Get Ahead of Sepsis – Know the Risks. Spot the Signs. Act Fast. | Patient Safety

Infections can put you and your family at risk for a life-threatening condition called sepsis.

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Each year:

• About 1.7 million adults in America develop sepsis.
• At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice.
• 1 in 3 patients who dies in a hospital had sepsis during that hospitalization.
• Sepsis, or the infection causing sepsis, starts before a patient goes to the hospital in nearly 87% of cases.

What is Sepsis?

Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

The

Get Ahead of Sepsis Educational Effort

It’s important that patients, their loved ones and caregivers, and healthcare professionals think about sepsis as a possibility. Get Ahead of Sepsis reminds these groups about the importance of sepsis prevention, early recognition, and appropriate treatment.

Anyone can develop sepsis, but some people are at higher risk for sepsis:

• Adults 65 or older
• People with weakened immune systems
• People with chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease
• People with recent severe illness or hospitalization, including due to severe COVID-19
• People who survived sepsis
• Children younger than one

A person with sepsis might have one or more of the following signs or symptoms:

• High heart rate or weak pulse
• Fever, shivering, or feeling very cold
• Confusion or disorientation
• Shortness of breath
• Extreme pain or discomfort
• Clammy or sweaty skin

A medical assessment by a healthcare professional is needed to confirm sepsis.

What Can Patients Do?

You can take specific steps to reduce your risk of sepsis, including sepsis caused by COVID-19, such as:

1. Talk to your healthcare professional about steps you can take to prevent infections that can lead to sepsis, including:
   • Take good care of chronic conditions
   • Get recommended vaccines, since vaccinations prevent some infections, but do not cure sepsis
2. Practice good hygiene:
   • Wash your hands
   • Keep cuts and wounds clean and covered until healed
3. Know the signs and symptoms of sepsis. A medical assessment by a healthcare professional is needed to confirm sepsis.
4. Sepsis is a medical emergency. If you or your loved one has an infection that’s not getting better or is getting worse, ACT FAST. Get medical care IMMEDIATELY. Ask your healthcare professional, “Could this infection be leading to sepsis?” and if you should go to the emergency room.

What Can Healthcare Professionals Do?

As a healthcare professional you can:

• Know sepsis signs and symptoms to identify and treat patients early.
• ACT FAST if you suspect sepsis.
• Prevent infections by following infection control practices (e.g., hand hygiene, appropriate catheter management) and ensuring patients receive recommended vaccines
• Educate your patients and their families about:
  • Preventing infections
  • Keeping cuts and wounds clean and covered until healed
  • Managing chronic conditions
  • Recognizing early signs and symptoms of worsening infection and sepsis
  • Seeking immediate care if signs and symptoms are present

• Get Ahead of Sepsis
• CDC’s Sepsis Website

Top of Page

Sepsis (Blood Infection): Symptoms, Causes & Treatments

Written by Mary Anne Dunkin

• What Is Sepsis?
• Sepsis Causes and Risk Factors
• Sepsis Symptoms
• Sepsis Diagnosis
• Sepsis Treatment
• Sepsis Complications
• Sepsis Prevention
• More

Sepsis is when your body has an unusually severe response to an infection. It’s sometimes called septicemia.

During sepsis, your immune system, which defends you from germs, releases a lot of chemicals into your blood. This triggers widespread inflammation that can lead to organ damage. Clots reduce blood flow to your limbs and internal organs, so they don’t get the nutrients and oxygen they need.

In severe cases, sepsis causes a dangerous drop in blood pressure. Doctors call this “septic shock.” It can quickly lead to organ failure, such as your lungs, kidneys, and liver. This can be deadly.

Bacterial infections are most often to blame for sepsis. But it can also happen because of other infections. It can begin anywhere bacteria, parasites, fungi, or viruses enter your body, even something as small as a hangnail.

An infection of the bone, called osteomyelitis, could lead to sepsis. In people who are hospitalized, bacteria may enter through IV lines, surgical wounds, urinary catheters, and bed sores.

