What is sepsis and how does it develop. Who is at risk of sepsis and what are the warning signs. How to recover from sepsis and what to expect during rehabilitation.

Defining Sepsis: A Life-Threatening Medical Emergency

Sepsis is a severe and potentially fatal condition that occurs when the body’s response to infection spirals out of control. It triggers a chain reaction throughout the body, leading to widespread inflammation and, if left untreated, can result in tissue damage, organ failure, and death.

To understand the gravity of sepsis, consider these alarming statistics:

• At least 1.7 million adults in America develop sepsis annually
• Approximately 350,000 adults who develop sepsis die during hospitalization or are discharged to hospice
• One in three hospital deaths involves sepsis
• In nearly 87% of cases, sepsis or the infection causing it starts before a patient is hospitalized

The Origins and Spread of Sepsis

Can sepsis be transmitted from person to person? While sepsis itself is not contagious, the infections that lead to sepsis can be. Most commonly, sepsis-causing infections originate in the lungs, urinary tract, skin, or gastrointestinal system.

Bacterial infections are the primary culprits behind sepsis cases. However, viral infections like COVID-19 and influenza, as well as fungal infections, can also trigger sepsis. It’s crucial to understand that any infection, if left unchecked, has the potential to escalate into sepsis.

Identifying High-Risk Groups for Sepsis

While sepsis can affect anyone, certain groups are at higher risk:

• Adults aged 65 or older
• Individuals with compromised immune systems
• People with chronic medical conditions (e.g., diabetes, lung disease, cancer, kidney disease)
• Those recently experiencing severe illness or hospitalization
• Sepsis survivors
• Children under one year of age

Understanding these risk factors can help in early identification and prompt treatment of sepsis.

Recognizing the Signs and Symptoms of Sepsis

Early detection of sepsis is crucial for successful treatment. What are the key indicators of sepsis? Look out for the following signs and symptoms:

• Elevated 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

It’s important to note that a medical assessment by a healthcare professional is necessary to confirm sepsis. If you suspect sepsis, seeking immediate medical attention is crucial.

Taking Action: What to Do If You Suspect Sepsis

Sepsis is a medical emergency that requires swift action. If you or a loved one has an infection that’s not improving or is worsening, follow these steps:

1. Seek medical care immediately
2. Ask your healthcare provider, “Could this infection be leading to sepsis?”
3. In case of a medical emergency, call 911 and inform the operator if you suspect sepsis or have COVID-19
4. If possible, wear a mask before medical help arrives

Remember, prompt recognition and treatment significantly increase survival rates. Treatment typically involves urgent medical care in an intensive care unit, close monitoring of vital signs, and often, administration of antibiotics.

The Road to Recovery: Rehabilitation After Sepsis

Surviving sepsis is just the beginning of the journey. What does the rehabilitation process entail for sepsis survivors? Rehabilitation usually starts in the hospital, focusing on gradually restoring mobility and self-care abilities. The ultimate goal is to help patients return to their previous level of health or as close to it as possible.

Key aspects of sepsis rehabilitation include:

• Slowly increasing physical activities (bathing, sitting up, standing, walking)
• Working closely with healthcare professionals to develop an appropriate rehabilitation plan
• Gradually building up activities while ensuring adequate rest

Post-Sepsis Syndrome: Understanding the Aftermath

Recovering from sepsis can be a challenging process, both physically and mentally. Many survivors experience a range of symptoms known collectively as Post-Sepsis Syndrome. What physical symptoms might you encounter after returning home from sepsis treatment?

• Extreme weakness and fatigue
• Breathlessness
• General body pains or aches
• Difficulty moving around
• Sleep disturbances
• Weight loss and lack of appetite
• Dry, itchy, or peeling skin
• Brittle nails
• Hair loss

In addition to physical symptoms, sepsis survivors may also face emotional and psychological challenges:

• Feelings of uncertainty and self-doubt
• Lack of interest in personal appearance
• Social withdrawal
• Flashbacks and unpleasant memories
• Difficulty distinguishing reality from imagination
• Increased anxiety and worry
• Poor concentration
• Depression, anger, or lack of motivation
• Frustration with physical limitations

Strategies for Coping with Post-Sepsis Recovery

Recovering from sepsis can be a long and challenging process. How can sepsis survivors and their caregivers navigate this difficult period? Here are some strategies to aid in the recovery process:

