sepsis

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Sepsis

 

Definition

Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.

Description

Sepsis is also called bacteremia. Closely related terms include septicemia and septic syndrome. In the general population, the incidence of sepsis is two people in 10,000. The number of deaths from sepsis each year has almost doubled in the United States since 1980 because more patients are developing the condition. There are three major factors responsible for this increase: a rise in the number of organ transplants and other surgical procedures that require suppressing the patient's immune system; the greater number of elderly people in the population; and the overuse of antibiotics to treat infectious illnesses, resulting in the development of drug-resistant bacteria.

Causes and symptoms

Sepsis can originate anywhere bacteria can gain entry to the body; common sites include the genitourinary tract, the liver and its bile ducts, the gastrointestinal tract, and the lungs. Broken or ulcerated skin can also provide access to bacteria commonly present in the environment. Invasive medical procedures, including dental work, can introduce bacteria or permit them to accumulate in the body. Entry points and equipment left in place for any length of time present a particular risk. Heart valve replacement, catheters, ostomy sites, intravenous (IV) or arterial lines, surgical wounds, or surgical drains are examples. IV drug users are at high risk as well.
People with inefficient immune systems, HIV infection, spinal cord injuries, or blood disorders are at particular risk for sepsis and have a higher death rate (up to 60%); in people who have no underlying chronic disease, the death rate is far lower (about 5%). The growing problem of antibiotic resistance has increased the incidence of sepsis, partly because ordinary preventive measures (such as prophylactic antibiotics) are less effective.
Cancer patients are at an increased risk of developing sepsis because chemotherapy and other forms of treatment for cancer weaken their immune systems.
The most common symptom of sepsis is fever, often accompanied by chills or shaking, or other flu-like symptoms. A history of any recent invasive procedure or dental work should raise the suspicion of sepsis and medical help should be sought.

Diagnosis

The presence of sepsis is indicated by blood tests showing particularly high or low white blood cell counts. The causative agent is determined by blood culture.
In some cases the doctor may order imaging studies to rule out pneumonia, or to determine whether the sepsis has developed from a ruptured appendix or other leakage from the digestive tract into the abdomen.

Treatment

Identifying the specific causative agent ultimately determines how sepsis is treated. However, time is of the essence, so a broad-spectrum antibiotic or multiple antibiotics will be administered until blood cultures reveal the culprit and treatment can be made specific to the organism. Intravenous antibiotic therapy is usually necessary and is administered in the hospital. The patient's chances of survival are increased by rapid admission to an intensive care unit followed by aggressive treatment with antibiotics.

Key terms

Bacteremia — The medical term for sepsis.
Prophylactic — Referring to medications or other treatments given to prevent disease.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Bacteremia and Septic Shock." Section 13, Chapter 156 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Cunha, Burke A., MD. "Sepsis, Bacterial." eMedicine September 29, 2004. http://www.emedicine.com/med/topic3163.htm.
Koranyi, K. I., and M. A. Ranalli. "Mycobacterium aurum Bacteremia in an Immunocompromised Child." Pediatric Infectious Diseases Journal 22 (December 2003): 1108-1109.
Larche, J., E. Azoulay, F. Fieux, et al. "Improved Survival of Critically Ill Cancer Patients with Septic Shock." Intensive Care Medicine 29 (October 2003): 1688-1695.
Paphitou, N. I., and K. V. Rolston. "Catheter-Related Bacteremia Caused by Agrobacterium radiobacter in a Cancer Patient: Case Report and Literature Review." Infection 31 (December 2003): 421-424.
Petrosillo, N., L. Pagani, G. Ippolito, et al. "Nosocomial Infections in HIV-Positive Patients: An Overview." Infection 31, Supplement 2 (December 2003): 28-34.
Wall, B. M., T. Mangold, K. M. Huch, et al. "Bacteremia in the Chronic Spinal Cord Injury Population: Risk Factors for Mortality." Journal of Spinal Cord Medicine 26 (Fall 2003): 248-253.