Sepsis is more common in people who:

• Have weakened immune systems because of conditions like HIV or cancer or because they take drugs such as steroids or those that prevent rejection of transplanted organs
• Are pregnant
• Are very young
• Are elderly, especially if they have other health problems
• Were recently hospitalized or had major surgeries
• Use catheters or breathing tubes
• Have diabetes
• Have a serious medical condition such as appendicitis, pneumonia, meningitis, cirrhosis, or a urinary tract infection

Because it can begin in different parts of your body, sepsis can have many different symptoms. The first signs may include rapid breathing and confusion. Other common symptoms include:

• Fever and chills
• Very low body temperature
• Peeing less than usual
• Fast heartbeat
• Nausea and vomiting
• Diarrhea
• Fatigue or weakness
• Blotchy or discolored skin
• Sweating or clammy skin
• Severe pain

Your doctor will do a physical exam and run tests to look for things like:

• Bacteria in your blood or other body fluids
• Signs of infection on an X-ray, CT scan, or ultrasound
• A high or low white blood cell count
• A low number of platelets in your blood
• Low blood pressure
• Too much acid in your blood (acidosis)
• A lack of oxygen in your blood
• Problems with how your blood clots
• Uneven levels of electrolytes
• Kidney or liver problems

Your doctor will probably keep you in the hospital’s intensive care unit (ICU). Your medical team will try to stop the infection, keep your organs working, and manage your blood pressure. IV fluids and extra oxygen can help with this.

Broad-spectrum antibiotics may fight infections caused by bacteria early on. Once your doctor knows what’s causing your sepsis, they can give you medicine that targets that specific germ. Often, doctors prescribe vasopressors (which make your blood vessels narrow) to improve blood pressure. You could also get corticosteroids to fight inflammation or insulin to keep control of your blood sugar.

If your case is severe, you might need other types of treatment, like a breathing machine or kidney dialysis. Or you may need surgery to drain or clean out an infection.

As sepsis gets worse, it causes more problems throughout your body. These may include:

• Kidney failure
• Dead tissue (gangrene) on fingers and toes, leading to amputation
• Lung, brain, or heart damage
• A higher risk of infections over time

Sepsis can be deadly in between 25% and 40% of cases.  

Preventing infection is the best way to prevent sepsis. Take these steps:

• Wash your hands often with soap and water for at least 20 seconds each time.
• Keep up with recommended vaccines for things like flu and chickenpox.
• Keep control of any chronic health conditions.
• If you have an injury that’s broken your skin, clean it as soon as possible. Keep it clean and covered as it heals, and watch for signs of infection.
• Treat any infections. Get medical care right away if they don’t get better or if they seem like they’re getting worse.

Top Picks

Sepsis – causes, symptoms, diagnosis and treatment of blood poisoning

This is a dangerous condition associated with the penetration of infectious agents into the blood. Against its background, poisoning of the body develops, and without proper therapy, a syndrome of multiple organ failure occurs. Sepsis can cause severe complications or even death of the patient. An important role in preventing such consequences is played by early diagnosis and a properly selected treatment program.

Causes of sepsis

Sepsis is an infectious disease. Most often it occurs when infected with streptococci and staphylococci. In some cases, the pathogens can be Escherichia and Pseudomonas aeruginosa, salmonella, pneumococci. The gates of the disease are wounds, as well as a long course of the inflammatory process. The risk of developing sepsis increases significantly if:

1. The patient has a weakened immune system. Pregnant women, the elderly, and newborns are at the highest risk for this condition. Also, sepsis can develop after a long illness, against the background of cancer therapy, with malnutrition.

2. The patient is taking drugs that suppress the functions of the immune system. Immunosuppressants are included in the treatment program for many pathologies. Regular use of medications increases the risk of a bacterial common infection.

3. There was a lot of blood loss. Bulk bleeding also weakens the body. The condition occurs against the background of damage to large veins or arteries. The elderly and infants are especially sensitive to blood loss.

