What is Sepsis? | Sepsis

• What is sepsis?
• Is sepsis contagious?
• What causes sepsis?
• Who is at risk?
• What are the signs & symptoms?
• What should I do if I think I might have sepsis?
• Fact Sheet, Brochure, and Conversation Starter

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

• At least 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 people 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.

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.

Is sepsis contagious?

You can’t spread sepsis to other people. However, an infection can lead to sepsis, and you can spread some infections to other people.

Sepsis happens when…

Transcript: Sepsis happens when [TXT 1 1 KB]

What causes sepsis?

Infections can put you or your loved one at risk for sepsis. When germs get into a person’s body, they can cause an infection. If you don’t stop that infection, it can cause sepsis. Bacterial infections cause most cases of sepsis. Sepsis can also be a result of other infections, including viral infections, such as COVID-19 or influenza, or fungal infections.

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Who is at risk?

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

People who survived sepsis

Children younger than one

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What are the signs & symptoms?

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

High heart rate or weak pulse

Confusion or disorientation

Extreme pain or discomfort

Fever, shivering, or feeling very cold

Shortness of breath

Clammy or sweaty skin

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

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What should I do if I think I might have sepsis?

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.

If you have a medical emergency, call 911. If you have or think you have sepsis, tell the operator. If you have or think you have COVID-19, tell the operator this as well. If possible, put on a mask before medical help arrives.

With fast recognition and treatment, most people survive.  Treatment requires urgent medical care, usually in an intensive care unit in a hospital, and includes careful monitoring of vital signs and often antibiotics.

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Fact Sheet, Brochure, and Conversation Starter (Print Only)

Protect Yourself and Your Family from Sepsis [PDF – 2 pages]

It’s Time to Talk about Sepsis [PDF – 2 pages]

Start the Conversation Today [PDF – 2 Pages]

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I Survived Sepsis.

What’s Next? | Sepsis

What are the first steps in recovery?

After you have had sepsis, rehabilitation usually starts in the hospital by slowly helping you to move around and look after yourself: bathing, sitting up, standing, walking, taking yourself to the restroom, etc. The purpose of rehabilitation is to restore you back to your previous level of health or as close to it as possible. Work with your healthcare professional to determine the most appropriate rehabilitation plan and what activities are safe for you. Begin your rehabilitation by building up your activities slowly, and rest when you are tired.

How will I feel when I get home?

You have been seriously ill, and your body and mind need time to get better. You may experience the following physical symptoms upon returning home:

• General to extreme weakness and fatigue
• Breathlessness
• General body pains or aches
• Difficulty moving around
• Difficulty sleeping
• Weight loss, lack of appetite, food not tasting normal
• Dry and itchy skin that may peel
• Brittle nails
• Hair loss

You may also experience the following feelings once you’re at home:

• Unsure of yourself
• Not caring about your appearance
• Wanting to be alone, avoiding friends and family
• Flashbacks, bad memories
• Confusing reality (e. g, not sure what is real and what isn’t)
• Feeling anxious, more worried than usual
• Poor concentration
• Depressed, angry, unmotivated
• Frustration at not being able to do everyday tasks

• What are the first steps in recovery?
• How will I feel when I get home?
• What can I do to recover at home?
• Are there any long-term effects of sepsis?
• Do the effects of sepsis get better? Am I at risk for sepsis again? What should I do if I think I have sepsis again?

What sepsis survivors need to know (Print Only) [PDF – 2 pages]

Talk with your healthcare professional if you or your caregivers are concerned about any physical symptoms or feelings you are experiencing.

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What can I do to recover at home?

Work with your healthcare professional to determine the most appropriate rehabilitation plan and what activities are safe for you. Some examples may include:

• Set small, achievable goals for yourself each week, such as taking a bath, dressing yourself, or walking up the stairs
• Rest and rebuild your strength
• Talk about what you are feeling to family and friends
• Record your thoughts, struggles, and milestones in a journal
• Learn about sepsis to understand what happened
• Ask your family to fill in any gaps you may have in your memory about what happened to you
• Eat a balanced diet
• Exercise if you feel up to it
• Make a list of questions to ask your healthcare professional when you go for a check up

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Are there any long-term effects of sepsis?