Organizations

American College of Epidemiology. 1500 Sunday Drive, Suite 102, Raleigh, NC 27607. (919) 861-5573. http://www.acepidemiology.org.
American Public Health Association (APHA). 800 I Street NW, Washington, DC 20001-3710. (202) 777-APHA. http://www.apha.org.
Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Other

"Supportive Care for Patients—Fever, Chills, and Sweats." National Cancer Institute Cancer Net 16 April 16, 2001. http://cancernet.nci.nih.gov/coping.html.

sepsis

 [sep´sis]
1. the presence in the blood or other tissues of pathogenic microorganisms or their toxins.
puerperal sepsis sepsis after childbirth, due to putrefactive matter absorbed from the birth canal; see also puerperal fever.

sep·sis

, pl.

sep·ses

(sep'sis, -sēz),
The presence of various pathogenic organisms, or their toxins, in the blood or tissues; septicemia is a common type of sepsis.
[G. sēpsis, putrefaction]

sepsis

/sep·sis/ (sep´sis)
1. presence in the blood or other tissues of pathogenic microorganisms or their toxins.

catheter sepsis  sepsis occurring as a complication of intravenous catheterization.
puerperal sepsis  that occurring after childbirth.

sepsis

(sĕp′sĭs)
n.
Systemic infection by pathogenic microorganisms, especially bacteria, that have invaded the bloodstream, usually from a local source. Sepsis is characterized by fever, increased number of white blood cells, increased heart rate, and other signs of widespread infection.

sepsis

[sep′sis]
Etymology: Gk, sepein, to become putrid
infection; contamination. Compare asepsis. septic, adj.

sepsis

Infectious disease Sepsis is defined by clinical parameters as 'SIRS–systemic inflammatory response syndrome plus a documented–ie, 'culture-positive' infection', and is part of a continuum of an inflammatory response to infection that evolves toward septic shock Clinical Tachypnea, tachycardia, hyperthermia, hypothermia Management Ibuprofen ↓ prostacyclin, thromboxane, ↓ tachycardia, fever, O2 consumption, lactic acidosis; NSAIDs do not prevent shock, ARDS, or improve survival. See Postanginal sepsis, Septic shock, Severe sepsis, SIRS.

sep·sis

, pl. sepses (sep'sis, -sēz)
The presence of various pus-forming and other pathogenic organisms, or their toxins, in the blood or tissues; septicemia is a common type of sepsis.
[G. sēpsis, putrefaction]

sepsis

The condition associated with the presence in the body tissues or the blood of micro-organisms that cause infection or of the toxins produced by such organisms. Sepsis varies in severity from a purely local problem to an overwhelming and fatal bacterial intoxication. Sepsis has been defined as the systemic inflammatory response to infection based on the clinical criteria of a temperature over 38 C, a heart rate of over 90 beats per minute, a respiratory rate of over 20 per minute and a white blood cell count increase of more than 12,000 or with more than 10 per cent immature neutrophil polymorphs. Severe sepsis is defined as sepsis associated with organ dysfunction. Severe sepsis has a mortality of up to 50 per cent.