4. There is a history of purulent disease. Purulent foci occur due to a violation of hygiene, against the background of cuts or wounds, due to friction of the skin with clothing. All this leads to the penetration of bacteria. Without adequate therapy, a boil, carbuncle or phlegmon can lead to sepsis.

5. There is a postoperative period. During surgery, bacteria can be introduced to the mucous membranes of the internal organs.

6. Inflammatory diseases present. The primary foci of infection can be inflamed appendicitis, pancreas, sinusitis, sinusitis and other pathologies associated with an intense inflammatory process.

7. History of extensive trauma. These include not only wounds, but also open fractures, burns.

8. Parasites detected. The vital activity of worms and fungi refers to the causes of the condition.

9. Performing invasive procedures. Catheters, cannulas and probes also lead to the penetration of infections into the body.

10. Long-term inpatient treatment. Associated with infection with nosocomial infections, the formation of bedsores and general weakening.

This is not a complete list of the causes of the condition. Sepsis threatens the entire body, so it is important to identify the cause and localization in a short time.

Pathogenesis

Infection of the blood involves a complex process that takes place in several stages. First, bacterial agents penetrate the blood and lymph from the primary focus. And in response, the immune system releases endogenous substances that lead to obstruction of the endothelium of the vascular wall. Under the influence of free radicals, the process of blood clotting is activated. The latter leads to DIC – a disorder of homeostasis, expressed in thrombotic, hemorrhagic and microcirculatory disorders.

In parallel, toxic compounds containing oxygen are released. These include hydrogen peroxide and nitric oxide. The amount of fluid passing through the circulatory and lymphatic systems decreases, and oxygen utilization by the organs becomes less. The result of the inflammatory reaction is hypoxia and multiple organ failure.

Classification

The classification of sepsis is based on the location of the infection gate. If they cannot be detected, then sepsis is recognized as primary. If localization is established, then the pathology is secondary. The latter implies the following types:

1. Obstetrics and gynecology. Often, infectious agents penetrate the uterine mucosa during childbirth or during an abortion. It is often associated with the fact that the doctor violated sanitary standards during the operation or during the delivery.

2. Surgical. Debuts from the wound left after surgery.

3. Dermal. It occurs as a result of skin diseases and damage to the dermis. Most often it develops from abscesses and wounds.

4. Urosepsis. The source of infection is located in the genitourinary system. Prerequisites may be prostatitis, pyelonephritis, cystitis.

5. Enteric. Localization of the gate of infection in the abdominal cavity.

6. Otogenic. It is mainly associated with purulent otitis or other infectious process of the ears.

7. Pleuropulmonary. In this case, the infection spreads from the lungs. Sepsis is a complication of pneumonia, empyema.

8. Odontogenic. Associated with diseases of the teeth and gums. Even banal caries can lead to sepsis.

9. Umbilical. It occurs exclusively in newborns suffering from omphalitis. Neonatal sepsis is associated with infectious diseases in the mother, childbirth outside the hospital, and a long anhydrous period.

10. Rhinogenic. Associated with an infectious process occurring in the sinuses and nasal cavity.

11. Tonsilogenic. The disease can debut due to a sore throat caused by streptococcus or staphylococcus aureus.

Symptoms of sepsis

The manifestation of the disease depends on the form of sepsis and the rate of development of the condition. The disease can progress in a short time, reaching severe stages in 1-2 days. There is a state of protracted flow, lasting 5-7 days. There are cases of chronic and subacute development. The condition may have a clear symptomatic picture or differ in a blurred atypical course. The standard symptoms of sepsis are fever, general weakness, the appearance of abscesses on the skin and organs. There may be shortness of breath, a violation of the pulse, a decrease in the amount of urine excreted. Consider the manifestations in accordance with the stages of pathology:

1. Sepsis. In this case, the bacteria are found in the blood, lymph, urine, cerebrospinal fluid. The patient has signs of peritonitis (abdominal pain, fever, nausea and vomiting) or other inflammatory diseases. For example, pneumonia, purpura, prostatitis in acute forms. At this stage, diagnosing blood poisoning is extremely difficult.