1. Be patient with yourself: Recovery takes time, and progress may be slow
2. Maintain open communication with your healthcare team: Regular check-ups and discussions about your progress are crucial
3. Set realistic goals: Break down larger recovery goals into smaller, achievable steps
4. Prioritize rest and sleep: Adequate rest is essential for healing and recovery
5. Gradually increase physical activity: Work with a physical therapist to develop a safe exercise plan
6. Eat a balanced diet: Proper nutrition supports your body’s healing processes
7. Seek emotional support: Consider joining a support group or speaking with a mental health professional
8. Keep a recovery journal: Track your progress and note any concerns to discuss with your healthcare provider

The Role of Nutrition in Sepsis Recovery

Proper nutrition plays a vital role in the recovery process after sepsis. How can dietary choices support healing and rehabilitation? Consider the following nutritional strategies:

• Focus on protein-rich foods to support tissue repair and immune function
• Include a variety of fruits and vegetables for essential vitamins and minerals
• Stay hydrated by drinking plenty of water throughout the day
• Consider nutritional supplements if recommended by your healthcare provider
• Eat smaller, more frequent meals if appetite is poor
• Choose nutrient-dense foods to maximize calorie intake

The Importance of Mental Health Support

The emotional and psychological impact of sepsis can be significant. How can survivors address their mental health needs during recovery? Consider these approaches:

• Seek professional counseling or therapy to process the trauma of sepsis
• Practice mindfulness or meditation to manage anxiety and stress
• Join a sepsis survivors support group to connect with others who understand your experience
• Engage in activities that bring joy and relaxation
• Communicate openly with family and friends about your emotional needs
• Consider cognitive behavioral therapy to address any persistent anxiety or depression

Long-Term Outlook: Life After Sepsis

While the recovery journey can be challenging, many sepsis survivors go on to lead fulfilling lives. What can sepsis survivors expect in the long term? The long-term outlook varies from person to person, but many survivors experience:

• Gradual improvement in physical symptoms over time
• Enhanced resilience and appreciation for life
• A new perspective on health and well-being
• Opportunities to advocate for sepsis awareness and support other survivors

It’s important to remember that recovery is a unique journey for each individual. Some survivors may face ongoing health challenges, while others may return to their pre-sepsis level of functioning. Regular follow-ups with healthcare providers and a commitment to overall health and wellness can contribute to positive long-term outcomes.

Preventing Future Sepsis Episodes

For sepsis survivors, preventing future episodes is a top priority. How can individuals reduce their risk of developing sepsis again? Consider these preventive measures:

• Stay up-to-date with vaccinations, including flu shots and pneumococcal vaccines
• Practice good hygiene, including regular handwashing
• Manage chronic health conditions effectively
• Seek prompt medical attention for any signs of infection
• Be aware of the signs and symptoms of sepsis
• Inform healthcare providers of your history with sepsis

Raising Awareness: The Importance of Sepsis Education

Increasing public awareness about sepsis is crucial for early detection and prevention. How can individuals contribute to sepsis education and awareness? Consider these actions:

• Share your sepsis story with friends, family, and community members
• Participate in sepsis awareness campaigns and events
• Support organizations dedicated to sepsis research and education
• Advocate for improved sepsis protocols in healthcare settings
• Educate others about the signs and symptoms of sepsis

By raising awareness, we can help reduce the incidence of sepsis and improve outcomes for those affected by this life-threatening condition.

The Role of Research in Advancing Sepsis Treatment

Ongoing research plays a crucial role in improving sepsis diagnosis, treatment, and outcomes. What are some areas of focus in current sepsis research?

• Development of more accurate and rapid diagnostic tools
• Investigation of novel treatment approaches, including immunomodulatory therapies
• Identification of genetic factors that influence sepsis susceptibility and outcomes
• Exploration of long-term effects of sepsis and strategies for improving recovery
• Implementation of artificial intelligence and machine learning in sepsis prediction and management

As research continues to advance our understanding of sepsis, we can hope for improved prevention strategies, more effective treatments, and better outcomes for sepsis survivors.

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.

Top of Page

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

Top of Page

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.

Top of Page

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.

Top of Page

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]

Top of Page

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.

Top of Page

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

Top of Page

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.

Top of Page

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.