Many people who survive sepsis recover completely and their lives return to normal. However, as with some other illnesses requiring intensive medical care, some patients have long-term effects. These problems may not become apparent until several weeks after your hospital stay and may include such consequences as:

• Insomnia, difficulty getting to or staying asleep
• Nightmares, vivid hallucinations, panic attacks
• Disabling muscle and joint pains
• Decreased mental (cognitive) function
• Loss of self-esteem and self-belief
• Organ dysfunction (kidney failure, lung problems, etc.)
• Amputations (loss of limb(s)

Talk with your healthcare professional if you have concerns about what you might experience in the weeks and months after getting home from the hospital.

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Do the effects of sepsis get better? Am I at risk for sepsis again? What should I do if I think I have sepsis again?

Generally, the effects of sepsis do improve with time. Some hospitals have follow-up clinics or staff to help patients and families once they have been discharged. Find out if yours does or if there are local resources available to help you while you get better. However, if you feel you are not getting better or finding it difficult to cope, call your healthcare professional.

Keep in mind that people who survived sepsis are at higher risk for getting sepsis again. 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. With fast recognition and treatment, most people survive.

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Page last reviewed: August 9, 2022

Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP)

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Related Links

Antibiotic/ Antimicrobial Resistance

Antibiotic Prescribing and Use in Hospitals and Long-Term care

Healthcare-Associated Infections

Methicillin-resistant Staphylococcus aureus (MRSA) Infections

Preventing Infections in Cancer Patients

Sepsis

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• Sepsis

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Key facts

• The global epidemiological burden of sepsis cannot be accurately estimated. It is estimated that it develops in more than 30 million people each year and possibly kills 6 million people(1). The problem of sepsis is likely to be most prevalent in low- and middle-income countries.
• An estimated 3 million newborns and 1.2 million children suffer from sepsis each year (2). Three out of ten deaths due to neonatal sepsis are suspected to be due to drug-resistant pathogens.
• One in ten deaths due to pregnancy and childbirth are due to maternal sepsis, with 95% of maternal sepsis deaths occurring in low- and middle-income countries (4). Each year, one million newborns die due to maternal infections, in particular maternal sepsis (5).
• Sepsis may be a clinical manifestation of infections acquired both outside and inside healthcare facilities. Healthcare-associated infection is one of the most common, if not the most common, type of adverse events occurring in the course of healthcare, affecting millions of patients worldwide every year (6). Because these infections are often resistant to antibiotics, they can cause rapid clinical deterioration.

General information

Sepsis is a life-threatening organ dysfunction caused by dysregulation of the body’s response to infection (7). If sepsis is not recognized early and treated promptly, it can cause septic shock, multiple organ failure, and death. Sepsis can be caused by any type of infectious pathogen. Antimicrobial resistance is a leading factor in the lack of clinical response to treatment and the rapid development of sepsis and septic shock. Among patients with sepsis caused by drug-resistant pathogens, there is an increased risk of hospital mortality.

Who is at risk?

Anyone with an infection can develop sepsis, but vulnerable populations such as the elderly, pregnant women, newborns, hospitalized patients, and those with HIV/AIDS, cirrhosis of the liver, cancer, kidney disease, autoimmune disease, and a removed spleen are at increased risk (8).

Signs and symptoms

Sepsis is an emergency. However, the signs and symptoms of sepsis in patients may be different at different points in time, since such a clinical condition as sepsis can be caused by many pathogens and change its character at different stages. Warning signs and symptoms include a rise or fall in body temperature and chills, altered mental status, shortness/rapid breathing, rapid heart rate, slow pulse/low blood pressure, oliguria, blue or marbling of the skin, cold extremities, and severe pain or discomfort in the body (9-eleven). Suspicion of sepsis is the first step towards its early recognition and diagnosis.

Prevention

There are two main ways to prevent sepsis:
1. Prevention of microbial transmission and infection;
2. Prevention of complications of infection to the state of sepsis.

