Septicemia | Johns Hopkins Medicine

What is septicemia?

Septicemia, or sepsis, is the clinical name for blood poisoning by bacteria. It is the body’s most extreme response to an infection. Sepsis that progresses to septic shock has a death rate as high as 50%, depending on the type of organism involved. Sepsis is a medical emergency and needs urgent medical treatment. Without treatment, sepsis can quickly lead to tissue damage, organ failure, and death.

What causes sepsis?

These infections are most often associated with sepsis:

These 3 germs most frequently develop into sepsis are:

• Staphylococcus aureus (staph)

• Escherichia coli (E. coli)

• Some types of Streptococcus

Who is at risk for sepsis?

An infection can happen to anyone, but there are certain risk factors that put people at higher risk for developing sepsis. These include people with:

• Chronic medical conditions such as diabetes, cancer, lung disease, immune system disorders, and kidney disease

• Weak immune systems

• Community-acquired pneumonia

• A previous hospitalization (especially hospitalization for an infection)

Also at risk are:

What are the symptoms of sepsis?

The following are the most common symptoms of sepsis. However, each person may experience symptoms differently.

People with sepsis often develop a hemorrhagic rash—a cluster of tiny blood spots that look like pinpricks in the skin. If untreated, these gradually get bigger and begin to look like fresh bruises. These bruises then join together to form larger areas of purple skin damage and discoloration.

Sepsis develops very quickly. The person rapidly becomes very ill, and may:

• Lose interest in food and surroundings

• Become feverish

• Have a high heart rate

• Become nauseated

• Vomit

• Become sensitive to light

• Complain of extreme pain or discomfort

• Feel cold, with cool hands and feet

• Become lethargic, anxious, confused, or agitated

• Experience a coma and sometimes death

Those who become ill more slowly may also develop some of the signs of meningitis. The symptoms of sepsis may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.

How is sepsis diagnosed?

The diagnose sepsis, your healthcare provider will look for a variety of physical finding such as low blood pressure, fever, increased heart rate, and increased breathing rate. Your provider will also do a variety of lab tests that check for signs of infection and organ damage. Since some sepsis symptoms (such as fever and trouble breathing) can often be seen in other conditions, sepsis can be hard to diagnose in its initial stages.

How is sepsis treated?

Specific treatment for sepsis will be determined by your healthcare provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Sepsis is a life-threatening emergency that needs immediate medical attention. People with sepsis are hospitalized and treatment is started as quickly as possible. Treatment includes antibiotics, managing blood flow to organs, and treating the source of the infection. Many people need oxygen and IV (intravenous) fluids to help get blood flow and oxygen to the organs. Depending on the person, help with breathing with a ventilator or kidney dialysis may be needed. Surgery is sometimes used to remove tissue damaged by the infection.

How can I prevent sepsis?

One of the most important infection control behaviors is hand washing. You should wash hands with clean, running water for at least 20 seconds. Wash your hands:

• Before eating

• After using the toilet

• Before and after caring for a sick person

• Before, during, and after preparing food

• Before and after cleaning a wound or cut

• After blowing your nose, coughing, or sneezing

• After touching an animal or handling pet food or pet treats

• After changing diapers or cleaning up after a child who has used the toilet

• After touching garbage

To help keep your immune system strong and prevent sepsis, also:

• Keep cuts clean and covered until healed.

• Manage chronic medical conditions such as diabetes.

• Maintain a healthy weight.

• Eat a healthy well-balanced diet.

• Exercise.

• Get recommended vaccinations on schedule.

• When an infected area is not getting better or is getting worse, get medical care.

Sepsis and Wounds – End Sepsis

Cuts and scrapes can happen, but a simple wound, if not treated properly, can quickly become a serious health risk. Even small scrapes or cuts can allow germs–including viruses and bacteria–to enter the blood stream, causing an infection which can lead to sepsis.

Symptoms.

• Cuts that have pus or liquid. Infected wounds tend to build up pus or fluid which is cloudy, green or foul smelling.
• Red skin around the injury. Red skin is sign of irritation. If the discoloration continues, there is a high probability that it is an infected wound.
• Swelling that gets worse after a few days. Swelling is associated with wounds; if swelling persists it could be a sign of infection.
• A pimple or yellowish crust on top. As the wound begins to dry, a crust starts to form in the outer layer. If the crust is yellowish and if there is a formation of pimples on or near the wound, it could be septic.
• Sores that look like blisters. If there is a formation of sores which look like pockets of fluid around the area, they could be septic.
• Pain that gets worse after a few days. If the pain experienced increases over time, this could be a sign of a septic wound.
• The wound hasn’t healed. If there’s nothing wrong with the wound but it looks the same and hasn’t closed up after 10 days, the wound may be septic.
• High fever.  When a wound is septic, individuals tend to have a fever.