Top of Page

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)

To receive email updates about this page, enter your email address:

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

Sepsis

• Health Issues »
• A
• B
• C
• D
• D
• E
• Y

R

• C
• T
• U
• F
• X
• C
• H
• W
• W 9000 5
• b
• S
• B
• E
• S
• I
• Popular Topics
  • Air pollution
  • Coronavirus disease (COVID-19)
  • Hepatitis
• Data and statistics »
  • News bulletin
  • The facts are clear
  • Publications
• Find Country »
• A
• B
• C
• D
• L
• E
• Y
• W
• W
• I
• Y
• K
• L 90 005
• M
• H
• O
• R
• R
• C
• T
• U
• F

90 004 X

• C
• H
• W
• W
• L
• S
• L
• E 900 05
• Yu
• I
• WHO in countries »
  • Reporting
• Regions »
  • Africa
  • America
  • Southeast Asia
  • Europe
  • Eastern Mediterranean
  • Western Pacific
• Media Center
  • Press releases
  • Statements
  • Media messages
  • Comments
  • Reporting
  • Online Q&A
  • Events
  • Photo reports
  • Case Studies
  • Questions and answers
  • Speeches
• Update
• Emergencies ”
• News ”
  • Disease Outbreak News
• WHO data »
• Dashboards »
  • COVID-19 Monitoring Dashboard
• Basic moments ”
• About WHO »
  • CEO
  • About WHO
  • WHO activities
  • Where does WHO work?
• Governing Bodies »
  • World Health Assembly
  • Executive committee
• Main page/
• Media Center /
• Newsletters/
• Read more/
• Sepsis

©
Photo

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.

90,000 Postpartum infections. What are Postpartum Infections?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Postpartum infections are a group of diseases of infectious etiology that develop within 6 weeks after childbirth and are directly related to them. Include local wound infections, infections of the pelvic organs, generalized septic infections. In the diagnosis of postpartum infections, the time of their development and connection with childbirth, the picture of peripheral blood, data from a gynecological examination, ultrasound, and bacteriological examination are of paramount importance. Treatment of postpartum infections includes antibiotic therapy, immunostimulating and infusion therapy, extracorporeal detoxification, sanitation of the primary focus, etc.

• Causes of postpartum infections
• Classification of postpartum infections
• Symptoms of postpartum infections
• Diagnosis of postpartum infections
• Treatment of postpartum infections
• Prognosis and prevention
• Prices for treatment

General

Postpartum (puerperal) infections are purulent-inflammatory diseases pathogenetically caused by pregnancy and childbirth. They include wound infections (postpartum ulcers, endometritis), infections limited to the pelvic cavity (metritis, parametritis, salpingoophoritis, pelvioperitonitis, metrothrombophlebitis, etc.), diffuse infections (peritonitis, progressive thrombophlebitis) and generalized infections (septic shock, sepsis). The time frame during which these complications can develop is from the moment the placenta is isolated to the end of the sixth week of the postpartum period. Puerperal diseases of infectious etiology occur in 2-10% of puerperas. Septic complications play a leading role in the structure of maternal mortality, which puts them in a number of priority problems in obstetrics and gynecology.

postpartum infections

Causes of postpartum infections

The occurrence of postpartum infections is due to the penetration of microbial agents through the wound surfaces formed as a result of childbirth. The entrance gate can be ruptures of the perineum, vagina and cervix; the inner surface of the uterus (placental site), postoperative scar during caesarean section. At the same time, pathogens can get to the wound surface both from the outside (from the instruments, hands and clothing of personnel, surgical underwear, care items, etc.), and from endogenous foci as a result of the activation of their own opportunistic flora.

The etiological structure of postpartum infections is very dynamic and variable. Of the conditionally pathogenic microorganisms, aerobic bacteria predominate (enterococci, E. coli, staphylococci, group B streptococci, Klebsiella, Proteus), but anaerobes (fusobacteria, bacteroids, peptostreptococci, peptococci) are also quite common. The importance of specific pathogens is great – chlamydia, mycoplasmas, fungi, gonococci, Trichomonas. A feature of postpartum infections is their polyetiology: in more than 80% of cases, microbial associations are sown, which are more pathogenic and resistant to antibiotic therapy.

The risk of developing postpartum infections is significantly increased in women with pathology of pregnancy (anemia, toxicosis) and childbirth (early discharge of water, weak labor, prolonged labor, bleeding, retention of parts of the placenta, lochiometer, etc. ), extragenital pathology (tuberculosis, obesity, diabetes mellitus). Endogenous factors predisposing to microbial contamination of the birth canal can be vulvovaginitis, colpitis, cervicitis, pyelonephritis, tonsillitis, sinusitis in the puerperal woman. When infected with a highly virulent flora or a significant decrease in the immune mechanisms in a puerperal, the infection can spread beyond the primary focus by the hematogenous, lymphogenous, intracanalicular, perineural route.