Infection prevention in the community includes good hygiene practices such as handwashing and safe food preparation, improving the quality and availability of water and sanitation, ensuring access to vaccines, especially for those at high risk of developing sepsis, and good nutrition, including breastfeeding newborns.
Prevention of nosocomial infections is generally ensured by having functioning infection prevention and control programs and appropriate teams of staff, good hygiene practices, including hand hygiene, along with cleanliness of the premises and proper operation of equipment.

Prevention of sepsis in both the community and in health care settings involves appropriate antibiotic treatment of infections, including regular assessment of patients for rational use of antibiotics, prompt medical attention, and early detection of signs and symptoms of sepsis.
The effectiveness of infection prevention is clearly supported by scientific evidence. For example, with strict hand hygiene practices in health care settings, infections can be reduced by up to 50% (12), and in public places, these interventions can reduce the risk of diarrhea by at least 40% (13). Measures to improve water supply, sanitation and hygiene (WASH) can reduce the overall burden of disease worldwide by 10% ¹⁴ . Every year, vaccinations help prevent 2–3 million infection-related deaths (15).

Diagnosis and clinical management

In order to detect sepsis early and manage it appropriately in a timely manner, it is essential to recognize and not ignore the signs and symptoms listed above, and to identify certain biomarkers (particularly procalcitonin). Post-early detection, diagnostic procedures are important to help identify the causative agent of the infection that caused sepsis, since this determines the choice of targeted antimicrobial treatment. Antimicrobial resistance (AMR) can hinder the clinical management of sepsis, as it often requires empirical antibiotic selection. Therefore, it is necessary to understand the epidemiological parameters of the spread of AMR in these settings. Once the source of the infection has been identified, the most important task is to eliminate it, for example, by draining the abscess.
Fluid therapy is also important in the early management of sepsis to normalize circulating fluid volume. In addition, vasoconstrictor drugs may be required to improve and maintain tissue perfusion. Further measures for the correct management of sepsis are selected based on the data of repeated examinations and diagnostic measures, including monitoring of the patient’s vital signs.

Sepsis and the Sustainable Development Goals

Sepsis is a major cause of maternal death, as well as death of newborns and children under five years of age. For this reason, the control of sepsis will clearly contribute to the achievement of targets 3.1 and 3.2 of the Sustainable Development Goals (SDGs).

Sepsis is a highly relevant cause of maternal death, as well as death of newborns and children under five years of age. For this reason, the control of sepsis will clearly contribute to the achievement of targets 3.1 and 3.2 of the Sustainable Development Goals (SDGs).
The indicators for achieving these two SDG targets are maternal, newborn and under-five mortality rates. Sepsis occupies an important place among the causes of these preventable deaths. It is often the clinical condition that ultimately causes death in patients with HIV, tuberculosis, malaria and other infectious diseases mentioned in target 3.3, but it is usually not recorded as a cause of death for such patients and is not included in the statistics for SDG target 3.3 indicators.
Sepsis is also important, though more indirectly, to other health-related targets under SDG 3. For example, prevention and/or proper diagnosis and management of sepsis is also relevant to adequate vaccine coverage, universal coverage of quality health services, capacity to comply with the International Health Regulations, preparedness and provision of water and sanitation services. However, achieving universal prevention, diagnosis and management of sepsis remains a challenge.

WHO activities

In May 2017, the Seventieth World Health Assembly, based on a report by the WHO Secretariat, adopted a resolution on sepsis.

Resolution WHA70.7. Improving the prevention, diagnosis and clinical management of sepsis
Report of the WHO Secretariat A70/13. Improving the prevention, diagnosis and clinical management of sepsis
Several programs at the WHO headquarters level, in collaboration and coordination with the WHO Regional Offices, are currently studying the public health impact of sepsis and providing country-level guidance and support on the prevention, early and correct diagnosis, and timely and effective clinical management of sepsis for a comprehensive response to this problem. The Global Infection Prevention and Control Team, located at WHO Headquarters in the Department of Service Delivery and Safety, coordinates sepsis activities and leads prevention efforts.

Bibliography

(1) Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med 2016; 193(3): 259-72.

(2) Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of pediatric and neonatal sepsis: a systematic review. The Lancet Respiratory medicine 2018; 6(3): 223-30.

(3) Laxminarayan R, Matsoso P, Pant S, et al. Access to effective antimicrobials: a worldwide challenge. Lancet 2016; 387(10014): 168-75.

