What are the symptoms of sepsis. How is sepsis diagnosed. What causes sepsis and who is at risk. How is sepsis treated. Can sepsis be prevented. What complications can arise from sepsis. How does sepsis affect the body.

The Silent Killer: Unraveling Sepsis and Its Impact

Sepsis, sometimes referred to as septicemia, is a potentially life-threatening condition that occurs when the body’s response to infection spirals out of control. This severe reaction can lead to widespread inflammation, organ failure, and in extreme cases, death. Understanding sepsis is crucial for early detection and timely treatment.

During sepsis, the immune system releases an excessive amount of chemicals into the bloodstream. This overreaction triggers a cascade of events that can cause significant damage throughout the body. Blood clots may form, reducing blood flow to vital organs and limbs, depriving them of essential nutrients and oxygen.

The Severity Spectrum of Sepsis

Sepsis can range from mild to severe, with the most critical form being septic shock. In septic shock, blood pressure drops dangerously low, leading to rapid organ failure. This condition can quickly become fatal if not addressed promptly.

Identifying the Culprits: Causes and Risk Factors of Sepsis

While bacterial infections are the most common cause of sepsis, it can also result from viral, fungal, or parasitic infections. Any part of the body can be the starting point for sepsis, even from seemingly minor injuries like hangnails or small cuts.

Is sepsis more likely to occur in certain individuals. Yes, some people are at higher risk for developing sepsis:

• Those with weakened immune systems (e.g., HIV patients, cancer patients, transplant recipients)
• Pregnant women
• Very young children and infants
• Elderly individuals, especially those with pre-existing health conditions
• Recently hospitalized patients or those who have undergone major surgery
• People using catheters or breathing tubes
• Individuals with diabetes
• Those with serious medical conditions such as appendicitis, pneumonia, meningitis, cirrhosis, or urinary tract infections

Recognizing the Red Flags: Symptoms of Sepsis

Sepsis can manifest in various ways, making it challenging to diagnose. However, there are several common symptoms to watch for:

• Rapid breathing and confusion
• Fever and chills, or conversely, very low body temperature
• Decreased urine output
• Rapid heartbeat
• Nausea and vomiting
• Diarrhea
• Extreme fatigue or weakness
• Blotchy or discolored skin
• Excessive sweating or clammy skin
• Severe pain

Can sepsis symptoms vary from person to person. Indeed, the symptoms can differ depending on the initial site of infection and the individual’s overall health status. It’s crucial to seek medical attention if you suspect sepsis, as early intervention can be life-saving.

Unmasking the Threat: Diagnosing Sepsis

Diagnosing sepsis requires a comprehensive approach. Medical professionals will typically perform a physical examination and run a series of tests to confirm the presence of sepsis and identify its underlying cause.

Diagnostic Tools for Sepsis

1. Blood tests to detect bacteria or other pathogens
2. Imaging studies (X-rays, CT scans, ultrasounds) to locate potential infection sites
3. White blood cell count analysis
4. Platelet count assessment
5. Blood pressure measurement
6. Blood gas analysis to check for acidosis
7. Oxygen level evaluation
8. Blood clotting tests
9. Electrolyte level checks
10. Kidney and liver function tests

How quickly can sepsis be diagnosed. With modern diagnostic tools, sepsis can often be identified within hours. However, the challenge lies in recognizing the need for these tests in the first place, as sepsis symptoms can mimic other conditions.

Fighting Back: Treatment Strategies for Sepsis

Once diagnosed, sepsis requires immediate and aggressive treatment. Patients are typically admitted to the intensive care unit (ICU) for close monitoring and specialized care.

Key Components of Sepsis Treatment

• Intravenous fluids to maintain blood pressure and organ function
• Oxygen therapy to support breathing
• Broad-spectrum antibiotics to combat bacterial infections
• Vasopressors to improve blood pressure
• Corticosteroids to reduce inflammation
• Insulin for blood sugar control

In severe cases, additional interventions may be necessary:

• Mechanical ventilation for respiratory support
• Kidney dialysis for renal failure
• Surgery to remove infected tissue or drain abscesses

Is sepsis treatment always successful. While treatment can be effective, especially when initiated early, sepsis remains a serious condition with a mortality rate between 25% and 40%.

The Aftermath: Complications and Long-term Effects of Sepsis

Even with successful treatment, sepsis can leave lasting impacts on a person’s health. Potential complications include:

• Kidney failure
• Tissue death (gangrene) in extremities, potentially leading to amputations
• Lung, brain, or heart damage
• Increased susceptibility to future infections

Can sepsis survivors fully recover. While many people do recover from sepsis, some may experience long-term physical and cognitive effects, often referred to as post-sepsis syndrome. This can include persistent fatigue, muscle weakness, difficulty concentrating, and mood changes.