Classification of postpartum infections

Based on the anatomical, topographical and clinical approach, 4 stages of the progression of postpartum infection are distinguished (authors – S. V. Sazonova, A. V. Bartels).

• Stage 1 – local infection that does not spread beyond the area of ​​the wound surface (postpartum ulcer of the perineum, vagina and uterine wall, suppuration of sutures, suppuration of hematomas, postpartum endometritis)
• Stage 2 – postpartum infection that extends beyond the boundaries of the wound surface, but limited to the pelvic cavity (metroendometritis, adnexitis, parametritis, metrothrombophlebitis, limited pelvic thrombophlebitis, pelvioperitonitis)
• Stage 3 – diffuse postpartum infection (peritonitis, progressive thrombophlebitis)
• 4th stage – generalized septic infection (sepsis, infectious-toxic shock).

As a separate form of postpartum infection, lactational mastitis is isolated. The severity of infectious complications after childbirth depends on the virulence of the microflora and the reactivity of the macroorganism, so the course of the disease varies from mild and erased forms to severe and fatal cases.

Symptoms of postpartum infections

A postpartum ulcer is formed as a result of infection of abrasions, cracks and tears in the skin of the perineum, vaginal mucosa and cervix. The clinical picture of this postpartum complication is dominated by local symptoms, the general condition is usually not disturbed, the temperature does not exceed subfebrile figures. The puerperal complains of pain in the suture area, sometimes itching and dysuric phenomena. When examining the birth canal, an ulcer with clear boundaries, local edema and inflammatory hyperemia are found. At the bottom of the ulcer, a grayish-yellow coating, areas of necrosis, and mucopurulent discharge are determined. The ulcer bleeds easily on contact.

Postpartum endometritis (metroendometritis), among other postpartum infections, is the most common – in 36-59% of cases. There are classic, obliterated, abortive forms and metroendometritis after caesarean section. In a typical (classic) variant, postpartum endometritis manifests itself on the 3-5th day after childbirth with a rise in temperature to 38-39 ° C and chills. Locally marked subinvolution of the uterus, its pain on palpation, cloudy purulent discharge from the cervical canal with a fetid odor. The abortive form of postpartum infection develops on days 2-4, but undergoes a rapid regression due to the start of therapy. For the erased course of postpartum endometritis, a late onset (5-8 days), a protracted or undulating course, and less pronounced symptoms are typical. The clinical manifestation of endometritis after delivery by cesarean section falls on days 1-5; pathology proceeds with general and local manifestations.

Postpartum parametritis develops on the 10-12th day when the infection passes to parametrium – periuterine tissue. A typical clinic includes chills, febrile fever, which lasts 7-10 days, intoxication. The puerperal is concerned about pain in the iliac region on the side of inflammation, which gradually increase, radiate to the lower back and sacrum. A few days after the onset of postpartum infection in the area of ​​the lateral surface of the uterus, a painful infiltrate is palpated, first of a soft, and then of a dense consistency, soldered to the uterus. The outcomes of postpartum parametritis may be resorption of the infiltrate or its suppuration with the formation of an abscess. Spontaneous opening of the abscess can occur in the vagina, bladder, uterus, rectum, abdominal cavity.

Postpartum thrombophlebitis can affect superficial and deep veins. In the latter case, the development of metrothrombophlebitis, thrombophlebitis of the veins of the lower extremities and veins of the pelvis is possible. They usually appear within 2-3 weeks after delivery. Clinical harbingers of postpartum complications of this type are prolonged fever; persistent step-like increase in heart rate; pain in the legs when moving and pressing on soft tissues; swelling in the ankles, lower leg or thigh; cyanosis of the lower extremities. The development of metrothrombophlebitis is indicated by tachycardia up to 100 bpm, subinvolution of the uterus, prolonged bleeding, palpation of painful cords along the lateral surfaces of the uterus. Thrombophlebitis of the pelvic veins is dangerous for the development of ileofemoral venous thrombosis and pulmonary embolism.

Postpartum pelvioperitonitis, or inflammation of the peritoneum of the small pelvis, develops 3-4 days after childbirth. The manifestation is acute: the body temperature rises rapidly to 39-40°C, there are sharp pains in the lower abdomen. Vomiting, flatulence, painful defecation may occur. The anterior abdominal wall is tense, the uterus is enlarged. Postpartum infection is resolved by resorption of the infiltrate in the pelvis or the formation of an abscess of the Douglas pouch.