2. Severe sepsis. The patient is transferred to the intensive care unit. It combines the signs of the underlying disease and a number of aggravating symptoms. Significant disturbances in the work of internal organs are found. The patient’s pulse and respiration change. The digestive and urinary systems are unstable. Arterial hypotension develops – a pronounced decrease in pressure. Ischemia is diagnosed – a decrease in local blood circulation against the background of the same low pressure.

3. Septic shock. A condition with a high risk of death. Against the background of a decrease in blood supply to vital organs, every second patient dies. All of the symptoms listed above are exacerbated. Slowing down of urine synthesis, confusion of consciousness, stupor are diagnosed. The patient may go into a coma.

In some cases, the patient may develop septic psychosis. This condition is associated with the appearance of hallucinations, delusions, depression of mood. This is due to toxic damage to the brain.

Diagnosis

In the process of diagnosis, it is important not only to establish the fact of pathology, but also to identify the cause of sepsis. Knowing the pathogen, you can choose an effective treatment and normalize the condition in a short time. Diagnosis of sepsis takes place in several stages:

1. Patient examination. During the examination, the doctor examines breathing, the condition of the skin, measures pressure and heart rate. Be sure to measure the temperature and the amount of oxygen in the blood. If the patient is conscious, then the doctor collects an anamnesis.

2. Laboratory studies. A general blood test allows you to evaluate the number of platelets, as well as obtain data on the leukocyte formula. It is imperative to conduct a biochemical analysis in order to assess the level of C-reactive protein, a marker of the inflammatory process. Additionally, the level of creatinine, bilirubin is analyzed. Presepsin and procalcitonin are also specific markers.

3. Bacteriological culture. It is aimed at determining the pathogen, it is necessary for the selection of an antibiotic, it is carried out to monitor the effectiveness of the therapy. Detection of microbes in the blood is an important but not essential sign of sepsis. Unfortunately, even the most modern method of research is not always possible to isolate the pathogen from the blood. In 50% of cases, the analysis remains uninformative. A negative culture result in the presence of clinical symptoms should not be interpreted as the absence of sepsis.

4. PCR. This is a research method that allows you to isolate the DNA of the pathogen. It can be used alone or in parallel with bacterial seeding.

Treatment of sepsis

Treatment of sepsis is based on the correct selection of antibiotic therapy. It is based on determining the form of the pathogen, the stage and severity of the disease. The drugs are administered in large doses, taking into account the sensitivity of the bacteria and the patient’s response. Also in therapeutic tactics can be included:

1. Sulfonamides. Suppress the causative agent of infection, temporarily reducing the ability to reproduce. There are means of short and long action (with a cumulative effect).

2. Enhanced nutrition. To increase the body’s resistance, the patient must be introduced protein nutrition. Recommended fortified medical mixtures.

3. Specific sera, autovaccines, gamma globulin. They are a source of immunoglobulins that allow to destroy bacteria.

4. Surgical treatment. It is aimed at excision of the affected tissues and drainage of the gates of infection.

5. Osmotic ointments. They have pronounced antiseptic and sorption properties.

6. Blood transfusion. Indicated in violation of hemostasis.

7. Oxygen transport. To alleviate the condition, respiratory support and infusion of solutions are carried out to normalize the electrolyte balance.

Forecast. Prevention

The disease is associated with a high risk of complications:

• disorders of respiratory function and gas exchange;

• deterioration in the filtration capacity of the urinary system;

• increased blood clotting and DIC;

• polyneuropathies and difficulties with spontaneous breathing;

• septic shock and psychosis.