Staying One Step Ahead: Strategies for Sepsis Prevention

Prevention is key when it comes to sepsis. By taking proactive measures to avoid infections and manage existing health conditions, you can significantly reduce your risk of developing this life-threatening condition.

Effective Sepsis Prevention Techniques

1. Practice good hand hygiene by washing hands frequently with soap and water for at least 20 seconds
2. Stay up-to-date with recommended vaccinations, including flu shots
3. Manage chronic health conditions effectively
4. Clean and cover any wounds promptly, monitoring for signs of infection
5. Seek medical attention for infections that worsen or don’t improve with treatment
6. Be aware of sepsis symptoms, especially if you’re in a high-risk group

How effective is sepsis prevention. While it’s impossible to prevent all cases of sepsis, these strategies can significantly reduce your risk. Early recognition and prompt treatment of infections are crucial in preventing their progression to sepsis.

Beyond the Basics: Advanced Concepts in Sepsis Management

As our understanding of sepsis evolves, so do the approaches to its management. Recent advancements in sepsis care focus on personalized treatment strategies and early intervention protocols.

Emerging Trends in Sepsis Care

• Biomarker-guided therapy to tailor treatment to individual patients
• Immunomodulation techniques to balance the immune response
• Machine learning algorithms for early sepsis prediction in hospital settings
• Novel antimicrobial agents to combat drug-resistant pathogens
• Extracorporeal therapies for severe sepsis and septic shock

Will these advancements significantly improve sepsis outcomes. While many of these approaches show promise, their long-term impact on sepsis mortality and morbidity is still being evaluated through ongoing clinical trials and real-world implementation.

The Role of Rapid Response Teams

Many hospitals have implemented rapid response teams specifically trained to identify and treat sepsis quickly. These teams can be activated at the first sign of potential sepsis, allowing for immediate intervention and potentially improving patient outcomes.

Sepsis Awareness: Empowering Patients and Caregivers

Education plays a crucial role in combating sepsis. By raising awareness about the signs and symptoms of sepsis, we can empower individuals to seek timely medical attention and potentially save lives.

Key Messages for Sepsis Awareness

• Sepsis is a medical emergency that requires immediate attention
• Anyone can develop sepsis, but certain groups are at higher risk
• Early recognition and treatment are critical for improving outcomes
• Proper infection prevention and management can reduce sepsis risk
• Sepsis survivors may face long-term health challenges and require ongoing support

How can healthcare providers improve sepsis awareness. Healthcare professionals can play a vital role by educating patients about sepsis risks, symptoms, and prevention strategies during routine check-ups and hospital discharges.

Global Impact: Sepsis as a Public Health Challenge

Sepsis is not just an individual health concern; it represents a significant global health challenge. The World Health Organization (WHO) recognizes sepsis as a priority healthcare issue, affecting millions of people worldwide each year.

Sepsis: A Global Perspective

• Sepsis accounts for approximately 20% of all deaths worldwide
• Low- and middle-income countries bear a disproportionate burden of sepsis cases and deaths
• Antimicrobial resistance complicates sepsis treatment globally
• Sepsis is a leading cause of maternal and neonatal mortality in many regions

What efforts are being made to address sepsis on a global scale. International organizations and healthcare systems are working to implement standardized sepsis protocols, improve access to critical care resources, and enhance infection prevention and control measures worldwide.

The Economic Burden of Sepsis

Beyond its human toll, sepsis also imposes a significant economic burden on healthcare systems and societies. The costs associated with sepsis care, long-term rehabilitation, and lost productivity are substantial.

Can improving sepsis care reduce healthcare costs. Yes, early detection and effective management of sepsis can potentially reduce hospital stays, decrease complication rates, and ultimately lower overall healthcare expenses associated with this condition.

The Future of Sepsis Research and Care

As we look to the future, ongoing research and innovation continue to shape our approach to sepsis. From novel diagnostic tools to cutting-edge treatments, the field of sepsis care is rapidly evolving.

Promising Areas of Sepsis Research

• Genetic markers for sepsis susceptibility and severity
• Artificial intelligence for real-time sepsis prediction and management
• Immunotherapy approaches to modulate the septic response
• Personalized medicine strategies based on host response patterns
• Development of sepsis-specific drugs targeting key pathways in the septic cascade

How might these advancements change sepsis care in the coming years. While it’s difficult to predict with certainty, these research areas hold the potential to revolutionize sepsis diagnosis, treatment, and prevention, potentially leading to significant improvements in patient outcomes and survival rates.