Causes.
Any wound that isn’t properly cleaned and covered can allow bacteria, viruses or fungi to enter through the opening in the skin, leading to infection. Sepsis occurs when the body overreacts to infection, releasing chemicals into the bloodstream that ultimately cause organ failure and death. The best way to prevent sepsis is to prevent infection.

Diagnosis.
Check for the symptoms listed above. If you have one or more of these symptoms, a doctor or medical professional can check the wound to see if it is septic.

Treatment.
A septic wound is a medical emergency requiring immediate professional attention. Treatment with antibiotics and IV fluids is necessary.

Prevention.
Cuts and scrapes happen, but do not take a simple wound for granted. Wounds must be treated properly by cleaning and covering to prevent infection and sepsis. Always check for the telltale signs of infection. If you think you or someone you know has an infected wound, do no hesitate to seek immediate help. Check for high fever, cuts with watery discharge or pus, persistent red skin around the wound and swelling.

Sepsis | Cedars-Sinai

Not what you’re looking for?

What is sepsis?

Sepsis is a serious condition that
can result in organ damage or death. It happens when the body’s immune system has a
severe response to an infection. Sepsis is a medical emergency. It needs to be treated
right away.

Bacteria, viruses, and fungi can invade your body and cause disease. When your body senses one of these, the immune system responds. Your body releases certain chemicals into the blood that can help fight infection.

In some cases, the body has an
abnormal and severe response to infection. This can cause inflammation around the body
and damage your body’s cells. Blood clots may start to form all over the body. Some
blood vessels may start to leak. Blood flow and blood pressure may start to drop. This
harms the body’s organs by stopping oxygen and nutrients from reaching them. If this
process isn’t stopped, organs in the body can stop working. This can lead to death.

The term sepsis is used to define
any condition in which the body’s organs stop working right and there is an infection.
Septic shock is when sepsis occurs along with changes to the circulatory, cellular, and
metabolic systems.

Sepsis is a common cause of death
in hospital intensive care units. It can affect people of all ages. But children and
older adults are at highest risk.

What causes sepsis?

Sepsis never happens on its own. It always starts with an infection somewhere in your body, such as:

• Lung infection
• Urinary tract infection
• Skin infection
• Abdominal infection such as from
  appendicitis or an infected gallbladder

Bacteria are the most common cause
of these infections. Viruses, parasites, and fungi can also cause them and lead to
sepsis. In some cases, the bacteria enter the body through a medical device such as a
blood vessel or urinary catheter. An infection that spreads around the body through the
bloodstream is more likely to cause sepsis. An infection in just one part of the body is
less likely to lead to sepsis.

Sepsis is sometimes called by the
nonmedical term blood poisoning. But this is misleading. Sepsis isn’t caused by
poison.

Who is at risk for sepsis?

Some health problems and other
conditions that affect your ability to fight infection can raise your risk for sepsis.
These include:

• HIV/AIDS
• Diabetes
• Cancer
• Liver disease
• Severe burns
• Respiratory failure
• Alcoholism
• Other conditions that affect the
  immune system

Babies, children, and older adults also have a higher risk of
developing sepsis.

Careful treatment of these health conditions may help reduce the risk of sepsis.

What are the symptoms of sepsis?

Symptoms and signs of sepsis can include:

• Fever or abnormally low temperature
• Chills
• Rash
• Confusion
• Trouble breathing
• Swelling
• Rapid heart rate and breathing rate
• Low blood pressure
• Signs of reduced blood flow to one or more organs
• Less urine

The symptoms may vary depending on the severity of the sepsis. These symptoms may be mild at first and then quickly get worse.

How is sepsis diagnosed?

To diagnose sepsis, a healthcare
provider will ask about your medical history and your symptoms. Some of the symptoms of
early sepsis are the same as other health problems. This can make sepsis hard to
diagnose in its early stages. A full exam of the body is needed to help diagnose
sepsis.

You may also have tests, such as:

• Urine tests to look for signs of infection in your urine, and check kidney function
• Blood tests to looks for signs of infection in your blood
• Imaging tests such as a chest X-ray,
  CT scan, or other tests to look for the site of infection

A healthcare provider will often
suspect sepsis in a person with certain signs and symptoms. These include an abnormal
body temperature, rapid heart and breathing rate, and abnormal white blood cell count. A
healthcare provider can make an official diagnosis when there is a source of infection
and abnormal signs and symptoms point to organ problems. Septic shock is diagnosed when
the signs of organ dysfunction do not get better with treatment.

How is sepsis treated?

Treatment is done in a hospital’s
intensive care unit (ICU). This is because sepsis treatment needs very close monitoring.
Vital signs such as heart rate, blood pressure, and breathing will be constantly
watched. Blood and urine tests will be done often. Your condition will be closely
watched and your treatment adjusted as often as needed.