(4) Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health 2014; 2(6): e323-33.

(5) Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank(c) 2016 International Bank for Reconstruction and Development / The World Bank.; 2016.

(6) World Health Organization. WHO Report on the burden of endemic health care-associated infection worldwide. 2017-11-21 15:11:22 2011.

http://apps. who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf?sequence=1 (accessed April 10 2018).

(7) Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315(8): 801-10.

(8) Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. British Medical Journal 2016.

(9) United States Centers for Disease Control and Prevention. Healthcare Professional (HCP) Resources : Sepsis. 2018-02-01T06:23:15Z.

https://www.cdc.gov/sepsis/get-ahead-of-sepsis/hcp-resources.html (accessed April 10 2018).

(10) Global Sepsis Alliance. Toolkits. https://www.world-sepsis-day.org/toolkits/ (accessed April 10 2018).

(11) UK SepsisTrust. Education. 2018. https://sepsistrust.org/education/ (accessed April 10 2018).

(12) Luangasanatip N, Hongsuwan M, Limmathurotsakul D, et al. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. british medical journal. 2015;351:h4728.

(13) UNICEF. UNICEF Data : Monitoring the Situation of Children and Women – Diarrhoeal Disease. https://data.unicef.org/topic/child-health/diarrhoeal-disease/ (accessed April 10 2018).

(14) Pruss-Ustun A, Bartram J, Clasen T, et al. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Tropical medicine & international health : TM & IH 2014; 19(8): 894-905.

(15) World Health Organization. Fact sheet: Immunization coverage. 2018-04-10 14:55:37.

Procalcitonin

A study aimed at detecting the level of procalcitonin in the blood for the diagnosis of sepsis, septic complications, severe bacterial infections and pyoinflammatory processes.

Synonyms Russian

Procalcitonin; biological marker procalcitonin.

Synonyms English

Procalcitonin; PCT; biomarker.

Test method

Immunochemiluminescent assay.

Units

Ng/mL (nanogram per milliliter)

What biomaterial can be used for research?

Venous blood.

How to properly prepare for the study?

• Eliminate alcohol from the diet for 24 hours prior to the study.
• Children under 1 year of age should not eat for 30 to 40 minutes prior to testing.
• Children aged 1 to 5 years should not eat for 2 to 3 hours prior to testing.
• Do not eat for 8 hours before the study, you can drink clean still water.
• Avoid physical and emotional stress for 30 minutes prior to examination.
• Do not smoke for 30 minutes prior to the study.

General information about the study

Procalcitonin is a prohormone, a precursor of the hormone calcitonin, which is involved in the metabolism of calcium and maintains its constant level in the blood. The procalcitonin polypeptide consists of 116 amino acids and is synthesized by C-cells of the thyroid gland. Normally, its amount is extremely small and is found in the blood in trace amounts.

In the presence of a bacterial infection, exposure to toxins increases extrathyroidal synthesis of procalcitonin by neuroendocrine cells of the liver, kidneys, lungs, muscle tissue, adipocytes, which leads to a significant increase in its level. With a systemic inflammatory response, under the influence of pro-inflammatory molecules – endotoxin, interleukins-1 and 6, tumor necrosis factor alpha – the synthesis of procalcitonin in macrophages and monocytic cells increases. The production of this biomarker can increase during the first 2-4 hours, reaching a maximum after 12 hours, the half-life is 22-26 hours. It should be noted that during a viral infection, the synthesis of procalcitonin is absent or suppressed.

The advantage of determining procalcitonin is that its synthesis in the systemic inflammatory response reaches high levels earlier than other acute phase proteins. The systemic inflammatory response or reaction syndrome is characterized by a change in body temperature greater than 38 °C or less than 36 °C, an increase in heart rate over 90 beats per minute, an increase in respiratory rate over 20 per minute, a change in the number of leukocytes in the blood (less than 4 × 10 ⁹ or more than 12 × 10 ⁹ cells per liter of blood) or by shifting the leukocyte formula to the left.