In conclusion, sepsis remains a formidable challenge in modern healthcare, requiring vigilance, prompt action, and continued research. By understanding its causes, recognizing its symptoms, and implementing effective prevention and treatment strategies, we can work towards reducing the devastating impact of this life-threatening condition. As individuals and as a global community, our collective efforts in combating sepsis can make a significant difference in saving lives and improving health outcomes worldwide.

Sepsis (Blood Infection): Symptoms, Causes & Treatments

Written by Mary Anne Dunkin

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

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

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

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

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

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

Sepsis is more common in people who:

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

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

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

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

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

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

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

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

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

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

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

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

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

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Sepsis (Blood Infection): Symptoms, Causes & Treatments

Written by Mary Anne Dunkin

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

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

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

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

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

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

Sepsis is more common in people who:

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

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

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

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

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

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

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

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

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

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

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

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

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

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Key facts

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

General information

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

Who is at risk?

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

Signs and symptoms

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

Prevention

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

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

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

Diagnosis and clinical management

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

Sepsis and the Sustainable Development Goals

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

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

WHO activities

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

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

Bibliography

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Obstetric sepsis. What is obstetric sepsis?

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.

Obstetric sepsis is a systemic complication of infections of the female genitourinary system and mammary gland that developed during pregnancy, expulsion of the fetus and in the postpartum (post-abortion) period. It is manifested by a severe general condition, increasing weakness, fever, palpitations, shortness of breath, and a decrease in blood pressure. As it progresses, clouding of consciousness, severe difficulty in breathing, a sharp decrease in the volume of urine separated are added. The diagnosis is established on the basis of data from a physical examination, ultrasound, laboratory blood tests. Treatment is complex: surgical debridement of abscesses, antibiotic therapy, intensive care.

ICD-10

O75.3 Other infections during labor

• Causes
• Pathogenesis
• Classification
• Symptoms of obstetric sepsis
• Complications
• Diagnostics
• Treatment of obstetric sepsis
• Prognosis and prevention
• Prices for treatment

General

Obstetric sepsis (puerperal fever) is a life-threatening condition characterized by disorders of hemodynamics, metabolism, blood clotting, multiple organ failure and occurring in response to infectious inflammation in the genital and urinary organs, as well as in the mammary gland in the gestational, birth and postpartum periods. The outdated synonym for sepsis “blood poisoning” is now irrelevant: the penetration of an infectious agent into the blood is not a prerequisite for the development of a septic process – bacteremia is recorded only in 50% of patients. Sepsis develops in one of 5000 pregnant women and childbirth and is accompanied by septic shock in 10% of cases, the share of the disease in the structure of maternal mortality is 12%. In 44% of cases, sepsis is recorded at the stage of pregnancy (with a uniform distribution over periods of gestation), in 10% – in childbirth, in 46% – in the postpartum period.

obstetric sepsis

Reasons

Obstetric sepsis is always secondary, its source is a local infection. The main causative agents of purulent-inflammatory diseases are representatives of the opportunistic flora (pyogenic streptococcus, group B streptococcus, Staphylococcus aureus, E. coli, Klebsiella, Proteus, Peptococcus, Peptostreptococcus, Bacteroid, Candida fungus), most often inhabit the lower parts of the genitourinary sphere and intestines and lead to pathology only under the influence of certain factors. The main causes and sources of infection include:

• Surgery and tissue trauma. The wound surface serves as a gate of infection and contributes to a significant decrease in local immunity. A purulent process can be the outcome of a caesarean section, early discharge of amniotic fluid (in the wrong position of the fetus, multiple pregnancy), ruptures obtained during childbirth and surgical interventions on the perineum.
• Therapeutic and diagnostic procedures. The causative agent is transmitted upon contact with a contaminated instrument, in addition, microtraumas obtained during the study create favorable conditions for lympho- and hematogenous infection. In the group of risk factors – cervical cerclage, amniocentesis, cordocentesis, urethral catheterization, in vitro fertilization, multiple vaginal examinations during childbirth.
• Physiological changes caused by pregnancy. The growing uterus compresses and displaces the surrounding anatomical structures, and progesterone reduces the tone of smooth muscles. These factors lead to disruption of urodynamics and create prerequisites for the development of gestational pyelonephritis and urosepsis.
• Stagnation of breast milk. As a result of lactostasis, there is an active growth of staphylococci that cause mastitis. Violation of the outflow of milk is the main cause of postpartum abscesses and phlegmon.