Prognosis in sepsis should be given with caution. This is an unpredictable disease that develops rapidly. Recovery is influenced by the characteristics of pathogenic microflora, the general condition of the patient at the onset of the disease, as well as the timeliness and correct choice of therapy tactics. Sepsis occurs most unfavorably in the elderly and in malnourished patients with concomitant diagnoses. The basis of prevention is the timely treatment of inflammatory diseases, the maintenance of immunity, as well as the observance of sanitary standards in medical institutions.

Author

Lyubov Anatolyevna Belik

infectious disease specialist, gastroenterologist

Experience 16 years

+7 (495) 032-15-21

Sepsis – blood poisoning, symptoms and causes, treatment

Sepsis is the most severe, generalized form of the infectious process, which develops either with a high pathogenicity of the pathogen, or with an insufficient response of the body’s defense systems. The international consensus recommends using the following definition: sepsis is a life-threatening dysfunction of internal organs caused by dysregulation of the body’s response to infection. With sepsis, there is a general intoxication syndrome, thrombohemorrhagic syndrome (hemorrhage) and damage to internal organs.

Causes of sepsis

Sepsis can be caused by most microorganisms known in epidemiology, including bacteria, viruses (including seasonal influenza viruses), fungi, parasites. Usually the causative agent of infection enters the body from the external environment. Under certain conditions, for example, with immunodeficiencies, the disease can develop from the natural, conditionally pathogenic flora of the body, which is normally present in every person. ^[1]

In itself, the presence of infection is not yet a guarantee of the development of sepsis. Additional conditions are needed that will lead to the generalization of the process and the pathological response of the body. The probability of such events increases in the following cases:

• The patient is over 75 years of age.
• Performing surgeries or invasive procedures.
• Presence of injuries and burns.
• Immune system disorders – AIDS, cancer, chemotherapy, the need for immunosuppressive therapy (for example, after organ transplantation), the need for high doses of glucocorticosteroids.
• Long-term treatment in a hospital.
• Presence of catheters, cannulas, probes and other invasive devices.
• Pregnancy and childbirth.
• The presence of chemical dependence – alcoholism, drug addiction.
• The presence of chronic diseases – chronic renal failure, respiratory failure, diabetes mellitus and much more.

Types of sepsis

Depending on the location of the primary focus of infection, primary (cryptogenic) and secondary sepsis are distinguished. In the primary case, the focus of infection cannot be established. With secondary sepsis, there is such a focus. Depending on its location, there are:

• Percutaneous sepsis. The primary focus is on the skin, it can be wounds, burns, purulent skin diseases (purulent abscesses, boils, etc.).
• Odontogenic sepsis. The cause of its development can be caries, pulpitis, periodontitis, jaw osteomyelitis and other diseases of the dentition.
• Otogenic sepsis. The primary focus is an inflammatory process in the ear. As a rule, these are purulent otitis media.
• Gynecological sepsis – the primary focus is located in the genitals of a woman.
• Surgical sepsis – develops as a result of infection of a surgical wound or infection during invasive procedures. ^[2-4]

Appointment for a consultation around the clock

+7 (495) 668-82-28

The first signs and symptoms of sepsis

Determining the first signs of sepsis can be difficult, even for specialists. This is due to the fact that, firstly, this syndrome develops already against the background of an existing pathology, which can have a wide variety of symptoms, and secondly, in the presence of immunodeficiency, the clinical picture can be erased. However, there are some symptoms that suggest the onset of sepsis:

• Increase or decrease in body temperature – above 38 and below 36 degrees.
• Pressure drop below operating value.
• Increased heart rate.
• Increased respiratory rate (shortness of breath).
• Decreased urine output.
• General weakness, exhaustion.
• Disturbance of consciousness or behavior.

Particular attention is paid to the occurrence of these signs in chronic patients, in the presence of leukopenia, oncological diseases, and in patients who have undergone trauma or surgery. If at least 2-3 of these symptoms occur, you should immediately contact your doctor.

Diagnosis of sepsis

Timely diagnosis of sepsis is crucial for the recovery of the patient. The sooner treatment is started, the greater the chance of success. The diagnosis is made on the basis of clinical examination data and laboratory and instrumental examination.

