What is Sepsis? | Sepsis

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

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

• At least 1.7 million adults in America develop sepsis.
• At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice.
• 1 in 3 people who dies in a hospital had sepsis during that hospitalization
• Sepsis, or the infection causing sepsis, starts before a patient goes to the hospital in nearly 87% of cases.

Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency.   Sepsis happens when an infection you already have triggers a chain reaction throughout your body.  Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Is sepsis contagious?

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

Sepsis happens when…

Transcript: Sepsis happens when [TXT 1 1 KB]

What causes sepsis?

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

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Who is at risk?

Anyone can develop sepsis, but some people are at higher risk for sepsis:

Adults 65 or older

People with weakened immune systems

People with chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease

People with recent severe illness or hospitalization

People who survived sepsis

Children younger than one

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What are the signs & symptoms?

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

High heart rate or weak pulse

Confusion or disorientation

Extreme pain or discomfort

Fever, shivering, or feeling very cold

Shortness of breath

Clammy or sweaty skin

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

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

Sepsis is a medical emergency. If you or your loved one has an infection that’s not getting better or is getting worse, ACT FAST.

Get medical care IMMEDIATELY. Ask your healthcare professional, “Could this infection be leading to sepsis?” and if you should go to the emergency room.

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

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

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

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

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

Start the Conversation Today [PDF – 2 Pages]

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Does cancer put me at risk for sepsis?

• When am I more likely to get an infection?
• How will I know if I have neutropenia?
• How can I prevent an infection?

Yes. Having cancer and undergoing certain treatments for cancer, such as chemotherapy, can put you at higher risk of developing an infection, and infections can lead to sepsis.

Chemotherapy works by killing the fastest-growing cells in your body—both good and bad. This means that along with killing cancer cells, chemo also kills your infection-fighting white blood cells.

When am I more likely to get an infection?

An infection or sepsis can happen at any time. However, when your body has very low levels of a certain type of white blood cell (neutrophils) that increases your risk of getting an infection. This condition is a common side effect of chemo called neutropenia.

How will I know if I have neutropenia?

Your doctor will routinely test for neutropenia by checking the level of your white blood cells.

How can I prevent an infection?

• Wash your hands often and ask others around you to do the same.
• Avoid crowded places and people who are sick.
• Talk to your doctor about getting a flu shot or other vaccinations.
• Take a bath or shower every day (unless told otherwise).
• Use an unscented lotion to try to keep your skin from getting dry or cracked.
• Clean your teeth and gums with a soft toothbrush.
• Use a mouthwash to prevent mouth sores (if your doctor recommends one).
• Do not share food, drink cups, utensils or other personal items, such as toothbrushes.
• Cook meat and eggs all the way through to kill any germs.
• Carefully wash raw fruits and vegetables.
• Protect your skin from direct contact with pet bodily waste (urine or feces).
• Wash your hands immediately after touching an animal or removing its waste, even after wearing gloves.
• Use gloves for gardening.

For a person with cancer, almost any infection can lead to sepsis, for more information see Preventing Infections in Cancer Patients.

Cancer, Infection and Sepsis Fact Sheet [PDF – 2 pages]
A potentially deadly combination that every cancer patient should know about

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Page last reviewed: August 18, 2022

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

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Related Links

Antibiotic/ Antimicrobial Resistance

Antibiotic Prescribing and Use in Hospitals and Long-Term care

Healthcare-Associated Infections

Methicillin-resistant Staphylococcus aureus (MRSA) Infections

Preventing Infections in Cancer Patients

Procalcitonin

Procalcitonin (PCT) – a marker of sepsis!

Procalcitonin (PCT) is a polypeptide that is an inactive precursor of calcitonin. Normally, PCT is formed from preprocalcitonin in C-cells of the thyroid gland under the influence of calcium-dependent factors. In healthy individuals, all the resulting PCT is converted into calcitonin and practically does not enter the bloodstream. Normally, in the early period of the newborn, an increase in the level of PCT is noted.
In severe bacterial infections and sepsis, the massive formation of endotoxins, an increase in the levels of pro-inflammatory cytokines IL-6 and TNF-α leads to an increase in PCT synthesis not only in the thyroid gland, but also extrathyroidally: first of all, in leukocytes, monocytes, as well as in neuroendocrine cells of the lungs, intestines and liver. All this leads to a rapid and sharp increase in the level of PCT (already 6-12 hours after the generalization of the process) against the background of maintaining the level of calcitonin.

It must be taken into account that the level of PCT increases only with the generalization of a bacterial infection (sepsis) and reflects its degree, local foci do not lead to an increase in the level of the marker. Therefore, not only the presence of an increase is of diagnostic importance, but also the degree of increase and the dynamics of the PCT level. In addition, it should be taken into account that an increase in PCT does not occur with fungal and viral infections, allergic and autoimmune diseases, which allows differential diagnosis of these conditions.