On the other hand, purulent processes can be complicated by sepsis only if the immune response is hypo- or hyperreactive. Functional disorders of the immune system lead to an increase in the activity of opportunistic microorganisms and the formation of a pathological reaction to purulent inflammation. Risk factors include obesity, diabetes mellitus, anemia, acute and chronic inflammation (genital and extragenital), malnutrition, age over 35 years.

Pathogenesis

Massive tissue damage by infection is accompanied by a permanent or periodic release of inflammatory response mediators into the bloodstream, which depletes the regulatory function of the immune system and triggers a number of uncontrolled reactions in distant organs and tissues. As a result, the endothelium is damaged, microcirculation (perfusion) worsens, and oxygen transport decreases. These changes lead to violations of homeostatic regulation, the development of acute multiple organ failure syndrome (MODS) and DIC.

The ventricles of the heart expand, there is a decrease in cardiac output, and vascular tone is disturbed. In the lungs, atelectasis is formed, respiratory distress syndrome develops. As a result of a decrease in the volume of circulating blood (BCV) and hemostatic disorders, the microcirculation of the renal tissue and the blood supply to the cortical layer worsen, followed by acute functional insufficiency. In the liver, metabolic processes are disturbed, and a lack of blood supply leads to the formation of necrotic areas. Hypoperfusion leads to pathological permeability of the intestinal mucosa with the release of toxins and microorganisms into the lymphatic system, as a result of ischemia, stress ulcers form on the walls of the digestive tract. Violation of metabolic processes and microcirculation of the brain causes neurological disorders.

Classification

Obstetric sepsis is classified according to different criteria: by the pathogen, by metastatic spread (septicemia, characterized by the presence of only the primary focus, and septicopyemia – the presence of purulent screenings in other tissues and organs) or by the clinical course. In modern obstetrics, a classification has been adopted that reflects the successive stages of the formation of a systemic inflammatory response:

• Systemic inflammatory response syndrome (SIRS). A harbinger of a septic condition is a systemic reaction to an inflammatory process of any etiology. It is established in the presence of an inflammatory disease and on the basis of at least two clinical manifestations of SIRS: tachycardia, tachypnea or hyperventilation, hypo- or hyperthermia, leukocytosis (leukopenia), or an increase in the proportion of immature neutrophils. In 12% of patients with sepsis, there are no signs of SIRS.
• Sepsis. Pathological systemic response to primary or secondary infection. The diagnosis is made in the presence of an infectious focus or on the basis of verified bacteremia and acutely developed signs of functional insufficiency of two or more organs (MOD).
• Septic shock. Extreme form of pathological reaction. Accompanied by severe, persistent, poorly amenable to drug correction hypotension and impaired perfusion.

Symptoms of obstetric sepsis

Postpartum sepsis manifests itself on the second or third day after the expulsion of the fetus with sanious-purulent discharge, general intoxication (tachycardia, shortness of breath, weakness, loss of appetite, sometimes vomiting and diarrhea) and fever up to 39-40 ° C with chills. Hyperthermia is usually stable, but there may be forms with a gradual increase or a large variation in daily temperature and rare bouts of chills. Pain in the abdomen or mammary glands is noted, generalized rashes may be recorded. The severity of symptoms and the duration of the disease vary depending on the form of the clinical course.

For fulminant obstetric sepsis, the increase in symptoms is characteristic during the day, in the acute form, the clinical picture unfolds over several days. In the subacute form, the signs are less pronounced, the process develops for weeks. Chroniosepsis is characterized by mild changes (low-grade fever, increased sweating, headache and dizziness, drowsiness, diarrhea) and a sluggish course for many months. The recurrent form represents a series of attenuations (periods of remission without noticeable manifestations) and exacerbations (periods with vivid symptoms) and is characteristic of septicopyemia, when the deterioration is due to repeated episodes of the formation of secondary abscesses.

In the absence of treatment, intoxication of the body increases and a severe form with shock syndrome develops. In the early (“warm”) phase, weakness progresses, dizziness is noted. At the same time, the temperature decreases to normal or subfebrile values, tachycardia increases. The mucous membranes and nail beds become bluish, the skin is hyperemic. Excitation is observed, consciousness can be clear or confused, psychoses, hallucinations are frequent. The average duration of the early stage is 5-8 hours, less often – up to two days. In the case of a gram-negative infection, this phase can last several minutes.

The late (“cold”) stage is marked by an increase or decrease in the heartbeat with a transition to bradycardia, a drop in temperature below normal, and significant difficulty in breathing. Anxiety and excitement intensifies, then gives way to adynamia, consciousness is darkened. The skin acquires an earthy hue, becomes covered with sticky cold sweat, a cyanotic-marble pattern appears on the legs, especially pronounced in the knee area. Oliguria develops, sometimes jaundice appears.

