Sepsis

Sepsis is a life-threatening medical emergency that happens when your body’s response to an infection causes damage to its own tissues and organs. It is one of the most frequent causes of death worldwide, requiring immediate medical attention and treatment to improve chances of survival.

What is sepsis?
Who is at risk?
Common infections that lead to sepsis
Signs and symptoms
Stages of sepsis
How sepsis is diagnosed
Treatment
Recovery and long-term effects
Prevention
Important facts and statistics

What is sepsis?

Sepsis is a serious condition in which the body responds improperly to an infection. The infection-fighting processes turn on the body, causing the organs to work poorly^[1]. In other words, it’s your body’s overactive and toxic response to an infection^[4].

Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency^[2]. When an infection you already have triggers a chain reaction throughout your body, sepsis happens^[2].

Sepsis is a life-threatening condition that happens when your body’s immune system (the system that protects your body from germs and infections) has an extreme response to an infection. When you have an infection, your immune system works to try to fight it. But sometimes your immune system stops fighting the infection and starts damaging your normal tissues and organs, leading to widespread inflammation (swelling and irritation) throughout your body^[10].

At the same time, an abnormal chain reaction in your clotting system can cause blood clots to form in your blood vessels. This reduces blood flow to the different organs of your body and can cause significant damage or even failure^[10].

Who is at risk?

Anyone can develop sepsis, but some people are at higher risk for sepsis^[2]. Sepsis can affect anyone at any age, but especially susceptible are infants (under 12 months), pregnant women, older adults, and people with chronic health conditions like diabetes and/or weakened immune systems^[15].

You’re at a higher risk if you are over age 65, are pregnant, have certain medical conditions like diabetes, obesity, cancer and kidney disease, have a weakened immune system, are in the hospital for other medical reasons, or have severe injuries like large burns or wounds^[10]. People who have catheters, IVs or breathing tubes are also at higher risk^[10].

Newborns and infants are another at-risk group^[10]. Almost half (20 million) of all estimated sepsis cases worldwide occurred in children under 5 years of age^[3].

People who are malnourished can also contract infections more easily, which puts them at higher risk^[4].

Common infections that lead to sepsis

When germs get into a person’s body, they can cause an infection. If that infection doesn’t stop, 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 influenza. Fungal infections can also cause sepsis^[2].

Infections that lead to sepsis most often start in the lung, skin, gastrointestinal tract, or urinary tract^[2].

Sepsis is most commonly associated with the following types of infections: lung infections (like pneumonia), urinary tract infections, skin infections (especially burns), and infections of the digestive system^[15].

The infection leading to sepsis can start in many different parts of the body. Common sites and types of infections that can lead to sepsis include infections involving your lungs, such as pneumonia; urinary tract infections, which are especially likely if you have a catheter; infection of your appendix; bowel problems; and infection from a wound^[10].

Signs and symptoms

Sepsis can affect many different areas of your body, so there are many possible symptoms^[10]. Symptoms of sepsis may include change in mental status, fast shallow breathing, sweating for no clear reason, feeling lightheaded, shivering, and symptoms specific to the type of infection, such as painful urination from a urinary tract infection or worsening cough from pneumonia^[1].

Symptoms of sepsis are not specific. They can vary from person to person, and sepsis may appear differently in children than in adults^[1].

A person with sepsis might have one or more of the following signs or symptoms: clammy or sweaty skin, confusion or disorientation, extreme pain or discomfort, fever, shivering or feeling very cold, high heart rate or weak pulse, and shortness of breath^[2].

Other common sepsis symptoms include urinary issues such as reduced urination or an urge to urinate, low energy or weakness, fast heart rate, low blood pressure, fever or hypothermia (very low body temperature), shaking or chills, warm or clammy skin, confusion or agitation, hyperventilation (rapid breathing) or shortness of breath, and extreme pain or discomfort^[10].

If an infection such as blood poisoning triggered your condition, you may develop a sepsis rash on your skin. The rash makes your skin appear red and discolored. You may see small, dark-red spots on your skin^[10].

Stages of sepsis

Healthcare providers used to organize sepsis into three stages: sepsis, severe sepsis and septic shock. Now, they identify the condition on a more fluid scale. This scale ranges from infection and bacteremia (bacteria in your bloodstream) to sepsis and septic shock, which can lead to dysfunction of multiple organs and even death^[10].

Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can damage the lungs, kidneys, liver and other organs. When the damage is severe, it can lead to death^[1].

Severe sepsis may cause organ dysfunction and significantly reduced blood flow. The presence of low blood pressure, high blood lactate, or low urine output may suggest poor blood flow^[6]. Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement or requires medications to raise the blood pressure^[6].

Symptoms of septic shock include not being able to stand up, strong sleepiness or hard time staying awake, and major change in mental status, such as extreme confusion^[1]. Progression to septic shock raises the risk of death^[1].

How sepsis is diagnosed

Sepsis is diagnosed through a medical assessment performed by a healthcare provider. They diagnose sepsis using physical findings, such as fever, increased heart rate, low blood pressure, and trouble breathing^[2].

A single diagnostic test for sepsis does not yet exist, and so doctors and healthcare professionals use a combination of tests and immediate and worrisome clinical signs^[15].

Healthcare providers also perform tests that check for signs of infection or organ damage. Some of these tests are used to identify the germ that caused the infection that led to sepsis. This testing might include blood cultures looking for bacterial infections, fungal infections, or tests for viral infections, like influenza^[2].

Doctors often order several tests to try to pinpoint underlying infection. Blood samples are used to test for evidence of infection, blood-clotting problems, abnormal liver or kidney function, lower levels of oxygen than the body needs, and electrolyte imbalances^[9].

Other lab tests to find the source of the infection might include samples of urine, liquid from the wound, and mucus and saliva from the respiratory tract^[9].

If the site of infection is not readily found, your health care provider may order imaging tests. Some examples of imaging tests are X-ray, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI)^[9].

A urine sample can provide information about urinary tract infections or kidney problems. Markers found in the blood can show that the immune system has gone into an over-reactive mode^[15].

Treatment

Early, thorough treatment raises the likelihood of recovery. People who have sepsis need close monitoring and treatment in a hospital intensive care unit. This is because people with sepsis may need lifesaving measures to stabilize breathing and heart action^[9].

Sepsis needs treatment in hospital straight away because it can get worse quickly. You should get antibiotics within 1 to 6 hours of arriving at hospital^[11]. Research shows that rapid, effective sepsis treatment includes giving appropriate treatment, including antibiotics, as soon as possible; maintaining blood flow to organs; and sometimes surgery is required to remove tissue damaged by the infection^[2].

Healthcare providers should immediately evaluate and treat people who might have sepsis^[2]. Sepsis is a medical emergency. It needs to be treated as quickly and efficiently as possible as soon as it has been identified. The risk of death from sepsis increases by an average of up to 7.6% with every hour that passes before treatment begins^[12].

Antibiotics are the main treatment for sepsis. Treatment with antibiotics begins as soon as possible. Broad-spectrum antibiotics, which are effective against a variety of bacteria, are the first-line medications. These are intravenous antibiotics so they can get into the blood system quickly and efficiently^[12].

Antibiotics alone won’t treat sepsis; you also need fluids. The body needs extra fluids to help keep the blood pressure from dropping dangerously low, causing shock. Giving IV fluids allows the health care staff to track the amount of fluid and to control the type of fluid. Ensuring the body has enough fluids helps the organs to function and may reduce damage from sepsis^[12].

Different medications are used in treating sepsis and septic shock. They include antibiotics, intravenous fluids, medications called vasopressors (medicines used to raise blood pressure if it is low), and other medications^[9]. You may also need more treatment, such as mechanical ventilation where a machine is used to help you breathe, dialysis where a machine filters your blood to copy the function of your kidneys, a blood transfusion, steroids or insulin^[14].

If sepsis is not treated early, it can turn into septic shock and cause your organs to fail. This is life threatening. You may need other tests or treatments depending on your symptoms, including treatment in an intensive care unit, a machine to help you breathe (ventilator), and surgery to remove areas of infection^[11].

You may need to stay in hospital for several weeks^[11].

Recovery and long-term effects

Most people make a full recovery from sepsis. But it can take time. You might continue to have physical and emotional symptoms. These can last for months, or even years, after you had sepsis^[11].

Many people who survive sepsis recover completely and their lives return to normal. However, as with some other illnesses requiring intensive medical care, some patients have long-term effects^[16].

These long-term effects are sometimes called post-sepsis syndrome, and can include feeling very tired and weak and difficulty sleeping, lack of appetite, getting ill more often, changes in your mood or anxiety or depression, nightmares or flashbacks, and post-traumatic stress disorder (PTSD)^[11].