Clinical criteria:

• Body temperature greater than 38 degrees or less than 36 degrees.
• Heart rate over 90 or above normal for age.
• Breathing rate more than 20 times per minute.
• Presence of edema.
• Confusion of consciousness.
• Elevation of blood glucose more than 7.7 µmol/l in the absence of diabetes.
• Violation of hemodynamic processes – a decrease in systolic blood pressure less than 90 mm Hg, or its decrease by more than 40 mm Hg. from the usual value. ^[5.6]

Laboratory criteria

Complete blood count with leukocyte count and platelet count. With sepsis, leukocytosis is determined more than 12 * 109/ l or leukopenia, when the number of leukocytes is below 4 * 109 / l. There is also an exit into the bloodstream of immature forms of granulocytes and a decrease in the number of platelets.

In a biochemical blood test, an increase in C-reactive protein, creatinine, bilirubin is noted. But these are non-specific signs that can be observed in other diseases. Therefore, the search for more informative diagnostic methods continues.

Today, the main such markers are procalcitonin, presepsin, CRP. According to this laboratory indicator, a diagnosis is established and the dynamics of the disease is monitored.

Bacteriological culture

Detection of microorganisms in the blood is an important but not mandatory manifestation of sepsis. Even with the use of the most modern diagnostic systems and with careful observance of the material sampling technique, it is possible to isolate the pathogen from the blood in less than half of the cases. Therefore, a negative culture result in the presence of clinical symptoms should not be regarded as the absence of sepsis, and, conversely, the isolation of microorganisms from the blood in the absence of symptoms should be regarded as transient bacteremia or viremia, but not as sepsis.

Nevertheless, biological studies should in any case be present as one of the stages in the diagnosis of sepsis for the following reasons:

• Possibility of determining the etiology of the pathogen.
• Selection or change of antibiotic regimens.
• Monitoring the effectiveness of treatment.
• In some cases, it helps to identify the source of infection, for example, catheter-related infection, endocarditis, etc.

Appointment for a consultation around the clock

+7 (495) 668-82-28

Stages of development of sepsis

The development and course of the septic process is individual and depends both on the properties of the pathogen and on the characteristics of the patient’s body. Nevertheless, several phases of the course of this disease can be distinguished:

• Tension phase. In response to the introduction of the pathogen, the body’s defense systems are activated and mobilized, in particular, the pituitary-adrenal system is activated.
• Catabolic phase. The patient’s condition worsens due to metabolic disturbances. The processes of metabolism of proteins, fats and carbohydrates are intensified, they are extracted from the “depot”. Disorders of water-electrolyte metabolism and acid-base state also develop.
• Anabolic phase. At this time, the recovery processes begin. First of all, this concerns structural proteins.
• Rehabilitation phase. During this period, there is a further restoration of metabolic processes. In some cases, full recovery is not possible.

As for the duration of the disease, here again everything is individual. In some, stronger patients, sepsis stops within 3-4 weeks, in others it can last for years, periodically subsiding and flaring up.

In addition, when diagnosing sepsis, the following conditions are distinguished.

Toxic-resorptive fever

Toxic-resorptive fever is a condition that develops when bacterial toxins or tissue decay products are absorbed from the primary pathological focus. As a rule, this is typical for bacterial infections of wounds, catheters, etc. Common typical syndromes that accompany infectious processes are characteristic – fever, changes in the general blood and urine tests (leukocytosis, proteinuria). With the elimination of the primary focus, the patient’s condition stabilizes.

Septicemia

Septicemia is a form of sepsis in which there is a pronounced intoxication syndrome, hyperergy (increased reaction of the body) and a rapid course. Septic foci are either minimally expressed or absent. This form of sepsis is more typical for children of the first years of life. The clinical picture is more characterized by general manifestations:

• Hemolytic jaundice, accompanied by yellowing of the skin and sclera.
• Rash. At first, it appears as small pink dots that grow and merge with each other, forming pale pink or purple spots.
• In some patients, the elements of the rash may become blistered or ulcerated. With deep lesions, subcutaneous fatty tissue may be affected with the development of phlegmonous inflammation.
• Hemorrhagic syndrome – hemorrhages in internal organs.