The half-life of PCT is 25-30 hours, which allows it to be used as a marker of the effectiveness of antibiotic therapy, since after successful surgical treatment or antibiotic therapy, the level of procalcitonin in the blood decreases rapidly – by 30-50% per day.

On the other hand, if the level of procalcitonin persists for more than 4 days, correction of the therapy is necessary. If after treatment there is no rapid decrease in the level of PCT, then the prognosis of the disease is doubtful. Constantly increasing PCT values ​​indicate a poor prognosis of the disease. In acute pancreatitis, PCT is an indicator of the severity of the course and a marker of infectious complications.

An increase in the level of procalcitonin in the blood above 1.8 ng / ml indicates the development of infectious complications (sensitivity – 80-95%, specificity – 88-93%).

The level of PCT clearly correlates with the severity of the inflammatory process:

• PCT < 0.5 ng/ml - low risk of severe sepsis and/or septic shock.

• PCT from 0.5 to 2 ng / ml – moderate systemic inflammatory response syndrome (SIRS) – “gray zone”. It is impossible to make a diagnosis of sepsis with certainty, it is recommended to repeat the measurement within 6-24 hours.

• PCT> 2 ng / ml – severe systemic inflammatory response syndrome (SIRS), high risk of severe sepsis and / or septic shock (sensitivity 85%, specificity 93%).

• PCT 10 ng/mL and above – severe systemic inflammatory response syndrome (SIRS) – almost always due to severe bacterial sepsis or septic shock. Such levels of PCT are often associated with MODS (Multiple Organ Failure Syndrome), and indicate a high risk of death.

Dear patients, you can quickly and efficiently do an analysis to determine the level of procalcitonin in the blood in the clinical diagnostic laboratory of the Republican Scientific and Practical Center for Neurology and Neurosurgery at the address: Belarus, Minsk, 220114, st. F. Skorina, 24 (administrative and laboratory building No. 3), office No. 117.

Travel from the metro station “Moskovskaya” by buses No. 25, 64, 34, 145 to the stop “Republican Scientific and Practical Center for Neurology and Neurosurgery”. (look at the map)

Head of the Paid Services Department: Ekaterina Anatolyevna Shpak.

Phone: +375 17 249-40-49
E-mail: [email protected]

Text: Branevich O.V.

Septic shock. What is septic shock?

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.

Septic shock is a serious pathological condition that occurs when a massive intake of bacterial endotoxins into the blood. Accompanied by tissue hypoperfusion, a critical decrease in blood pressure and symptoms of multiple organ failure. The diagnosis is made on the basis of the general clinical picture, which combines signs of damage to the lungs, cardiovascular system (CVS), liver and kidneys, and centralization of blood circulation. Treatment: massive antibiotic therapy, infusion of colloid and crystalloid solutions, maintenance of CCC activity by introducing vasopressors, correction of respiratory disorders by mechanical ventilation.

ICD-10

R57.2

• Causes
• Pathogenesis
• Classification
• Symptoms of septic shock
• Complications
• Diagnostics
• Treatment of septic shock
• Prognosis and prevention
• Prices for treatment

General

Septic shock (SS) is also called infectious-toxic shock (ITS). As an independent nosological unit, pathology was first described in the 19th century, however, a full-fledged study with the development of specific anti-shock measures began no more than 25 years ago. It can occur with any infectious process. Most often occurs in patients of surgical departments, with meningococcal septicemia, typhoid fever, salmonellosis and plague. It is common in countries where the largest number of bacterial and parasitic diseases is diagnosed (Africa, Afghanistan, Indonesia). More than 500,000 people around the world die each year from TSS.

Septic shock

Reasons

In the vast majority of cases, pathology develops against the background of weakened immune responses. It occurs in patients suffering from chronic severe diseases, as well as in the elderly. Due to physiological characteristics, sepsis is more often diagnosed in men. The list of the most common diseases in which TTS events can occur includes:

• Foci of purulent infection. Signs of a systemic inflammatory reaction and associated disorders in the functioning of internal organs are noted in the presence of volumetric abscesses or phlegmon of soft tissues. The risk of a generalized toxic response increases with a long course of the disease, the absence of adequate antibiotic therapy, and the patient’s age over 60 years.
• Prolonged stay in the ICU. Hospitalization in the intensive care unit is always associated with the risk of sepsis and infectious shock. This is due to constant contact with microflora resistant to antibacterial drugs, weakening of the body’s defenses as a result of a serious illness, the presence of multiple gates of infection: catheters, gastric tubes, drainage tubes.
• Wounds. Violations of the integrity of the skin, including those that occurred during surgery, significantly increase the risk of infection with a highly contagious flora. TSS begins in patients with contaminated wounds who have not received timely care. Tissue trauma during surgery becomes the cause of a generalized infection only if the rules of asepsis and antisepsis are not followed. In most cases, septic shock occurs in patients who have undergone manipulations on the stomach and pancreas. Another common cause is diffuse peritonitis.
• Taking immunosuppressants. Immune depressant drugs (mercaptopurine, krizanol) are used to suppress the rejection reaction after organ transplantation. To a lesser extent, the level of self-protection decreases with the use of chemotherapeutic agents – cytostatics intended for the treatment of oncological diseases (doxorubicin, fluorouracil).
• AIDS. HIV infection in the AIDS stage leads to the development of atypical sepsis, provoked not by a bacterial culture, but by a fungus of the genus Candida. Clinical manifestations of the disease are characterized by a low degree of severity. The lack of an adequate immune response allows the pathogenic flora to multiply freely.

