What is Sepsis?

What is sepsis? Sepsis is a complex, but common and frequently fatal medical condition which is the result of the body’s inflammatory response to an infection. Infants, children, the elderly and those with weak immune systems are particularly susceptible to sepsis. The infectious agent travels from the initial site of infection to other organs via the bloodstream and in severe cases can lead to organ failure, hypoperfusion and/or hypotension. The body’s inflammatory reaction is on “over-drive” and instead of contributing to control the infection may make matters worse. As a result, sepsis may lead to a very dire state called “septic shock’ which can occur, causing multiple organ dysfunction syndrome and death.

Who gets sepsis? In the U.S., sepsis strikes 750,000 Americans, and is the tenth most-common cause of death overall, according to data from the Centers for Disease Control and Prevention. It occurs in 1 percent to 2 percent of all hospitalizations and accounts for as much as 25 percent of ICU bed utilization. It is a major cause of death in intensive-care units worldwide, with mortality rates that range from 20 percent for early stage sepsis to over 60 percent for the far end of the spectrum, septic shock.

What causes sepsis? Sepsis is caused by the presence of an infection PLUS an overwhelming inflammatory response on the part of the patient. For instance, you can have a bacterial infection, like pneumonia, without necessary developing sepsis. With the wrong triggers, your body’s response becomes out of control and sepsis can develop. It is not entirely clear why certain people develop sepsis with an infection but others do not. Part of it may be due to immune compromised states such as infancy, old age or active cancer, etc. However, part of it may be genetic or environmental. Clearly, one of the areas that doctors and nurses have control over is the timely administration of antibiotics for patients who have bacterial infections. Research shows one of the major factors determining the survival from septic shock is the quick initiation of antibiotics.

What are the symptoms of sepsis? Because the symptoms of sepsis are very general and can mimic other disorders, such as fever, chills, rapid breathing and heart rate, rash, confusion and disorientation, it can be difficult for a clinician to diagnose sepsis in its early stages.

Who is most at risk for acquiring sepsis? Patients with depressed immune systems seem to be at the most risk for developing sepsis. This includes the very young, the very old, and in our country people with immune system problems such as patients living with HIV or undergoing chemotherapy.

Why is the early detection of sepsis important? Research shows one of the major factors determining the survival from septic shock is the quick initiation of antibiotics. It is one of the few areas of sepsis we have control over. Another area where early detection in important is in the aggressive infusion of IV fluids. It turns out that this simple procedure can have a significant impact on sepsis survival.

What’s being done to better detect sepsis? Over a decade ago, a simple blood test was developed in Europe that clinicians found predicted quite well whether patients have a blood stream infection or sepsis. This test, called Procalcitonin (or PCT) has been extensively used in European hospitals for years with impressive effect. Prior to the arrival of the PCT test, sepsis was diagnosed by a combination of clinical factors (i.e. the physician’s assessment and judgment) as well as a few laboratory tools. One of the historical “gold standard” laboratory parameters is the blood culture. While still useful, it can take a day or more to get results from blood cultures confirming that a patient has bacteria growing in their bloodstream. There were some delays in getting the test available in the U.S. but PCT is now available and increasingly used in U.S. hospitals for the past 3 to 4 years with similar efficacy. However, not all hospitals in the U.S. offer PCT testing at present and not all U.S. hospitals offer PCT testing with the rapid response time needed to help care givers improve their medical decision making. Many hospitals in the San Diego area are participating in performance improvement initiatives to increase sepsis survival. In addition to individual hospitals having multi-disciplinary sepsis care improvement committees, there are regional meetings sponsored by the Hospital Association of San Diego and Imperial Counties where member hospitals share best practices and strategize as to how to improve system issues to get sepsis patients timely and effective treatment.

Dr. Neath acknowledges consultant relationships with several biomedical companies, including Thermo Fisher Scientific.