The source of the sepsis must be
treated. At first, you will often be treated with one or more antibiotics that work on
many types of bacteria. Results of culture and sensitivity testing can identify a
specific type of bacteria and the appropriate antibiotic. Pockets of infection may need
to be drained. These are called abscesses. In some cases, an infected part of the body
may need to be removed with surgery.

Along with antibiotic treatment,
you will also need other types of treatments to help support the body, such as:

• Extra oxygen, to keep up normal oxygen levels
• IV (intravenous) fluids, to help bring
  blood pressure and blood flow to organs back to normal
• A breathing tube and a ventilator, if
  you have trouble breathing
• Dialysis, in case of kidney failure
• Medicines to raise the blood
  pressure
• Other treatments to prevent problems such as deep vein thrombosis and pressure ulcers
• Insulin to keep blood sugars in the
  optimal range, even in you don’t have a history of diabetes

Most people with mild sepsis do get
better. But even with intense treatment, some people die from sepsis. Up to half of all
people with severe sepsis will die from it.

What are possible complications of sepsis?

Many people survive sepsis without
any lasting problems. Other people may have serious problems from sepsis, such as organ
damage. Some possible complications of sepsis are:

• Kidney failure
• Tissue death (gangrene) of fingers or toes that may require amputation
• Permanent lung damage from acute respiratory distress syndrome
• Permanent brain damage, which can cause memory problems or more severe symptoms
• Later problems with your immune
  system, which can raise the risk for future infections
• Damage to the heart valves
  (endocarditis), which can lead to heart failure

When should I call my healthcare provider?

Seek care right away if you or
someone else has symptoms of sepsis. Early diagnosis and treatment can help improve the
chances of a good recovery. After recovery, you may be more prone to infections and
other illnesses. Call or see your healthcare provider right away at the first signs of
an infection or illness.

Key points about sepsis

Sepsis is a serious medical condition that can result in organ damage or death. It happens when the body’s immune system has a severe response to an infection.

• Sepsis is a medical emergency. It
  needs to be treated right away.
• Possible signs and symptoms of sepsis
  include fever, confusion, trouble breathing, rapid heart rate, and very low blood
  pressure.
• Sepsis is treated with antibiotics, oxygen, and IV fluids as
  soon as possible. Other treatments such as kidney dialysis, breathing support, or
  surgery may also be needed.
• Sepsis can cause serious
  complications. These include kidney failure, gangrene, and death.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Barry Zingman MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: L Renee Watson MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Septic shock: Prevention, treatment, and causes

Septic shock is a severe and potentially fatal condition that occurs when sepsis leads to life-threatening low blood pressure. Sepsis develops when the body has an overwhelming response to infection.

Knowing how to recognize and prevent septic shock is vital. The body usually responds to an infection by releasing inflammatory substances into the bloodstream. These regulate the immune system to fight the infection.

When the body loses control of this response, it triggers damaging changes to the organs. As a result, they can become dysfunctional or even stop working entirely. This condition is called sepsis.

If a person with sepsis has low blood pressure that does not improve with fluid treatment, this means that their body has gone into septic shock. They will need medications called vasopressors to keep their blood pressure high enough to get blood to their organs.

Without this treatment, insufficient blood flow can result in vital organs not getting enough oxygen and beginning to fail, such as the brain, kidneys, lungs, and heart.

Sepsis is often fatal. According to the Centers for Disease Control and Prevention (CDC), it causes the death of about 258,000 people each year in the United States and is the ninth leading cause of disease-related deaths.

Septic shock is also a grave condition with life-altering complications that include chronic pain, incorrectly functioning organs, and post-traumatic stress disorder (PTSD).

This article discusses how to understand the signs and symptoms of septic shock and how to prevent it.

There are a few steps that people can take to reduce their risk of developing sepsis and septic shock:

• Get regular vaccinations against viral infections, such as flu, pneumonia, chickenpox, HIV, and other infections that could potentially lead to sepsis.
• Practice good hygiene, such as bathing and changing clothes regularly. Washing the hands frequently, especially after handling food, touching pets, and using bathroom facilities, is another way to keep infection at bay.
• Care for and clean any open or gaping wounds. Wear disposable gloves, and rinse wounds with clean, soap-free water to clear out debris or dirt. Cover the wound to protect it, and see a doctor if the wound does not close or might still contain dirt.
• Look out for signs of infection, such as fever, chills, rapid breathing, rash, or confusion.
• For any bacterial infections, follow the doctor’s advice on how to take the antibiotics and finish the whole course of treatment. Store the medicine according to the packaging instructions.
• Treat fungal and parasitic infections as soon as symptoms appear, and use medication specific to the particular fungus or parasite.
• Control diabetes, if relevant.
• Avoid smoking

Hand-washing tips for people with compromised immunity

People with compromised immune function should take extra care when washing their hands and follow the steps below:

• Remove rings and watches when possible to clean the areas of skin beneath them.
• Add warm, running water to the skin on the hands and wrists.
• Lather liquid soap onto the hands, being sure to include the skin between the fingers.
• Spend 10–15 seconds washing the hands.
• Use a towel to turn off the tap to prevent recontamination.