The causative agent of sepsis is gram-positive (streptococci, staphylococci, enterococci) and gram-negative (Enterobacter cloacae, Clostridium pneumoniae) bacteria. In many cases, cultures are insensitive to antibiotics, making it difficult to treat patients. Septic shock of viral origin is currently controversial among specialists. Some representatives of the scientific world argue that viruses are unable to cause pathology, others that an extracellular life form can provoke a systemic inflammatory response, which is the pathogenetic basis of TSS.

Pathogenesis

The symptoms are based on the uncontrolled spread of inflammatory mediators from the pathological focus. In this case, activation of macrophages, lymphocytes and neutrophils occurs. A systemic inflammatory response syndrome occurs. Against this background, peripheral vascular tone decreases, the volume of circulating blood decreases due to increased vascular permeability and fluid stagnation in the microvasculature. Further changes are due to a sharp decrease in perfusion. Insufficient blood supply causes hypoxia, ischemia of internal organs and disruption of their function. The most sensitive is the brain. In addition, the functional activity of the lungs, kidneys and liver worsens.

In addition to SVR, endogenous intoxication plays an important role in the formation of septic shock. In connection with a decrease in the efficiency of excretory systems, products of normal metabolism accumulate in the blood: creatinine, urea, lactate, guanine and pyruvate. In internal environments, the concentration of intermediate results of lipid oxidation (skatol, aldehydes, ketones) and bacterial endotoxins increases. All this causes severe changes in homeostasis, acid-base balance disorders, disturbances in the functioning of receptor systems.

Classification

The state of shock is classified according to pathogenetic and clinical principles. Pathogenetically, the disease can be “warm” and “cold”. Warm shock is characterized by an increase in cardiac output against the background of a decrease in overall vascular tone, endogenous hypercatecholaminemia, and dilation of intradermal vessels. The phenomena of organ failure are expressed moderately. The cold variety is manifested by a decrease in cardiac output, a sharp decrease in tissue perfusion, centralization of blood circulation, and severe MOF. According to the clinical course, septic shock is divided into the following varieties:

• Compensated. Consciousness is clear, safe, the patient is inhibited, but fully contactable. Arterial pressure is slightly reduced, the level of SBP is not less than 90 mm Hg. Tachycardia is detected (PS <100 bpm). Subjectively, the patient feels weakness, dizziness, headache and decreased muscle tone.
• Subcompensated. The skin is pale, the heart sounds are deaf, the heart rate reaches 140 beats per minute. SBP <90 mm. rt. Art., Respiration is rapid, shortness of breath up to 25 movements / min. Consciousness is confused, the patient answers questions with a delay, poorly understands what is happening around, where he is. Speech is quiet, slow, unintelligible.
• Decompensated. Marked depression of consciousness. The patient answers in monosyllables, in a whisper, often after 2-3 attempts. Motor activity is practically absent, the reaction to pain is weak. The skin is cyanotic, covered with sticky cold sweat. The heart sounds are deaf, the pulse on the peripheral arteries is not determined or is sharply weakened. Heart rate up to 180 beats / min, respiratory rate 25-30, shallow breathing. BP below 70/40, anuria.
• Terminal (irreversible). Consciousness is absent, the skin is marbled or gray, covered with bluish spots. Pathological breathing according to the type of Biot or Kussmaul, the respiratory rate decreases to 8-10 times / minute, sometimes breathing stops completely. SBP less than 50 mm Hg. pillar. There is no urination. The pulse is hardly palpable even on the central vessels.

Symptoms of septic shock

One of the defining signs of TSS is arterial hypotension. It is not possible to restore the level of blood pressure even with an adequate infusion volume (20-40 ml / kg). To maintain hemodynamics, it is necessary to use pressor amines (dopamine). Acute oliguria is noted, diuresis does not exceed 0.5 ml/kg/hour. Body temperature reaches febrile values ​​- 38-39 ° C, it is poorly reduced with the help of antipyretics. To prevent convulsions caused by hyperthermia, it is necessary to use physical methods of cooling.