Septicopyemia

Septicopyemia is a form of sepsis in which, in addition to general intoxication, metastatic abscesses in organs and tissues begin to appear in the body, which are the result of bacterial embolism. Most often, the first abscesses are found in the lungs, and then the process spreads to other organs: liver, liver, heart, meningeal membranes, synovial membranes. Abscesses can break through and cause the development of pleural empyema, phlegmon, peritonitis, etc.

Clinical staging of sepsis

Clinical staging of sepsis is important because it helps clinicians make the best choice and achieve the best possible outcome for each individual case. The following stages are distinguished:

• Sepsis is diagnosed when the internal temperature (measured on the mucous membranes) of the body rises above 38 degrees or falls below 36 degrees, the heart rate is 90 per minute or more, respiratory rate 20 per minute or more, or partial pressure of carbon dioxide in arterial blood (PaCO2) falls below 32 mm. rt. Art. At the same time, the level of leukocytes in the blood rises to more than 12,000 / μl or falls below ≤4000 / μl, or more than 10% of immature forms appear among them.
• Severe sepsis is sepsis associated with acute organ dysfunction.
• Septic shock is diagnosed when a patient has persistent hypotension (low blood pressure) or tissue hypoperfusion (insufficient blood supply) despite adequate fluid therapy.
• Syndrome of multiple organ dysfunction is a condition in which the patient has organ dysfunction (impaired functioning of internal organs), and his homeostasis cannot be maintained without medical intervention.

Treatment of sepsis

Treatment of sepsis is based on three principles:

1. Sanitation of the primary focus. This can be achieved with surgery and/or adequate antibiotic therapy. If a primary lesion is found that can be surgically treated, this should be done as soon as possible. This can be opening and drainage of abscesses, removal of infected invasive devices (catheters, implants, etc.), drainage and lavage of the abdominal cavity, etc.

   Antimicrobial therapy is another cornerstone of sepsis management, and timeliness and appropriateness are important. For example, with the development of septic shock, drugs should be administered within an hour from the onset of symptoms. At the same time, the drug should cover the entire spectrum of alleged pathogens and, importantly, penetrate into the primary infectious focus. If it is necessary to prescribe a combination therapy of several drugs, they are used for no more than 5 days, after which data from biological methods of research should be obtained and the treatment regimen should be corrected. ^[7]

2. Providing oxygen transport – all clinical manifestations of sepsis are aggravated in conditions of lack of oxygen, so it is very important to control this process. To do this, carry out:

   • Hemodynamic support – infusion of solutions that provide replenishment of water and electrolyte balance, prescribed drugs that maintain blood pressure, etc.
   • Respiratory support – mechanical ventilation, oxygen masks, etc.

3. Correction of metabolic disorders

   • Ensuring the supply of essential nutrients (proteins, fats, carbohydrates). If the patient is not able to take food or nutritional formulas on his own, the option of replacement therapy is considered.
   • Glucose monitoring.
   • Detoxification activities. ^[8-10]

One of the effective ways to treat sepsis is selective sorption on TORAYMYXIN columns. This technique has been successfully used in many countries around the world. Currently, more than 200 thousand patients with septic shock and severe forms of sepsis have undergone such treatment. The effectiveness and safety of the technology has been confirmed in clinical trials. ^[11.12]