Sepsis is a very severe illness, and immediate, intensive treatment is crucial for surviving the condition and preventing septic shock. People with sepsis and septic shock require hospitalization for close monitoring and treatment.

Studies have shown that the risk of death from sepsis and septic shock increases with each hour before the administration of antibiotics.

Doctors use the following medications to treat sepsis and septic shock:

Antibiotics: Treatment should begin within the first 6 hours after diagnosis. The doctor will administer these drugs directly into a vein.

They will usually start treatment with broad-spectrum antibiotics that act against most of the bacteria that could be causing the infection.

Once the blood test results have revealed which bacteria is responsible, the doctor is likely to switch to a more specific antibiotic.

Vasopressors: These medications are necessary to maintain adequate blood pressure in people with septic shock. A doctor will use these if blood pressure remains too low after a person receives fluids.

Vasopressors work by tightening the blood vessels to increase blood pressure. If the blood pressure continues to drop with this medication, the situation is a cause for concern.

Corticosteroids: Doctors use these when blood pressure and heart rate continue to be unstable even after they have received fluids and vasopressors.

Additional medications may include insulin to stabilize blood sugar levels and drugs to alter the response of the immune system. In some cases, a person might require surgery to remove an abscess, which is a sealed-off collection of pus, to stop the infection.

People with severe sepsis and septic shock usually need to be in an intensive care unit (ICU) as they may require oxygen, mechanical ventilation, intravenous (IV) fluids, and vasopressors. Depending on the severity of their condition, some individuals may also have to undergo dialysis because of kidney failure.

The most common cause of sepsis is a bacterial infection. Sepsis can then lead to septic shock.

Whenever bacteria find their way into the bloodstream, harmful infections might occur.

Bacteria or other infectious agents can get into the bloodstream through an opening in the skin, such as a cut or burn.

Sepsis can also be the result of an infection in an organ, such as a urinary tract infection (UTI) or lung infection. Fungi and viruses can also cause sepsis, particularly in people with weakened immune systems, but this is less common.

Some of the most common conditions that can lead to sepsis include pneumonia and infections of the abdominal area, kidneys, and urinary tract.

The following groups of people have a higher risk of sepsis:

• people who are under the age of 1 year or over 65 years old
• those who have a compromised immune system, such as people who have HIV or are receiving chemotherapy
• people who are already unwell or have long-term health conditions, such as diabetes, lung disease, or kidney failure
• individuals with open wounds, injuries, or burns
• those with implanted medical devices, such as IV catheters or breathing tubes

The symptoms of sepsis may vary from person to person, but early signs and symptoms typically include the following:

• shortness of breath
• fever, shivering, or feeling very cold
• extreme pain or discomfort
• a high heart rate
• unexplained confusion or disorientation
• sweaty or clammy skin

Additional symptoms may include:

• common signs of infection, such as fever, diarrhea, vomiting, or a sore throat
• decreased urination frequency
• pale or discolored skin
• rashes

It is vital to treat sepsis in its early stages before it progresses and becomes septic shock.

Sepsis

An individual is at risk of developing sepsis if they are not in the intensive care unit and meet two or more of the following criteria:

• a breathing rate of 22 breaths per minute or more
• confusion or another sign that the brain is not functioning normally
• systolic blood pressure of 100 mm Hg or less

For a doctor to diagnose sepsis, the individual must have an out-of-control response to an infection that leads to life-threatening dysfunction in one or more organs.

Septic shock

To receive a diagnosis of septic shock, the individual must meet the criteria for sepsis and also requires vasopressors in addition to fluids to maintain adequate blood flow.

It is crucial to identify sepsis and septic shock early.

However, it can sometimes be difficult to recognize these conditions because their symptoms are similar to those of other disorders and there is no specific test to confirm them.

Doctors with limited experience of these conditions can sometimes miss them as the diagnosis requires a collection of different findings. Tests that may help a doctor confirm sepsis and septic shock include:

• Blood cultures: A doctor will draw samples of blood from two different sites in the body and test them for signs of infection.
• Urine tests: If the doctor suspects a UTI, they may ask for a urine sample to check for bacteria and infection.
• Wound secretions: The doctor might test a small sample of liquid from a wound to help determine the best antibiotic to use.
• Respiratory secretions: If the individual is coughing up mucus, the doctor may test it to confirm what type of germ has caused the infection.

In many people, the exact site of the infection will not be apparent. In these cases, a doctor can use imaging scans, such as X-rays, CT scans, MRI scans, and ultrasounds, to help identify infected areas of the body.

Sepsis and septic shock are life-threatening conditions that require urgent medical treatment. Anyone who suspects that they or someone else may have sepsis or have gone into septic shock should seek emergency care.

Early diagnosis and treatment are vital to a good outcome.