sepsis

presence of pus/pus-forming pathogenic organisms/their toxins in blood or tissue; characterized by a portal of entry (e.g. break in skin integrity) and increasing symptoms as sepsis worsens, i.e. marked inflammation, acute tenderness (patient 'guards' infected area, unless there is sensory neuropathy), lymphangitis (of lymphatic vessels draining infected tissues), regional lymphadenopathy (see lymphadenitis), suppuration, pus and abscess formation, general malaise and pyrexia; treatment depends on the degree of infection, local and limb tissue status, host response to infection, and nature of infecting organism; resolution of infection due to e.g. presence of a foreign body/ingrowing toe nail/paronychia/corn is usually achieved by removal of the artefact (allowing free drainage of any pus) together with appropriate dressing, and review (Table 1); more extensive infection (e.g. cellulitis; lymphangitis; lymphadenitis) or localized infection in an 'at-risk' patient should be considered for systemic antibiosis
Table 1: Treatment of local sepsis
MnemonicRationaleTreatment modality
OOperateRemove the cause of the infection where possible, e.g. remove focal hyperkeratosis/foreign body/nail spike
CCleanseIrrigate area/cleanse cavity with Warmasol delivered under pressure from a sterile syringe
HHeatAssist drainage of pus/exudate by applying heat, e.g. immersion in a warm hypertonic NaCl bath
AAntisepticApply a liquid or powder antiseptic (e.g. Betadine)
DDressCover the lesion with a sterile dressing (e.g. sterile gauze; Lyofoam)
RRestImpose rest, e.g. deflective padding; shoe modification; walking cast; crutches, as necessary
AReappointArrange to review case in 24-72 hours
RReviewAt the subsequent appointment, review progress
If resolution has been initiated, continue to treat as above (O-A) and review weekly until healing is complete
If the infection has not improved, arrange for antibiosis, and continue to review and dress until healing is complete
RReferRefer for specialist review via GP: remember, slow-to-resolve infection can characterize undiagnosed diabetes, or other 'at-risk' patient category

Use all normal preoperative procedures; keep infected lesions covered until ready to treat; take a swab for pathology laboratory analysis of any exudate; use a sterile dressings pack; follow the OCH-A-DRARR treatment mnemonic.

'At-risk' patients presenting with infection or patients presenting with acute or spreading infection should be treated using the OCH-A-DRARR protocol, but provided with or referred for immediate antibiosis.

sep·sis

, pl. sepses (sep'sis, -sēz)
Presence of various pathogenic organisms, or their toxins, in blood or tissues.
[G. sēpsis, putrefaction]

sepsis

the presence in the blood or other tissues of pathogenic microorganisms or their toxins; the condition associated with such presence. See also toxemia, bacteremia.

puerperal sepsis
sepsis occurring after parturition. See also mastitis-metritis-agalactia.

Patient discussion about sepsis

Q. What Is Sepsis? What does the term "sepsis" mean?

A. Sepsis is a very serious medical condition. It is characterized by an inflammatory state of the entire body, caused by an infection. The infection may be viral, bacterial or another, and sometimes is caused by specific bacterial toxins, in the blood or tissues.

More discussions about sepsis
References in periodicals archive ?
For someone whose immune system has been weakened by other serious conditions, especially cystic fibrosis, HIV/AIDS, severe lung disease, burns, cancer or diabetes, these bacteria can cause infections including pneumonia, bone infections, urinary tract infections, gastrointestinal infections, meningitis and blood infections.
She said yesterday: "Jimmy isn't in a critical condition, but he has a blood infection which is affecting all his organs.
Dr Al Sa'ati also said several babies who were apparently almost well enough to go home were transferred to the Jidhafs Maternity Hospital to ease the overcrowding, but they came back to the SMC with a blood infection.
We will look to see what impact early detection has had on the number of patients contracting blood infection as a result of MRSA in emergency patients at the end of three months.
Untreated, it can progress to blood infection, and rarely, the lungs, causing pneumonic plague.
Angela McManus had been staying with her mother who was recovering from a blood infection.
The Cardiff-born man revealed he spent two days in hospital last week with a blood infection following a cut on his right hand he picked up during Wales' defeat to Ireland last week, and added: 'It was a frustrating week all round.
A blood infection may have removed Oscar's physical presence from us on May 29, but his art remains an enduring reminder of just how much he enriched American culture with his performances, wit, songs, plays, essays and activism.
Heroin addict Michael Greaves died of a blood infection caused by the drug being injected into his body, an inquest heard.
He lost blood due to internal bleeding and is also recovering from a blood infection.
And as the nine-year-old was retired to motherhood this week following a blood infection, part-owner Bob Clarke, from Kempsey, near Worcester, paid her the ultimate tribute.