The clinic of diffuse and generalized postpartum infection (peritonitis, sepsis) does not differ from that in infectious diseases of a different etiology. Lactational mastitis is discussed in detail in the section “Diseases of the mammary glands”.

Diagnosis of postpartum infections

Factors indicating the development of postpartum infections are signs of infectious-purulent inflammation in the area of ​​the birth wound or pelvic organs, as well as general septic reactions that occurred in the early period after childbirth (up to 6-8 weeks). Complications such as postpartum ulcers, suppuration of sutures or hematomas are diagnosed based on a visual examination of the birth canal. A vaginal examination allows a gynecologist to suspect postpartum infections of the pelvic organs. In these cases, a delayed contraction of the uterus, its soreness, pastosity of the periuterine space, infiltrates in the small pelvis, and cloudy, fetid discharge from the genital tract are usually found.

Additional data is obtained during a gynecological ultrasound. In case of suspected thrombophlebitis, dopplerography of the pelvic organs, ultrasound of the veins of the lower extremities is indicated. With postpartum endometritis, hysteroscopy is informative; with purulent parametritis – puncture of the posterior fornix of the vagina. According to indications, radiation diagnostic methods are used: phlebography, hysterography, radioisotope research.

All clinical forms of postpartum infection are characterized by a change in the picture of peripheral blood: a significant leukocytosis with a neutrophilic shift to the left, a sharp increase in ESR. In order to identify infectious agents, a bacteriological culture of the discharge of the genital tract and the contents of the uterus is performed. Histological examination of the placenta may indicate signs of inflammation and, therefore, a high likelihood of developing postpartum infections. An important role in planning therapy and assessing the severity of complications is the study of blood biochemistry, acid-base balance, blood electrolytes, and coagulograms.

Treatment of postpartum infections

The whole complex of therapeutic measures for postpartum infections is divided into local and general. Bed rest and applying ice to the abdomen helps stop further spread of the infection from the pelvic cavity.

Local procedures include treatment of wounds with antiseptics, dressings, ointment applications, removal of sutures and opening of the wound in case of suppuration, removal of necrotic tissues, topical application of proteolytic enzymes. With postpartum endometritis, it may be necessary to perform curettage or vacuum aspiration of the uterine cavity (with retention of placental tissue and other pathological inclusions in it), dilation of the cervical canal, aspiration and lavage drainage. When a parametrium abscess is formed, it is opened through the vagina or by laparotomy and drainage of the parauterine tissue.

Local measures for postpartum infections are carried out against the background of intensive general therapy. First of all, antibacterial agents are selected that are active against all isolated pathogens (broad-spectrum penicillins, cephalosporins, aminoglycosides, and others), which are administered intramuscularly or intravenously in combination with metronidazole. At the time of treatment, it is advisable to interrupt breastfeeding. In order to detoxify and eliminate the water-salt imbalance, infusions of colloidal, protein, salt solutions are used. It is possible to carry out extracorporeal detoxification: hemosorption, lymphosorption, plasmapheresis.

In postpartum infections of staphylococcal etiology, in order to increase specific immunological reactivity, antistaphylococcal gamma globulin, staphylococcal toxoid, and antistaphylococcal plasma are used. In order to prevent thrombosis, anticoagulants, thrombolytics, antiplatelet agents are prescribed under the control of a coagulogram. In the complex of drug therapy, antihistamines, vitamins, glucocorticoids are widely used. At the rehabilitation stage, laser therapy, local ultraviolet radiation, UHF therapy, ultrasound, electrical stimulation of the uterus, balneotherapy and other methods of physiotherapy are prescribed.

In some cases, surgical assistance may be required – removal of the uterus (hysterectomy) with its purulent fusion; thrombectomy, embolectomy or phlebectomy – with thrombophlebitis.

Prognosis and prevention

In wound infections and infections limited to the pelvic area, the prognosis is satisfactory. Timely and adequate therapy can stop the further progression of postpartum infections. However, in the long term, the prognosis for reproductive function can be variable. The most severe consequences for the health and life of the puerperal entail diffuse peritonitis, sepsis and septic shock.

Prevention of postpartum infections is ensured by strict and strict observance of the sanitary and hygienic regime in obstetric institutions, the rules of asepsis and antisepsis, and personal hygiene of personnel.