On the alert for a quiet killer

Severe sepsis is the top cause of death in non-cardiac intensive care units (ICUs),
according to research in the February 2010 Critical Care Medicine. The Surviving Sepsis Campaign (SSC) in 2002 provided evidence-based guidelines and
tools for managing the condition, yet progress has been uneven in different areas
of the hospital. In particular, physicians who work on general hospital wards are
less likely than emergency and critical care specialists to recognize the warning
signs and begin treatment soon enough, experts said.

“We know that the mortality of patients who become septic on the wards is higher
than if they come in septic to the emergency department or if they develop sepsis
in the ICU,” said Mitchell M. Levy, MD, director of critical care services
at Rhode Island Hospital in Providence, professor of medicine at Brown University
School of Medicine, and a member of the SSC executive committee.

Bacterial sepsis image with scanning electron microscope. Courtesy of Phototake.

“We suspect patients languish on the wards and go undiagnosed until they get
much sicker, and obviously ill with sepsis, and we’ve missed an opportunity to intervene
early,” Dr. Levy added. “The next area of the hospital that I think
could have a significant impact on the survival of patients with severe sepsis is
the hospitalists in the wards.”

Stealthy menace

Patients developing sepsis may go undiagnosed because the early symptoms can be subtle
or characteristic of other disorders. Altered mental status in an elderly patient,
for example, may be chalked up to delirium or stroke rather than the organ dysfunction
associated with sepsis. Physicians also may focus on patients’ underlying infection
and lose sight of the more immediate threat of sepsis.

“A hospitalist may get called to the bed of a patient with fever and think,
is it a urinary tract infection, is it pneumonia? Without thinking about the systemic
response to infection, the doctor focuses on antibiotics and diagnostics as opposed
to rapid treatment of sepsis,” said Mark J. Rosen, FACP, professor of medicine
at Hofstra North Shore-LIJ School of Medicine and pulmonologist in the division of
pulmonary, critical care and sleep medicine at North Shore-LIJ Health System. “Treating
the infection and neglecting the septic systemic response may be a killer.”

A patient with some but not all of the criteria for sepsis can look relatively well
and still be on the verge of a medical emergency, said Morgan Moncada, MD, director
of the hospitalist program at Reid Hospital in Richmond, Ind. “Many physicians
don’t understand how quickly sepsis can take a patient who looks good,” he
said. “I hear that all the time: ‘Oh, he looks good, his BP’s fine.’
And I say, ‘Yes, but he still meets the criteria for sepsis.’”

Recognizing SIRS

According to the SSC, patients with an existing infection or a suspected new infection
and who meet any two of the criteria for systemic inflammatory response syndrome (SIRS)
are considered septic. Those criteria are: hyperthermia (>38.3° C), hypothermia
(<36° C), tachycardia (>90 bpm), tachypnea (>20 bpm), acutely altered
mental status, leukocytosis (white blood count >12,000 µL), leukopenia
(white blood count <4,000 µL), and hyperglycemia (plasma glucose >120
mg/dL) in the absence of diabetes. An SSC screening tool and treatment guidelines
are available online.

The next step is to obtain lactic acid levels, blood cultures and complete blood count,
the SSC says. A lactate level exceeding 4 mmol/L, in particular, can help identify
patients with severe sepsis who have normal blood pressure or who don’t appear seriously
ill.

“A patient can come in with a normal blood pressure, with a fever but not looking
too bad, and then you find out the lactate is 5 or 6,” said Margaret M. Parker,
FACP, professor of pediatrics, anesthesia and medicine at Stony Brook University in
Stony Brook, N.Y. “That patient is a lot sicker than we sometimes appreciate.”

The importance of education

Educating staff on how to recognize sepsis and customizing a screening tool are key
to improving early diagnosis, experts said. The sepsis initiative at Stony Brook University
Medical Center, for example, includes group and individual instruction for nurses,
and lectures for house staff, residents and hospitalists on how to use the screening
tool, said Dr. Parker, who also served on the SSC executive committee.

Mortality from sepsis at Stony Brook has dropped from about 28% in 2006 to about 18%
currently, though most of that improvement occurred in the ED, Dr. Parker said.

“Hospital-wide, it has not been easy to get timely diagnosis of sepsis, so
over the past few months we’ve been trying to direct our efforts toward earlier diagnosis
on the floors,” she said. “Our rapid response teams screen every patient
for sepsis. We’re also working with information technology to have the computer flag
patients identified with altered mental status and a positive blood culture.”

Unlike the ED and ICU, which essentially have one team of doctors and nurses, there
are often several teams on the floors—as well as more patients per nurse. That
makes it more difficult to implement processes, such as daily SIRS screening, on the
floors than in the ICU, she said.

“We’ve tried to implement the screening tool on the (general medicine) floors
to be done each shift, but that hasn’t been as successful,” Dr. Parker said.
“Finding the right resident to order labs and make the determination about
new infection can be quite a challenge.”

