What are the primary symptoms of sepsis. How is sepsis diagnosed and treated. Can sepsis be prevented. What are the main risk factors for developing sepsis. How does sepsis affect different organs in the body. What is the mortality rate for sepsis. Why is early detection crucial in sepsis treatment.

What is Sepsis and How Does it Develop?

Sepsis is a potentially life-threatening condition that occurs when the body’s response to infection spirals out of control. It’s often referred to as blood poisoning or septicemia, though these terms aren’t entirely accurate. During sepsis, the immune system releases an overwhelming amount of chemicals into the bloodstream, triggering widespread inflammation that can lead to organ damage and failure.

The development of sepsis typically follows this progression:

1. An infection enters the body, often through a small wound or common illness.
2. The immune system responds by releasing chemicals to fight the infection.
3. These chemicals cause inflammation throughout the body.
4. Blood clots may form, reducing blood flow to limbs and organs.
5. Organs begin to malfunction due to lack of nutrients and oxygen.
6. In severe cases, blood pressure drops dramatically, leading to septic shock.

Is sepsis always caused by bacterial infections? While bacterial infections are the most common culprits, sepsis can also result from viral, fungal, or parasitic infections. Any infection, regardless of its origin, has the potential to trigger sepsis if the body’s response becomes dysregulated.

Recognizing the Signs and Symptoms of Sepsis

Early detection of sepsis is crucial for effective treatment. The symptoms can be varied and may mimic other conditions, making diagnosis challenging. However, there are several key indicators to watch for:

• Rapid breathing and heart rate
• Confusion or disorientation
• Fever, chills, or very low body temperature
• Decreased urine output
• Nausea and vomiting
• Diarrhea
• Extreme fatigue or weakness
• Skin discoloration or blotchiness
• Clammy or sweaty skin
• Severe pain or discomfort

Why is confusion often an early sign of sepsis? Confusion or altered mental state can be one of the first noticeable symptoms because sepsis affects blood flow to the brain. This cognitive impact often occurs before other physical symptoms become apparent, making it an important early warning sign.

Risk Factors and Vulnerable Populations for Sepsis

While sepsis can affect anyone, certain groups are at higher risk of developing this condition. Understanding these risk factors can help in prevention and early intervention:

High-Risk Groups:

• People with weakened immune systems (e.g., HIV patients, cancer patients)
• Pregnant women
• Very young children and infants
• Elderly individuals, especially those with other health problems
• Recent hospital patients or those who’ve undergone major surgery
• Individuals using catheters or breathing tubes
• People with diabetes
• Those with serious medical conditions like appendicitis, pneumonia, or meningitis

How does having diabetes increase the risk of sepsis? Diabetes can impair the immune system’s ability to fight infections effectively. Additionally, high blood sugar levels create an environment where bacteria can thrive, increasing the likelihood of infections that could lead to sepsis.

Diagnosis and Medical Assessment of Sepsis

Diagnosing sepsis requires a comprehensive medical evaluation. Doctors use a combination of physical examination, patient history, and various tests to confirm the presence of sepsis and assess its severity:

Diagnostic Tools and Tests:

• Blood tests to check for bacteria and other indicators of infection
• Imaging studies (X-rays, CT scans, ultrasounds) to locate potential infection sources
• White blood cell count analysis
• Platelet count assessment
• Blood pressure monitoring
• Blood gas analysis to check for acidosis
• Oxygen level measurement
• Coagulation tests
• Electrolyte level checks
• Kidney and liver function tests

Why is a low platelet count significant in sepsis diagnosis? A low platelet count (thrombocytopenia) is often observed in sepsis patients because the body consumes platelets rapidly in response to widespread inflammation and potential micro-clotting. This can be an important indicator of the severity of sepsis and the body’s struggle to maintain normal blood function.