Complications of sepsis

• Complications of the respiratory system. Violation of lung ventilation leads to an increase in the air-blood barrier and, as a result, leakage of fluid into the alveoli. This further disrupts gas exchange and leads to the development of shock lung and respiratory distress syndrome, which is aggravated by fatigue of the respiratory muscles.
• Renal complications. There is a decrease in the filtration function of the kidneys due to damage to the tubules, which has developed as a result of a decrease in pressure. Accompanied by a sharp decrease in excreted urine, proteinuria, azotemia.
• Violation of blood clotting due to a drop in the level of platelets and the development of DIC – a formidable condition in which mass formation of blood clots first occurs in the bloodstream, and then massive bleeding due to a lack of blood clotting factors.
• Neurological complications. Prolonged sepsis can lead to the development of polyneuropathy, which, in particular, leads to a weakening of the respiratory muscles and the impossibility of spontaneous breathing.
• Septic shock is the most severe manifestation of sepsis, accompanied by a persistent decrease in blood pressure, which is difficult to recover even with the use of fluid therapy and vasopressors. It develops due to the release of fluid from the blood vessels and due to general dehydration. At the same time, the violations are so severe that they can lead to the death of the patient from multiple organ failure. ^[13]

Prognosis in sepsis

Prognosis in sepsis is very poor. The possibility of recovery is influenced by the characteristics of the etiological microflora, the general condition of the patient at the onset of the disease, as well as the timeliness and adequacy of the treatment. The most unfavorable course of sepsis is in elderly people and in debilitated patients with concomitant diseases.

In general, in large clinics, the mortality rate for this condition is 30-40%. With the development of septic shock, the situation is aggravated and according to some data, in this case, up to 90% of patients die from it.

Appointment for consultation around the clock

+7 (495) 668-82-28

References:

1. Vengerov Yu. Ya., Nagibina M. V., Ugrinova A. P., Safonova A. P., Matosova S. V., Svistunova T. S., Shipulina O. Yu., Kovalenko T. M., Molotilova T. N., Chernyshov D. V. Sepsis. Analysis of modern concepts // Infectious diseases: News. Opinions. Education. 2016. No. 1 (14).
2. BT Muzdubayeva Modern classification of sepsis // Bulletin of KazNMU. 2017. No. 1.
3. Gruver KP, Beloborodov VB, Kuzmenko TN Actual aspects of sepsis // Antibiotics and Chemotherapy. 2011. No. 3-4.
4. Kutsevalova O.Yu., Zemlyankina L.P., Burikov M.A., Makhno Yu.E., Perepechai V.A., Yankovskaya G.V., Bokhanova E.G., Astvatsaturyan E.I., Kogan O.M., Perfilyeva A.A., Chesnikov S.G., Zholkovsky A.V., Beisova V.R. Etiological structure of sepsis // Journal of Fundamental Medicine and Biology. 2014. No. 1.
5. Karsanov A. M., Remizov O. V., Maskin S. S., Kulchiev A. A., Karsanova Z. O. Diagnosis of sepsis // Vestn. hir. 2016. №6.
6. Andrew Lever, Iain Mackenzie. Sepsis: definition, epidemiology, and diagnosis. BMJ. 2007 Oct 27; 335(7625): 879–883.
7. Servetnik A. F., Kozachenko A. V., Nudga A. N., Kovaleva E. A. Combined antibiotic therapy for surgical sepsis // MNS. 2012. No. 7-8 (46-47).
8. Gelfand B. R., Protsenko D. N., Gelfand E. B., Yaroshetsky A. I., Popov T. V. Intensive care of sepsis // General Medicine. 2004. No. 4.
9. Nekhaev IV Sepsis in oncosurgical patients // Tomsk State University Journal. RONTS im. N. N. Blokhin RAMS. 2008. No. 2.
10. St. Petersburg Society of Sepsis Specialists. Clinical guidelines for the diagnosis and treatment of severe sepsis and septic shock in medical institutions in St. Petersburg. St. Petersburg 2016.
11. Averyanov A. V., Gelfand B. R. Prospects for the treatment of sepsis // Clinical practice. 2010. No. 2 (2).
12. Tomoharu Shimizu, Toru Miyake, Masaji Tani. History and current status of polymyxin B‐immobilized fiber column for treatment of severe sepsis and septic shock. Ann Gastroenterol Surg. Jun 2017; 1(2): 105–113.