Checklists

Creating a checklist of criteria to identify sepsis is an idea that sounds simple
and can work, although getting physicians to refer to it can be challenging, experts
said.

“Getting doctors to agree that protocolized medicine is better than ‘I
think’ or ‘in my experience’ is the most difficult part,”
said Marc T. Zubrow, FACP, director of critical care medicine at Christiana Care Health
System in Newark, Del. “When I get asked to review a sepsis case for quality
issues, it’s rarely a diagnostic mystery. The problem was that someone didn’t realize
they were looking at SIRS criteria early on.”

Launched in early 2004, the Sepsis Alert program at Christiana Care began with an
intensive educational program focused on early identification of patients with SIRS.
Tactics included presentations to nursing and physician grand rounds and to all incoming
residents, in-service seminars, videos, posters and internal newsletter articles.
Physicians and nurses in the EDs and ICUs received a Sepsis Alert packet (including
a care management guideline, a treatment algorithm, a poster, and information to streamline
patient identification and management).

In addition, the Sepsis Alert team created a first-dose kit containing single-dose
vials of antibiotics and corticosteroids with administration guidelines. Providing
members of the rapid response team with the Sepsis Alert packet and medication kit
brought these key elements of the program to the bedside of hospitalized inpatients,
Dr. Zubrow said; the program achieved a 49.4% decrease in mortality over three years.

“After the initial development phase, we’ve devoted most of our efforts into
reawakening the education process,” said Dr. Zubrow. “I think for the
hospitalist, success depends on keeping that radar screen up all the time that this
could be sepsis. Think of that diagnosis, and if you’re not sure, give them antibiotics
anyhow because, clearly, that’s what’s going to improve your outcomes.”

Keeping vigilant

In addition to those with known infections, patients at higher risk for developing
sepsis include the elderly, those who are immunocompromised and those with indwelling
catheters, tubes and lines, Dr. Parker said. “The elderly can be particularly
difficult to diagnose because they are less likely to have fever with sepsis, which
is one of the common flags most health professionals look for, and they are more likely
to have nonspecific signs such as changes in mental status,” she added.

Comorbidities such as diabetes, chronic lung disease and heart disease also predispose
patients to develop severe sepsis, Dr. Levy said.

“When a patient comes to the ward with bronchitis or low-level pneumonia, or
a diabetic patient has a small skin ulcer, those are the patients that physicians
and nurses need to watch closely,” Dr. Levy said. “We need to have a
heightened sense of anxiety so that we’re able to pick up the transition earlier between
a simple infection and the development of sepsis or severe sepsis.”

Coordination and communication among departments and between physicians and nurses
are also essential to ensuring that septic patients aren’t missed. “It’s a
team effort, and the nurses are my eyes and ears when I’m not here,” said Dr.
Moncada. “Everyone needs to be able to recognize a problem and notify the rapid
response team, if necessary.”

The sepsis initiative at Reid Hospital, which is not yet a formalized program, began
with Dr. Moncada and his hospitalist group. Dr. Moncada, who became a sepsis “champion”
after studying critical care and sepsis medicine through a fellowship in 2006, said
the first step was educating his hospitalist team about sepsis. As the team became
better at identifying sepsis patients, it brought that information to the ED, he said.

“When the ED would call me about a patient, and I would fire questions about
white count, fever, etc., they started putting it on their radar,” Dr. Moncada
said.

Now, two years later, when the ED calls the hospitalists with an admission, the physicians
say, “I think this guy’s septic, he’s got these criteria,” he noted.
“A well-trained hospitalist can bridge the gap between intensive care medicine
and floor medicine, and that’s exactly what I was doing when I started this effort,”
Dr. Moncada said.

Jan Bowers is a freelance writer based in Evanston, Ill.

Symptoms, Diagnosis & Treatment > Fact Sheets > Yale Medicine

As with adults, when babies and children develop an infection, their immune systems fight the invading culprit, whether it’s bacteria, a virus, or a fungus. But sometimes the immune system’s response to an infection can spin out of control, leading to a life-threatening condition called sepsis. Sepsis occurs when the body’s response to an already-present infection gets out of hand, leading to severe inflammation throughout the body that, in turn, can cause tissue damage and organ failure. When organs begin to stop functioning, the body can enter a stage of sepsis called “septic shock,” and the threat of death is imminent. 

While sepsis is a serious condition at any age, it is particularly dangerous for children because their symptoms can be more difficult to detect. “The biggest difference between adult and pediatric sepsis is recognition,” says Yale Medicine pediatric intensive care doctor Sarah Kandil, MD. “A lot of symptoms we look for in sepsis, like a fever, are similar to other illnesses in children.”  

Though pediatric sepsis is unusual, it’s not all that rare either. Studies estimate that more than 75,000 children are treated for severe sepsis each year in the U.S. 

