Content

Introduction

Introduction

Sepsis is a rare complication of an "infection, the consequences of which can be very serious and potentially fatal. It consists of an excessive inflammatory response of the body to a" generalized infection that damages tissues and organs, compromising their functioning. Without immediate treatment it can result in death.

Every year 700,000 cases of sepsis are recorded in Europe, of which at least 1 in 5 with fatal outcome.

Sepsis can affect anyone who has an infection, however, it is more common in infants, children, the elderly, and people with persistent (chronic) disease or other medical conditions that weaken the immune system.

People admitted to hospital, if they have just undergone surgery or have undergone the implantation of a medical device, such as urinary catheter or venous catheter, are more at risk of sepsis. The longer the hospital stay, the greater it is. the risk of developing it.

The first complaints (symptoms) caused by sepsis are high fever or lower body temperature, chills, increased heart rate and respiratory rate. If action is not taken immediately, the situation can rapidly worsen and the initial symptoms (symptoms) can be joined by others, more serious, up to septic shock, with a drop in blood pressure.

Sepsis is caused by an infection anywhere in the body. Bacterial infections are the most common cause of sepsis. In rare cases, infections caused by viruses or fungi are involved.

The infections most commonly associated with sepsis are:

  • pneumonia
  • intra-abdominal infections
  • surgical infections
  • meningitis
  • encephalitis
  • kidney infections
  • osteomyelitis
  • endocarditis

In the case of sepsis of bacterial or fungal origin, the first step towards their development is the passage into the blood of the bacteria / fungi that caused the localized infection. When this occurs, the infection spreads to the whole organism and is said generalized or systemic. The second step is the appearance of an "exaggerated inflammatory response extended to the whole" organism that causes damage to organs and tissues.

The assessment (diagnosis) of sepsis is based on the observation of the disorders (symptoms), on the results of blood tests performed to highlight the possible presence of bacteria / fungi or other germs, on other laboratory tests able to evaluate the damage to different organs and their functioning (organ dysfunction).

If the source of the infection is not evident, laboratory tests can be supplemented by so-called diagnostic imaging to identify the infectious outbreak and proceed with the most appropriate treatments.

Treatment of sepsis includes administration of antibiotics, intravenous fluids, oxygen if needed, corticosteroids, and further treatments depending on the severity of the organ damage.

In severe cases, and especially if septic shock occurs, immediate hospitalization in an intensive care unit is required. Sepsis can be fatal due to vital organ malfunction. However, if identified and treated quickly, the patient's recovery can be complete and free of long-term consequences.

Sepsis and septicemia

Often the terms septicemia And sepsis they are used synonymously, that is to say as if they have the same meaning. In fact, the term septicemia refers only to the invasion of the blood by bacteria, while the word sepsis indicates the progressive damage to organs caused by the body's inflammatory response to septicemia but also to an infection (bacterial or rarely from fungi or viruses) without septicemia.

When to see your doctor

People who have recently contracted an infection or have injured themselves should see their doctor immediately if they notice symptoms such as high fever, chills, increased heart rate. sepsis will send the patient to the nearest emergency room for investigation and treatment Sepsis and septic shock are medical emergencies that require immediate hospitalization.

Symptoms

Symptoms

Disorders (symptoms) caused by sepsis in children under the age of 5

It is essential to call 118, or go to the nearest emergency room, in case the child develops one of the following problems:

  • cold, pale, bluish skin or patches that do not lighten under finger pressure
  • severe sleepiness or difficulty waking up (lethargy)
  • rapid breathing
  • convulsions

It is necessary to ask the pediatrician for immediate evaluation if the child presents:

  • body temperature
    • fever above 38 degrees, in children under 3 months of age
    • fever above 39 degrees, in children aged 3 to 6 months
    • fever associated with a total lack of interest in any object or activity
    • very low temperature (below 36 degrees), to be checked at least three times within ten minutes
  • breathing
    • difficult breathing, breathless or noisy
    • presence of pauses during breathing (apnea)
  • urine (pee)
    • no pee or dry diapers for at least 12 hours
  • supply
    • loss of appetite in infants less than 1 month of age
    • I have refused to drink liquids for over 8 hours (during the waking period)
    • green vomit (containing bile), tar-colored or with blood
  • other physical or behavioral disorders
    • swelling of the cranial fontanel in newborns
    • sunken eyes
    • lack of interest in any business
    • loss of muscle tone (baby appears flabby)
    • faint, whiny crying or uninterrupted crying in younger children
    • mental confusion in older children
    • poor reactivity or irritability
    • stiff neck, especially when looking up or down