Treatment Approaches and Management of Sepsis

Sepsis treatment typically occurs in a hospital’s intensive care unit (ICU) due to the condition’s severity and the need for close monitoring. The primary goals of treatment are to stop the infection, support organ function, and manage blood pressure. Treatment strategies include:

Immediate Interventions:

• Administration of intravenous (IV) fluids
• Oxygen therapy
• Broad-spectrum antibiotics

Targeted Therapies:

• Specific antibiotics once the causative pathogen is identified
• Vasopressors to improve blood pressure
• Corticosteroids to reduce inflammation
• Insulin for blood sugar control

Advanced Treatments:

• Mechanical ventilation for respiratory support
• Kidney dialysis if renal failure occurs
• Surgical intervention to remove sources of infection

Why is early administration of antibiotics crucial in sepsis treatment? Early antibiotic treatment significantly improves survival rates in sepsis patients. The sooner appropriate antibiotics are administered, the better the chance of controlling the infection before it causes irreversible organ damage or progresses to septic shock.

Complications and Long-term Effects of Sepsis

Sepsis can have severe and lasting impacts on the body, even after the initial infection is controlled. Understanding these potential complications is crucial for long-term patient care and recovery:

Immediate Complications:

• Kidney failure
• Tissue death (gangrene) in extremities
• Lung damage and respiratory failure
• Brain damage and cognitive impairment
• Heart damage and cardiovascular issues

Long-term Effects:

• Increased susceptibility to future infections
• Chronic pain and fatigue
• Post-traumatic stress disorder (PTSD)
• Cognitive difficulties and memory problems
• Muscle weakness and mobility issues

How does sepsis affect the brain long-term? Sepsis can cause both immediate and long-lasting effects on the brain. In the short term, it can lead to confusion, delirium, and even coma. Long-term effects may include cognitive impairment, memory problems, and an increased risk of developing dementia. These neurological complications are thought to be due to inflammation, reduced blood flow, and potential direct damage to brain cells during severe sepsis.

Prevention Strategies and Reducing Sepsis Risk

While it’s not always possible to prevent sepsis, there are several strategies that can significantly reduce the risk of developing this life-threatening condition:

Infection Prevention:

• Practice good hand hygiene
• Keep up-to-date with vaccinations
• Properly clean and care for wounds
• Seek prompt medical attention for infections

Managing Chronic Conditions:

• Control diabetes and maintain good blood sugar levels
• Manage other chronic health conditions effectively
• Follow prescribed treatment plans for any ongoing health issues

Healthcare-associated Prevention:

• Ensure proper care of catheters and other medical devices
• Follow post-operative care instructions carefully
• Be aware of infection risks in hospital settings

Why is proper wound care important in preventing sepsis? Even small wounds can serve as entry points for bacteria that could potentially lead to sepsis. Proper cleaning and care of wounds, including minor cuts and scrapes, can prevent bacterial colonization and reduce the risk of infection that could progress to sepsis.

Sepsis Awareness and Education: A Public Health Priority

Increasing public awareness about sepsis is crucial for improving outcomes and reducing mortality rates. Education efforts should focus on:

• Recognizing early signs and symptoms of sepsis
• Understanding risk factors and vulnerable populations
• Promoting preventive measures and good health practices
• Encouraging prompt medical attention for suspected infections
• Raising awareness among healthcare providers for rapid diagnosis and treatment

How can increased sepsis awareness impact patient outcomes? Greater awareness can lead to earlier recognition of sepsis symptoms, prompting individuals to seek medical attention sooner. This early intervention is critical in sepsis treatment, as each hour of delay in administering antibiotics can significantly increase mortality risk. Additionally, awareness can drive better preventive practices, potentially reducing the overall incidence of sepsis in the population.

Sepsis remains a significant global health concern, with mortality rates ranging from 25% to 40% in severe cases. The complexity of this condition, coupled with its rapid onset and progression, makes it a challenging medical emergency. Ongoing research into improved diagnostic tools, targeted treatments, and preventive strategies continues to be crucial in the fight against sepsis. By combining medical advancements with increased public awareness and education, we can hope to reduce the impact of this life-threatening condition and improve outcomes for those affected by sepsis.

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%).