Sepsis can develop from an injury as simple as an infected scrape on the arm, or it can emerge on top of an already life-threatening condition, such as acute appendicitis. “Those who have a weakened immune system, like kids undergoing chemotherapy, can be especially susceptible,” Dr. Kandil says.  

Besides being more difficult to detect in children, parents, caregivers, and even medical staff may not have enough knowledge about the signs of sepsis. “We have an ongoing campaign in at Yale New Haven Children’s Hospital that encourages medical providers and families to be aware of sepsis,” Dr. Kandil says. 

All Yale Medicine’s pediatric care providers are trained to recognize the early signs of sepsis in children, in order to provide quick and accurate care to interrupt the condition’s progress. 

Septic System Inspections – InterNACHI®

A septic system receives, treats and disposes of unwanted wastewater and solids from a building’s plumbing system. Solids are partially broken down into sludge within a septic tank and are separated from effluent (water) and scum (fat, oil and grease). Effluent regularly exits the tank into a drainfield where it is naturally filtered by bacteria and reentered into the groundwater. Scum and sludge must be pumped periodically and should never enter the drainfield. 

The septic system should be inspected once a year, including as soon as the house is put on the market for sale. This will enhance the home’s value and avoid any liability issues that might result from a malfunctioning system. It is in the interest of a prospective buyer to insist that the septic system be inspected before they purchase the home if it has not been done recently.

How to locate the septic system: 

Since they perform their essential functions underground and out of sight, it is not uncommon for a homeowner to not have any idea where the septic system is located. This is usually not an issue except for when it comes time to inspect or pump the tank!

The following suggestions can be used by inspectors to locate a septic tank if the homeowner does not already know where it is:

• An “as-built” drawing of the house should include the tank’s location. These drawings are often held in local health and zoning agencies. Old systems might not have any such record.
• The previous homeowner can be contacted.
• Newer tanks contain risers that rise visibly above the ground surface.
• A thin metal rod can be inserted into the earth and used to probe a suspected area. It is important to do this gently and only in soft, wet soil to avoid damaging the tank and associated pipes. A shovel can also be used but it requires a bit more work.
• A metal detector can be used if enough tank components are metal.
• A small radio transmitter can be flushed down the toilet and followed with a receiver. 
• The greenest grass in a yard is often directly above the septic tank. Snow also melts faster above the tank than the rest of the yard. While these are not foolproof location methods, they have been known to be helpful.

What might InterNACHI inspectors look for?

• Find the date that the tank was last pumped. Ultimately, sludge level should determine whether a tank should be pumped, but knowledge of previous pumping dates can be a helpful reference.
• Check the sludge level with a “sludge judge” or a similar device. Sludge accumulates on the tank bottom and should not occupy more than 1/3 of the tank’s total volume or rise to the level of the baffles.
• The septic tank and drainfield should be far from wells and streams.
• Ensure that the system is large enough for the home that it serves. A four-bedroom home, for instance, typically requires a 1,200-gallon tank. The more occupants living in the home, the larger the tank that is required. Capacity in gallons can be calculated by tank dimensions. For rectangular tanks, length x width x depth in feet x 7.5 = capacity in gallons. For round tanks, 3.14 x radius squared x depth in feet x 7.5 = capacity in gallons.
• Check for liquid waste that has made its way to the ground surface. This condition is unsanitary and indicates that the system is overloaded. Make sure that the tank is watertight so that wastewater does not contaminate groundwater, and groundwater does not flow into the tank and cause it to overfill.
• If riser lids are present, they should be inspected for cracks and made sure they are secure.
• Make sure that the baffles are firmly connected to the tank’s inlet and outlet pipes. 
• Drain lines should each receive the same amount of wastewater. They can be examined by opening the distribution box. If the box becomes tipped or clogged, it will disproportionately allocate effluent, and potentially flood sections of the drainfield.

What are baffles?

Baffles are septic tank components that slow wastewater entry sufficiently to ensure the distillation of solids, and prevent their release (as well as the release of scum) into the drainfield. In doing so, they protect the absorptive quality of the soil and prolong the life of the septic system as a whole. They are normally made from the same material as the septic tank — either fiberglass, steel or concrete.

Inspectors should check baffles for the following:

• solids covering the baffle. This should be reported immediately, as it indicates overflow.
• erosion from chemicals and water flow.
• evidence of previous overflow.
• sewage level should be several inches below the baffle top. A lower level indicates leakage and a higher level indicates blockage.