Anaerobic sepsis associated with uterine gangrene is characterized by a particularly severe course and a number of specific signs. The disease proceeds at lightning speed or acutely, accompanied by intense intractable pain in the lower abdomen, crepitus and increased pain on palpation of the uterus, gas and fetid liquid from the vagina with air bubbles, bronze skin, brown urine. The phenomena of septic shock appear already at the very beginning of the disease.

Complications

Patients who have survived an acute period may develop a severe, often fatal complication – superinfection. A significant deterioration in the quality of life or death of the patient often entails other consequences of sepsis: irreversible organ changes in the kidneys, liver, lungs, heart, brain associated with ischemia or purulent metastasis, perforation and bleeding from gastrointestinal stress ulcers, arterial thromboembolism and phlebothrombosis. Sepsis in pregnant women can cause premature birth, fetal death, encephalopathy, and cerebral palsy in the newborn.

Diagnostics

An obstetrician-gynecologist, therapist, resuscitator, microbiologist are involved in the diagnosis of obstetric sepsis, complicated forms require the involvement of a nephrologist, cardiologist, neurologist, hepatologist. In the course of a gynecological examination and a general examination, a septic condition can be suspected by the presence of a focus of purulent inflammation in the pelvic organs or the mammary gland, as well as signs of SIRS. The following studies are being carried out:

• Pathogen identification. Culture analysis of blood and vaginal smears can identify the infectious agent and select an effective drug to treat the infection. Bacteremia confirms the presence of a septic process. In the absence of bacteremia, a test for procalcitonin is performed to differentiate between local and generalized infection.
• Instrumental research. Ultrasound of the small pelvis and kidneys confirms (reveals) the presence of a primary purulent focus in the genitourinary organs. Ultrasound of the abdominal organs, chest x-ray, echocardiography can detect secondary abscesses in the liver, lungs, heart.
• Clinical and biochemical blood tests. A general blood test detects leukocytosis, leukopenia, a shift of the leukocyte formula to the left – values ​​\u200b\u200bthat indirectly confirm a septic condition. Data from biochemical studies indicate violations of the water-electrolyte balance and the functions of the kidneys and liver. Analysis of blood gases reveals violations of acid-base balance and respiratory failure. According to the results of the coagulogram, blood clotting disorders are determined. Plasma lactate testing can detect tissue hypoperfusion and assess the severity of shock. The immunogram testifies to disorders of immune activity.

Obstetric sepsis should be differentiated from preeclampsia, amniotic embolism and pulmonary embolism, acute infections (severe influenza, brucellosis, typhoid, malaria, miliary tuberculosis), acute pancreatitis, leukemia, lymphogranulomatosis. For differential diagnosis, it may be necessary to consult a cardiac surgeon, an infectious disease specialist, a phthisiatrician, and an oncohematologist.

Treatment of obstetric sepsis

Therapeutic measures are carried out in the conditions of a gynecological or observational obstetric department, patients with severe forms of sepsis are transferred to the intensive care unit. The treatment is complex, includes surgical and conservative methods and is aimed at fighting infection and correcting vital functions:

• Infusion therapy. Treatment provides for the correction of homeostatic disorders (hypotension, coagulopathy, disorders of acid-base and water-salt metabolism, BCC deficiency), restoration of tissue perfusion, detoxification. For these purposes, saline and colloidal solutions, albumin, cryoplasma, inotropes and vasopressors are introduced.
• Antibacterial therapy. It is aimed at the destruction of the infectious agent in order to block the inflammatory cascade. Initial treatment includes intravenous administration of a combination of broad-spectrum drugs. After the pathogen is isolated, etiotropic antibiotic therapy is started.
• Surgical treatment. The elimination of purulent foci increases the effectiveness of intensive care and improves the prognosis. Treatment involves sanitation of primary and secondary foci – opening and emptying of abscesses, curettage, vacuum aspiration or removal of the uterus (hysterectomy).

If necessary, artificial ventilation of the lungs, enteral nutrition of the patient is carried out. Additional intensive care methods include the use of corticosteroids, surgical detoxification (plasmapheresis, hemosorption, hemofiltration) after surgical treatment of suppuration, immunotherapy.

Prognosis and prevention

In the early stages, when pronounced signs of MODS, persistent hypotension and DIC have not developed, the prognosis is favorable. With the development of septic shock, mortality can reach 65% (average – 45%).