In addition to bacterial agents, severe infections caused by fungal infections and protozoa can lead to an increase in its content. In patients in intensive care units, the determination of this marker is important in severe infectious processes of various localization. In particular, with severe bronchitis, pneumonia, pancreatitis, appendicitis, peritonitis. Local inflammatory process – tonsillitis, pharyngitis, sinusitis, gastritis and others – do not lead to a diagnostically significant increase in the level of procalcitonin.

An important diagnostic value is an increase in the concentration of procalcitonin in the syndrome of multiple organ failure, sepsis, shock, especially in newborns and children. The highest values ​​are observed in sepsis, septic shock, septicemia, meningitis. Also, the levels of this biomarker increase after major surgical interventions, operations under cardiopulmonary bypass, multiple injuries, severe burns, acute transplant rejection, subarachnoid hemorrhage, and chronic heart failure. In severely ill patients, procalcitonin levels correlate with the severity of the pathological process and mortality after the disease.

Along with the assessment of the clinical course of the disease, the data of laboratory and instrumental methods of research, the detection of the level of procalcitonin can be used to determine the effectiveness of ongoing antibiotic therapy, as well as to determine the moment to stop this treatment. In patients with viral infections, allergic, autoimmune diseases, an increase in the concentration of procalcitonin occurs only in the case of a secondary bacterial infection.

What is the test used for?

• For the diagnosis of sepsis, septicemia, septic shock;
• For the diagnosis of systemic inflammatory response syndrome;
• For the diagnosis of multiple organ failure syndrome;
• For the diagnosis of severe bacterial infection of various localization;
• For the diagnosis of infectious complications in patients of surgical departments and intensive care units;
• For prescribing and monitoring the effectiveness of antibiotic therapy in patients with infectious and purulent-septic diseases.

When is the test scheduled?

• Suspected sepsis, septic shock, systemic inflammatory response syndrome, multiple organ failure syndrome;
• With symptoms of severe infectious, purulent-inflammatory processes of various localization;
• If a generalized bacterial infection is suspected in adults, children and newborns;
• If you suspect the development of infectious complications in patients in the conditions of surgical and intensive care units;
• If a secondary bacterial infection is suspected in patients with viral infections, allergic, autoimmune diseases;
• After extensive surgical interventions, operations under cardiopulmonary bypass, multiple injuries, severe burns, acute graft rejection, subarachnoid hemorrhage, chronic heart failure;
• When prescribing and monitoring specific antibiotic therapy.

What do the results mean?

Reference values: 0 – 0. 046 ng/mL.

Procalcitonin level:

> 2.0 ng/mL – high probability of severe sepsis and/or septic shock.

Causes of increase:

• Sepsis, septicemia, septic shock;
• Neonatal sepsis;
• Systemic inflammatory response syndrome;
• Multiple organ failure syndrome;
• Infectious processes of various localization: severe bronchitis, pneumonia, pancreatitis, appendicitis, peritonitis; meningitis;
• Severe infections due to fungal infection, protozoa;
• Major surgery, cardiopulmonary bypass;
• Multiple injuries, burns;
• Acute graft rejection;
• In newborns in the first 2-3 days of life after birth.

Reasons for the decrease:

• Normal levels of procalcitonin can be observed in viral infections, allergic, autoimmune diseases, local inflammatory processes.

What can influence the result?

• The use of drugs: immunosuppressants, hormonal drugs.

Important notes

• When interpreting the results of the study, it is necessary to take into account the clinical picture of the disease, the presence of concomitant diseases and complications, the use of antibiotic therapy.
• In newborns, the level of procalcitonin increases in the first 12 hours after birth, reaching a maximum within 24-36 hours, decreasing to a normal level by 4-5 days after birth. In this regard, it is recommended to repeat the study after 24 hours to exclude a generalized bacterial infection, neonatal sepsis.
• The use of drugs, in particular immunosuppressants, that increase the synthesis of pro-inflammatory cytokines, can increase the concentration of procalcitonin.

Also recommended changes)

[02-006] Urinalysis with microscopy

[06-182] C-reactive protein, quantitative (method with normal sensitivity)

Who orders the test?

Anesthesiologist-resuscitator, surgeon, oncologist, obstetrician-gynecologist, pediatrician, internist, cardiologist, infectious disease specialist.