90% of cases of SS are accompanied by respiratory failure of varying severity. Patients with decompensated and terminal course of the disease need hardware respiratory support. The liver and spleen are enlarged, compacted, their function is impaired. There may be intestinal atony, flatulence, stools mixed with mucus, blood and pus. In the later stages, symptoms of disseminated intravascular coagulation occur: petechial rash, internal and external bleeding.

Complications

Septic shock leads to a number of severe complications. The most common of these is multiple organ failure, in which the function of two or more systems is impaired. First of all, the central nervous system, lungs, kidneys and heart suffer. Somewhat less common damage to the liver, intestines and spleen. Mortality among patients with MOF reaches 60%. Some of them die 3-5 days after being removed from a critical state. This is due to organic changes in internal structures.

Another common consequence of TSS is bleeding. With the formation of intracerebral hematomas, the patient develops a clinic of acute hemorrhagic stroke. The accumulation of extravasate in other organs can lead to their compression. A decrease in blood volume in the vascular bed potentiates a more significant decrease in blood pressure. DIC against the background of infectious-toxic shock causes the death of the patient in 40-45% of cases. Secondary organ damage, provoked by microthromboses that occur at the initial stage of coagulopathy formation, is observed in almost 100% of patients.

Diagnostics

The diagnosis is established by an anesthesiologist-resuscitator. The assumption is based on clinical data, however, it is possible to accurately determine the existing condition only if there are results of hardware and laboratory studies. If septic shock is suspected, all tests are done in an emergency mode, “according to cito”. Resuscitation activities should begin without waiting for the end of the support services. A comprehensive examination necessary to determine and confirm TTS includes:

• Examination and physical examination. Implemented directly by the attending physician. The specialist detects the characteristic clinical signs of a shock state. For this, tonometry, a visual assessment of the color of the skin, features of respiratory movements, counting the pulse and respiratory rate, auscultation of the heart and lungs are performed. If complications are suspected, an assessment of the neurological status is necessary for symptoms of cerebral hemorrhage.
• Hardware research. Has an auxiliary value. The patient is shown to control the condition using an anesthetic monitor. The screen of the device displays information about the value of blood pressure, heart rate, degree of blood oxygen saturation (with lung failure SpO2<90%) and coronary rhythm. Against the background of respiratory disorders and toxic damage to the myocardium, tachycardia, arrhythmia and blockade of intracardiac conduction may occur.
• Laboratory research. Allows you to identify existing violations of homeostasis, failures in the work of internal organs. In patients with shock of septic origin, elevated levels of creatinine (> 0.177 mmol / l), bilirubin (> 34.2 μmol / l), lactate (> 2 mmol / l) are found. Thrombocytopenia (<100 × 10⁹/l) indicates a violation of coagulation. With progressive anemia, erythrocytes are 1.5-2.5 million per 1 mm3, hemoglobin is below 90 g/l. venous blood pH <7.3 (metabolic acidosis).

Treatment of septic shock

Patients are given intensive care. Treatment is carried out in intensive care units using the methods of hardware and drug support. The attending physician is a resuscitator. Consultation with an infectious disease specialist, cardiologist, gastroenterologist and other specialists may be required. It is required to transfer the patient to artificial lung ventilation, round-the-clock supervision of nurses, parenteral feeding. Mixtures and products intended for introduction into the stomach are not used. All methods of exposure are conditionally divided into pathogenetic and symptomatic:

• Pathogenetic treatment. If sepsis is suspected, the patient is prescribed antibiotics. The scheme should include 2-3 drugs of various groups with a wide spectrum of action. The selection of the drug at the initial stage is carried out empirically, in accordance with the expected sensitivity of the pathogen. At the same time, blood is taken for sterility and susceptibility to antibiotics. The result of the analysis is prepared within 10 days. If by this time it was not possible to select an effective drug regimen, the study data should be used.
• Symptomatic treatment. It is selected taking into account the existing clinical picture. Usually patients receive massive infusion therapy, glucocorticosteroids, inotropic agents, antiplatelet agents or hemostatics (depending on the state of the blood coagulation system). In severe cases of the disease, blood products are used: fresh frozen plasma, albumin, immunoglobulins. If the patient is conscious, the introduction of analgesic and sedative drugs is indicated.

Prognosis and prevention

Septic shock has a poor prognosis for life. With a subcompensated course, about 40% of patients die. Decompensated and terminal varieties end in the death of 60% of patients. In the absence of timely medical care, mortality reaches 95-100%. Some patients die a few days after the elimination of the pathological condition. Prevention of TSS consists in the timely relief of foci of infection, the competent selection of antibiotic therapy in surgical patients, compliance with antiseptic requirements in departments involved in invasive manipulations, and the maintenance of an adequate immune status in representatives of the HIV-infected stratum of the population.