Sepsis

Definition:

Causes:

"a potentially fatal whole-body inflammation caused by severe infection"

• Primarily sepsis is caused by infection from the lungs, abdomen and urinary tract.
• Almost 50% of septic cases start as an infection of the lungs.
• Infective agents are usually bacteria but may be fungi and viruses.
• Canada sees approximately 9300 deaths annually from sepsis and over 30,000 cases each year diagnosed.
• In developing world sepsis account for 60-80% of childhood deaths.
• It can be caused by anything from a scraped knee to appendicitis.

Those at greater risk:

• People with decreased immunity such as HIV/AIDS, cancer
• Very young babies
• The elderly
• People who have been hospitalized recently
• Diabetics

Sepsis

Types:

• Severe sepsis: sepsis complicated by organ dysfunction
• Septic shock: Sepsis complicated by a high lactate level or by shock that doesn't improve after fluid resuscitation
• Bacteremia: Presence of viable bacteria in the blood

Sepsis is otherwise known as:

Systemic Inflammatory Response System (SIRS)

Symptoms:

2 of the following symptoms must be exhibited to be diagnosed septic:

• Fever above 38.5 C or below 35 C
• Heart rate greater than 90 beats per minute
• Respiratory rate greater than 20 breaths per minute
• Probable or confirmed infection

Diagnosis would be upgraded to severe sepsis if one of the following symptoms. This would indicate an organ may be failing.

• Significantly decreased urine output
• Abrupt change in mental status
• Decrease in platelet count
• Difficulty breathing
• Abnormal heart pumping function
• Abdominal pain

Control/Prevention

The most effective way to decrease the incidence of sepsis is to prevent the infection from occurring in the first place. Proper aseptic technique, cleansing wounds and hand washing decreases chances of sepsis.

This disease is extremely serious and may result in death if not treated promptly. In those that survive there may be long term effects if any organs have been damaged by the disease.

Although sepsis can not be transmitted from person to person vaccinations are important. The "Flu Shot" can decrease the likelihood of lung infection. IV drug users are at greater risk as they are possibly introducing bacteria at time of injection.

Diagnosis:

Prompt diagnosis is key in the treatment of sepsis. Within the first 3 hours of suspected sepsis diagnostic studies should be performed. These include:

• measurement of serum lactate
• obtain blood cultures (this ensures that the appropriate antibiotic is being used as long as it does not prolong intervention greater than 45 minutes)

Treatment/Cure

Management of sepsis includes IV fluids, antibiotics, surgical drainage of infected fluid collections and support for organ dysfunction.

Broad spectrum antibiotics are recommended within one hour of making a diagnosis of severe sepsis. For every one hour delay in the administration of antibiotics there is a 6% rise in the mortality rate.