis. The following may occur quickly after the early signs of sepsis if it is not recognized and treatment started immediately:

• Confusion or disorientation, difficult to rouse
• Severe hypotension
• Inability to stand up
• Clammy or sweaty skin
• Extreme sleepiness
  (Mayo Clinic, 2023)

Diagnosing Sepsis

Sepsis is diagnosed based on history, physical findings, and laboratory and other tests. Since the signs and symptoms of sepsis are the same as in many other conditions, sepsis may be hard to diagnose in its early stage.

Several tests may be ordered in order to determine underlying infection. A blood sample may be drawn to test for:

• Evidence of infection (peripheral blood cultures from two different sites)
• Clotting problems
• Abnormal liver or kidney function
• Impaired gas exchange
• Electrolyte imbalances
• Serum lactate (essential to determine adequate tissue perfusion)

Depending on symptoms, other tests may be done on one or more body fluids including:

• Urine
• Wound secretions
• Respiratory secretions

If the site of infection is not obvious, one or more of the following imaging tests may be done to target a suspected site of infection:

• Chest, abdominal, or extremity X-ray
• CT scan of abdomen or head
• Abdominal ultrasound
• MRI

A lumbar puncture test is indicated when there is clinical evidence or suspicion of either meningitis or encephalitis.

A venous or arterial blood lactate level should be drawn early with suspected infection and sepsis, in the presence of mildly abnormal vital signs. A high lactate level places the patient at increased risk of adverse outcomes.

DART is a sepsis scoring tool used to plan for early recognition, assessment, and treatment for sepsis in order to prevent it from becoming septic shock:

• Detect: identify sepsis early, measure lactate
• Act: give a crystalloid bolus to start and reassess, start antibiotics early, and get source cultures quickly
• Reassess: repeat lactate measurement, reassess patient after fluid bolus
• Titrate: monitor patient response, address ongoing hypotension
  (ACEP, 2023; Mayo Clinic, 2023)

Principles of Sepsis Treatment

Patients with sepsis and septic shock require admission to the hospital. Early and aggressive treatment boosts a patient’s chances of surviving sepsis. Management principles of sepsis and septic shock include:

• Early recognition
• Early and adequate antibiotic therapy
• Treating the source of infection with antimicrobial therapy, surgery, or both
• Early hemodynamic resuscitation and continued support
• Proper ventilator management with low tidal volume in patients with acute respiratory distress syndrome
• Renal dialysis, if indicated
  (Cleveland Clinic, 2023; Sepsis Alliance, 2022)

Patient Education and Prevention

Sepsis and septic shock have serious consequences. Therefore, it is imperative that patients and families are educated about what it is and how to prevent it from happening to them. Since the best way to prevent sepsis is to block pathogens from entering the body, education should include such measures as:

• Practicing good hygiene, such as handwashing
• Keeping scrapes and cuts clean and covered until healed
• Getting recommended vaccinations
• Having any serious cut or animal or human bite examined by a primary care provider
• Managing chronic medical conditions
• Recognizing early signs and symptoms of worsening infection and sepsis
• Seeking immediate care if signs and symptoms are present
  (Cleveland Clinic, 2023)