Sepsis
What is Sepsis?
Sepsis is the body’s dangerous overreaction to an infection that can cause organ damage and become life-threatening if not treated quickly. It can also be triggered by injuries such as a severe burn. Rather than fighting the infection or healing in a controlled way, the body causes widespread inflammation, and in severe cases, organ failure.
Sepsis is very common, affecting approximately 1.7 million adults in the U.S. every year and is responsible for about one in three hospital deaths.
Some risk factors for sepsis include having a weak immune system, recent hospitalization or surgery, implanted medical devices, recent travel or a history of sepsis.
How to Recognize Sepsis Symptoms
Sepsis can be difficult for patients and healthcare workers to recognize, because symptoms are like what’s experienced with a common infection. General sepsis symptoms can include:
- Chills, shivering or sweating
- Confusion or an inability to stay awake
- Faster-than-normal heart rate
- Feeling weak or unwell
- Fever or, in some cases, a low body temperature
- Mottled skin that’s cool and blotchy may indicate dangerously low blood pressure and poor circulation
- Rapid or trouble breathing
- Unexplained pain or discomfort
What’s the ‘Golden Hour’ of Sepsis?
The "golden hour" refers to the crucial first sixty minutes after a doctor, nurse or advanced practitioner identifies sepsis. During this time, the risk of death increases significantly with every passing hour treatment is delayed. The goal is to rapidly administer antibiotics and IV fluids to combat the infection and stabilize the patient. Acting quickly within this window can dramatically improve a patient's chances of survival.
If you have any reason to believe you may have sepsis, it’s important to be seen by a medical professional as soon as possible.
Infection-Specific Symptoms
Newborn Sepsis
Neonatal sepsis is a severe infection in a newborn, often seen during or shortly after childbirth. Infections can come from the mother, contaminated medical equipment or the environment.
A Neonatal Sepsis Calculator can help assess a newborn's risk. It works by considering key factors, like the baby's vital signs and mother's risk factors during pregnancy. This produces a risk score that helps guide a doctor's decision on whether to start immediate treatment or simply monitor the baby.
Maternal Sepsis
Maternal sepsis is a life-threatening condition that can happen anytime from conception up to six weeks after delivery — making it important for all pregnant people, and new mothers, to be aware of the symptoms.
It’s often triggered when an infection develops in a childbirth-related wound, such as a C-section incision or vaginal tear. However, any infection during this time — including common issues like COVID, an infection associated with a miscarriage or a urinary tract infection — can lead to sepsis.
The World Health Organization considers sepsis a leading cause of maternal death. While signs and symptoms are like general sepsis, a pregnant or postpartum person's vitals and lab readings vary because of the unique bodily changes that occur during this time.
A woman can develop symptoms of sepsis after returning home from the hospital as well, making it critical for new mothers to be aware of the signs of infection.
How Can Maternal Sepsis be Avoided?
Sepsis is best avoided by preventing infections and treating them quickly, for example:
- Ensuring any pre-existing infections, like a UTI, are treated promptly
- Practicing good hygiene, especially with handwashing
- Keeping any surgical incisions or wounds clean and dry
- Seeking medical attention for any signs of infection, such as fever, persistent pain or unusual discharge
- Staying current on seasonal vaccinations, such as COVID and flu vaccines
How to Test for Sepsis
In a hospital setting, healthcare providers check for sepsis by assessing vital signs, drawing blood and using cultures and imaging studies to locate the source of the infection.
Your care team is trained to recognize when a patient's symptoms are more severe, or different, than expected as well as when vital signs are abnormal. Your team may run tests to diagnose sepsis, including:
- Blood cultures: This is a primary test used to identify bacterial or fungal infections in the bloodstream.
- Blood tests, such as white blood cell count, lactate levels or inflammation markers: High levels can be a sign of a severe infection and poor organ function
- Other cultures: Samples from other areas, like urine or skin, may be cultured to find the source of the infection.
- Spinal fluid studies: In some cases, fluid from the spinal cord is tested to check for central nervous system infections.
A final diagnosis is made by combining the results of these tests with your clinical signs and symptoms.
What are the Stages of Sepsis?
Sepsis progresses in distinct stages:
- Sepsis: The first stage where an infection is present, and the body begins to show systemic symptoms like fever or fast heart rate.
- Severe Sepsis: The infection starts to cause organ dysfunction, leading to symptoms like confusion or low urine output.
- Septic Shock: The most dangerous stage, characterized by dangerously low blood pressure that doesn’t respond to fluid resuscitation.
Sepsis vs. Septic Shock
Sepsis is the overall condition caused by a severe immune response to an infection. Septic shock is the most severe and life-threatening stage of sepsis. It’s characterized by a dangerous drop in blood pressure and inability to respond to IV fluids. A person can have sepsis without being in septic shock, but septic shock is always a result of sepsis.
How Deadly is Sepsis?
Sepsis is extremely deadly if not treated quickly. In cases of septic shock, a patient can deteriorate and die within 24 to 48 hours. The sepsis survival rate varies by age and health status. For young adults, the survival rate is 70-90% but it drops to 40-50% in older adults. Immunocompromised patients, and those with chronic conditions, are at higher risk.
People with weak immune systems or long-term health problems are more likely to get sepsis.
Some sepsis survivors may also have a reduced life expectancy.
Post-Sepsis Syndrome
Post-sepsis syndrome affects about 50% of sepsis survivors and can include a range of persistent symptoms that continue after recovery. These can include ongoing fatigue, chronic joint and muscle pain, sleep disturbances, anxiety, depression and long-term issues with memory and thinking.
Is Sepsis Contagious?
No, sepsis isn’t contagious. However, the infection that led to sepsis may be. For example, a contagious bacterial infection can cause sepsis in an individual, but the sepsis itself can’t be passed to another person.
How is Sepsis Treated?
Sepsis is curable, especially when caught and treated early. Treatment focuses on getting the infection under control and supporting organ function. It typically involves:
- Immediate antibiotics for bacterial infections
- IV fluids to maintain blood pressure
- Vasopressors (medications to raise blood pressure) if fluids aren't effective
- Oxygen or a breathing machine
- Surgery or drainage to treat a localized infection
- Treatment is managed by a team of providers, including emergency medicine physicians, hospitalists and intensive care unit (ICU) physicians
How to Prevent Sepsis
The best way to prevent sepsis is to prevent and quickly treat infections. Key strategies include:
- Get infections treated quickly by a medical professional.
- Make sure wounds are clean and know the signs of infection: warmth and spreading redness and swelling.
- Stay up to date on seasonal vaccinations, such as the flu and pneumonia vaccines.
- Wash your hands. It’s one of the best preventive measures when done properly.