Sepsis disorders in older children and adults

In older children and adults, the first signs of sepsis are:

  • very high or very low body temperature (fever)
  • chills and tremors
  • increased heart rate
  • rapid breathing

In some cases, these disorders (symptoms) can be associated with the signs of septic shock (characterized by a dangerous lowering of blood pressure) such as:

  • feeling faint or severely weak
  • changes in mental status (confusion or disorientation)
  • diarrhea
  • nausea and vomit
  • respiratory difficulties
  • significant reduction in urine production (such as total absence of urine for 24 consecutive hours)
  • cold, clammy, pale or patchy skin
  • loss of consciousness
Causes

Causes

Sepsis is caused by an infection taking place in any part of the body and by the passage of the responsible microorganisms in the blood with the consequent spread of the infection to the whole organism (generalized or systemic infection). Generally, it is caused by bacteria; more rarely, from viruses and fungi.

Sources of infection

The types of infections that can give rise to sepsis include:

  • pneumonia
  • appendicitis
  • peritonitis (infection of the thin envelope that lines the inside of the abdomen)
  • urinary tract infections (infection of the bladder, urethra or kidneys)
  • cholecystitis (gallbladder infection) or cholangitis (bile duct infection)
  • infections of the skin and underlying layers (cellulitis), which can be caused by a venous catheter inserted to deliver fluids or drugs
  • infections after surgery
  • meningitis (infection of the membranes lining the brain), encephalitis (brain infection)
  • osteomyelitis (bone infection)
  • endocarditis (infection of the valves of the heart)

Sometimes, the infection that led to the sepsis remains unknown.

What causes the disorders (symptoms) of sepsis

Under normal conditions, the body's defense system (immune system) keeps the infection limited to the area of ​​the body where it originated. In these cases, the infection is said to be localized. The body produces white blood cells which travel to the site of infection to destroy the germs responsible for the infectious process. A series of biological phenomena are therefore activated that help fight the infection and prevent it from spreading. This mechanism is called inflammation.

If the immune system is weakened, or the infection is particularly severe, the infection can spread through the blood to other parts of the body, over-stimulating the immune system.

The end result is the "extension of the infection to the entire organism, that is a generalized infection, accompanied by a abnormal inflammatory response which causes many more problems than the original infection itself. The generalized inflammatory response damages organs and tissues and obstructs blood flow. Reduction, or interruption, of blood flow causes a dangerous drop in pressure which prevents oxygen from reaching the bloodstream. different organs and tissues, causing further damage with often fatal consequences.

People at risk

Virtually everyone is at risk of developing sepsis after contracting an infection, even a minor one.

However, the likelihood is greater in infants, children, the elderly, and people with any of the following conditions:

  • immune system compromised by diseases such as "AIDS or leukemia
  • administering drugs that weaken the immune system, such as chemotherapy and prolonged cortisone therapy
  • pregnancy
  • chronic diseases such as diabetes
  • use of mechanical ventilation (breathing with the help of special equipment)
  • implantation of invasive medical devices, such as catheters and drains
  • surgery or the presence of injuries and injuries from trauma or accidents
  • genetic predisposition to infections

The risk of developing sepsis is particularly high in people admitted to hospital for serious illness. Bacterial infections that can be contracted in hospital are the potentially most dangerous, as they are caused by bacteria that have often become resistant to the most commonly used antibiotics. An example of this is the "MRSA infection (from the English Methicillin-Resistant Staphylococcus aureus, i.e. strains of the bacterium Staphylococcus aureus resistant to methicillin) or from Enterobacteria (such as Escherichia coli And Klebsiella pneumoniae) multi-resistant.

Diagnosis

Diagnosis

The assessment (diagnosis) of sepsis is based on the presence of an infection and on the observation of the following parameters:

  • body temperature
  • heart rate
  • breath frequency

In addition to the control of clinical parameters (temperature, heart rate and respiratory rate), blood culture analysis (blood culture) must be performed to highlight the type of microorganism present and other laboratory tests capable of evaluating the damage to organs caused by sepsis. Additional microbiological and imaging tests, such as x-rays, ultrasound scans, or computed tomography (CT), may be done to identify the type of infection and its location.

Therapy

Therapy

The treatment of sepsis varies according to the site and cause of the initial infection, the organs affected and the severity of the damage caused. In general, at the first signs of sepsis, even if only suspected, the family doctor prescribes hospitalization for the necessary investigations and treatments. In some cases immediate hospitalization in an intensive care unit is necessary.