Maintenance Tips

Inspectors should know the following information so they can inform their clients about ways they can inadvertently damage their septic system:

• Only bath tissue can be flushed down the toilet. Tampons, paper towels, cigarette butts and diapers should be put in the trash. Household chemicals such as gasoline, paint, medication, antifreeze and pesticides can damage bacteria in the septic system and should never be flushed or dumped down the sink. Detergents and bleach can enter the plumbing system in moderate amounts.
• Cars should not be driven on or near the drainfield. Their weight can unknowingly damage subterranean piping.
• Only grass should be planted above the septic tank and drainfield. Roots from trees and large shrubs can cause unseen damage.
• No one should ever dig or build on top of the drainfield.
• All water drainage from rainwater, sump pumps, or any surface water should be diverted away from the drainfield. An over-saturated drainfield can retard the water treatment process and cause plumbing fixtures to back up.
• An easy way to prolong a septic system’s life and prevent a very costly replacement is to fix leaky faucets and toilets immediately. Any household water waste should be avoided. Taking shorter showers and not using a garbage disposal are ways to limit water use.

Some Precautions:

• Inspectors should not enter the septic tank to look for cracks. Tank interiors are very dirty and entrance should be avoided. If a crack is present, it will likely be at the level of the effluent, which will have drained from the tank through the crack. A strong sign that a crack is present is an effluent level significantly below the level of the tank outlet. A tank with cracks that allow effluent to leak into the surrounding earth is essentially a cesspool and needs to be replaced.
• Above-ground water indicates an overloaded septic system, if this water originates from the tank. Inspectors sometimes use a dye flushed down the toilet to confirm that the water originates from the house and not elsewhere. While this measure can be helpful, it is not an acceptable method to test septic system functionality. Flushed dye that appears in the puddle will confirm a faulty septic system, but dye that does not appear does not ensure a working system. Dye can take days to appear and may be too diluted to see clearly.
• Septic system inspection is outside the scope of general home inspection and requires special training. Laws vary by jurisdiction, and inspectors should know them well before performing this service. They should disclaim any part of the inspection of the septic system that they did not inspect.

Septic System Dangers

Septic systems are designed to handle dangerous waste and can pose serious health hazards to homeowners and inspectors. The following are a list of precautions:

• A professional septic tank pumping service, not an inspector, should remove solid waste.
• No one besides a licensed, equipped professional should enter a tank. Noxious fumes such as methane can cause rapid asphyxiation and death.
• If a septic tank shows signs of weakness, tread with caution! Collapse can be fatal. Beware of tanks with rusting metal, homemade lids, or anything else that appears unstable.

In summary, septic system inspections should be performed on an annual basis to ensure proper function. The septic tank is the most expensive household fixture and its lifespan will be shortened significantly if it is not maintained.

Diagnosis of sepsis in critically ill patients | Romasheva

The aim of the study is to establish the information content of the determination of procalcitonin in the diagnosis of critical conditions and in assessing the effectiveness of therapy.

Materials and methods. 60 patients aged 25-50 years (38.1 ± 11.2 years) with symptoms of systemic inflammatory reaction syndrome were examined, including patients with severe sepsis (30 people, 50.0%), septic shock (21 people, 35 , 0%), meningitis of various etiologies (3 people, 5.0%), candidal infection (2 people, 3.3%), thrombovasculitis (1 person, 1.7%), pulmonary embolism (3 people, 5, 0%).All patients underwent determination of procalcitonin in blood serum using the PCTv-Q test from BRAHMS on the first day of stay in the ICU and 72 hours after the start of multicomponent therapy.

Results. In patients with severe sepsis and multiple organ failure syndrome, a positive test result with a plasma procalcitonin level of 2 ng / ml and above was obtained in 100% of cases. In meningitis, the procalcitonin concentration ranged from 0.5 to 2 ng / ml; with candidiasis infection, thrombovasculitis – up to 0.5 ng / ml.A negative test result was obtained for pulmonary embolism. In 14 patients with septic shock and multiple organ failure syndrome, extracorporeal methods of treatment were used as part of complex therapy (a procedure of continuous veno-venous hemodiafiltration on a PRISMA apparatus). In 9 of them (64.3%), a decrease in its concentration of various degrees, normalization of the acid-base state of the blood, a decrease in the concentration of urea and creatinine in plasma, stabilization of the vital functions of the body was obtained, in 5 (35.7%) – a lethal outcome.Among the remaining 37 patients with severe sepsis and septic shock, 32 (86.5%) showed positive dynamics and a decrease in the level of procalcitonin against the background of complex therapy; 5 (13.5%) had a lethal outcome.

Conclusion. Procalcitonin is a highly specific marker for sepsis. A decrease in the concentration of procalcitonin in patients with severe sepsis and septic shock indicates the effectiveness of the therapy in this category of patients. Procalcitonin can be recognized as a reliable parameter for monitoring not only the severity of bacterial infection, but also for determining the effectiveness of treatment in critically ill patients under ICU conditions.

NEW ASPECTS OF SEPSIS PATHOGENESIS AND SEPTIC SHOCK IN CHILDREN. COMPLEMENT SYSTEM AS A TARGET FOR EFFECTIVE THERAPY | Prodeus

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Septic shock: promising methods of diagnosis and treatment based on immunopathogenesis | Gomanova

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