You have been seriously ill, and your body and mind need time to get better^[16]. You may experience the following physical symptoms upon returning home: breathlessness, brittle nails, difficulty moving around, difficulty sleeping, dry and itchy skin that may peel, general body pains or aches, general to extreme weakness and fatigue, hair loss, and weight loss, lack of appetite, food not tasting normal^[16].

You might also experience the following feelings once you are at home: confusing reality (not sure what is real and what isn’t), depressed, angry, unmotivated, feeling anxious or more worried than usual, flashbacks and bad memories, frustration at not being able to do everyday tasks, poor concentration, unsure of yourself, wanting to be alone and avoiding friends and family^[16].

After you have had sepsis, rehabilitation usually starts in the hospital by slowly helping you to move around and look after yourself: sitting up, standing, walking, taking yourself to the restroom, bathing and other activities. The purpose of rehabilitation is to restore you back to your previous level of health or as close to it as possible^[16].

Most symptoms of post-sepsis syndrome should get better on their own. But it can take time. There are things you can do to help with some long-term effects: ask your work about changes to your working hours or conditions while you’re recovering, do some gentle, easy exercises to build your strength, get regular sleep, try to prevent infections by washing your hands regularly, try to eat little and often if you have a small appetite, and do not try to rush your recovery – give yourself time^[11].

Since sepsis survivors are at risk for repeat infections, you should also speak with your doctor about any vaccinations that you may need to reduce the likelihood of getting another infection^[19].

Prevention

You can take specific steps to reduce your risk of sepsis^[2]. Preventing infections is the best way to avoid sepsis^[22].

The Centers for Disease Control and Prevention recommends these four ways to get ahead of sepsis: prevent infections by taking care of chronic conditions, getting recommended vaccines and keeping cuts clean until healed; practice good hygiene by proper handwashing – wash hands frequently with soap and water for at least 20 seconds and dry them well, and if you can’t wash your hands, clean them with hand sanitizer; know the symptoms; and act fast – get medical attention immediately if you suspect sepsis or have an infection that’s not getting better or is getting worse^[20].

While not all cases of sepsis can be prevented, the risk can be reduced by taking antibiotics or other antimicrobials if prescribed and finishing the entire course of medications; not taking antibiotics you do not need or taking someone else’s antibiotics (using antibiotics wisely can help reduce the chances of developing antibiotic-resistant infections); frequent and thorough handwashing with soap and water for at least 20 seconds; asking your doctor, nurse, or other healthcare professional to wash their hands if you have not seen them do so; getting an annual flu immunization and other immunizations as recommended by a trusted healthcare professional; and coughing into your elbow, not your hand (to help prevent spreading of germs)^[21].

Any infection could lead to sepsis. Go to a health care provider if you have symptoms of sepsis or an infection or wound that isn’t getting better. Symptoms such as confusion or fast breathing need emergency care^[1].

Important facts and statistics

Sepsis is one of the most frequent causes of death worldwide^[3]. Each year, at least 1.7 million adults in the U.S. develop sepsis. At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice^[2]. More than 1.7 million people in the United States receive a diagnosis of sepsis each year^[10].

From data published in 2020, there were 48.9 million cases and 11 million sepsis-related deaths worldwide, representing 20% of all global deaths^[3].

1 in 3 people who dies in a hospital had sepsis during their hospital stay. Most cases of sepsis start before a patient goes to the hospital. Most people who develop sepsis have at least one existing medical condition like chronic lung disease or a weakened immune system. Nearly a quarter to a third of people with sepsis had a healthcare visit in the week before they were hospitalized^[2].

For every 1000 hospitalized patients, an estimated 15 patients will develop sepsis as a complication of receiving health care^[3]. While sepsis can affect any individual worldwide, significant regional disparities in incidence and mortality exist with the highest rates in lower-middle-income countries^[3].

Sepsis is costly; the average hospital-wide cost of sepsis was estimated to be more than US $32,000 per patient in high-income countries^[3]. Sepsis is the number 1 cost of hospitalization in the U.S. Costs for acute sepsis hospitalization and skilled nursing are estimated to be $62 billion annually^[4].

Studies investigating survival and sepsis deaths have reported slightly different numbers, but it appears that on average, approximately 30% of patients diagnosed with severe sepsis do not survive. Up to 50% of survivors suffer from post-sepsis syndrome^[4].