Sepsis in the hospital is treated according to a complex scheme that includes, within one "hour of its assessment (diagnosis), the administration of:

  • antibiotics (by mouth or intravenously, depending on the severity of the condition)
  • intravenous fluids
  • oxygen, if your blood levels are low

Emergency care

Admission to the intensive care unit of a hospital is essential in severe cases and in cases of septic shock, in which blood pressure plummets to dangerously low levels. In intensive care units, while the infection is being treated, it is also possible to support the vital functions of the body compromised by sepsis, such as breathing or blood circulation. Depending on the severity of the damage to vital organs, people affected by sepsis can find themselves in very critical conditions. The death rate in severe cases is 4 out of 10. The situation is even more serious in the case of septic shock. About 6 out of 10 people fail to survive. However, if recognized and treated quickly, sepsis can be completely cured in most cases.

Antibiotics

The main treatment to combat sepsis of any degree is antibiotic therapy. Typically, antibiotics are given directly into a vein via an IV. Ideally, antibiotic treatment should begin within one "hour" of disease detection (diagnosis) to reduce the risk of complications or death.Generally, while awaiting the results of blood culture, an analysis that identifies the type of bacteria responsible for the infection, broad-spectrum antibiotics are administered that are capable of fighting many varieties of bacteria and treating the most common infections. Once the bacterium has been identified. responsible for the infection, treatment with broad-spectrum antibiotics is replaced by targeted, limited-spectrum antibiotic therapy.

Viral infections

If the sepsis is caused by viruses, it cannot be cured with antibiotics as they are not effective against them. However, antibiotics are usually given anyway because it would be too dangerous to delay treatment pending the results of the laboratory tests. In the case of a confirmed viral infection, there is not always an adequate antiviral therapy; in most cases there are no effective drugs and it is necessary to wait for the immune system to fight the infection.

Intravenous fluids

People with sepsis need to take in large amounts of fluids to combat dehydration and kidney failure. For this reason, they are given intravenous fluids for at least 24 to 48 hours after hospital admission. In case of lowering of blood pressure (arterial pressure) caused by sepsis, special drugs are administered intravenously, called vasopressors, and, if necessary, other liquids that favor the increase of pressure. In addition, to evaluate possible renal insufficiency, a catheter is inserted into the bladder in order to measure the amount of urine produced by the kidneys.

Oxygen

In the event of sepsis, the body's need for oxygen increases. If the concentration in the blood is low, it is necessary to administer oxygen through a face mask or cannulae inserted into the nostrils.

Treatment of the infection

Once the infection that caused the sepsis has been identified, it is necessary to proceed with the necessary treatments: drain the pus if the cause is an abscess, perform surgery to remove infected or damaged tissues, if the cause is an infected wound.

Other treatments

In some cases, additional care may be needed which includes:

  • administration of corticosteroids or insulin
  • blood transfusions
  • artificial respiration (mechanical ventilation)
  • dialysis, a method of blood purification through an appliance that replaces kidney function

Most of these treatments are performed in intensive care units.

Healing times

Some people recover from sepsis quite quickly. Recovery times depend on several factors:

  • severity of sepsis
  • general conditions of the person
  • length of stay in hospital
  • possible hospitalization in an intensive care unit

In some cases, the so-called post sepsis syndrome, which includes several long-term ailments, such as:

  • severe sleepiness or excessive tiredness
  • muscle weakness
  • swelling of the limbs or joint pain
  • chest pain or shortness of breath
Prevention

Prevention

The best sepsis prevention measure is to reduce the risk of getting infections. A key role in this direction is played by vaccinations, which protect not only vaccinated people but, indirectly, also those who cannot be vaccinated due to their state of health, thanks to a mechanism known as herd immunity. When a high level of vaccinated people is reached (vaccination coverage) in the population, in fact, the chain of spread of infections is interrupted, providing indirect protection even to unvaccinated people.

For some bacteria that cause infections that can give rise to sepsis, specific vaccines are available such as those against:

  • streptococcus pneumoniae
  • neisseria meningitidis
  • haemophilus influenzae, type b

The care of localized infectious foci with adequate antibiotics it can be effective in preventing the spread of microorganisms through the blood and, therefore, the evolution from localized infection to generalized (systemic) infection.

Another very effective yet underestimated defense weapon against infections is correct hand hygiene, on which germs of all kinds lurk, including those capable of causing disease, coming from the objects and surfaces with which one enters daily contact. To remove microorganisms from hands simply washing with soap and water or, in the absence of these, with gel or alcoholic solutions. Hand washing of healthcare personnel in hospitals plays an essential role in preventing the transmission of infections and in the prevention of sepsis.

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