Sepsis

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is sepsis?

Sepsis is an extreme and overwhelming response to an infection anywhere in the body. The organisms that caused the serious infection stimulate the release of substances into the blood that cause widespread inflammation. This quickly leads to organ damage, organ failure, or even death.

There is often a lot of confusion about sepsis due to some related terms that people sometimes use interchangeably. However, they each mean something slightly different. Here is a look at these terms:

  • Sepsis is an extreme response to an infection somewhere in the body, which leads to organ problems. It is possible to have organ problems from sepsis and n

  • Bacteremia is the presence of bacteria in the blood. This is mainly a lab finding. A healthy immune system normally clears the body of small amounts of bacteria introduced into the bloodstream. But under some circumstances, bacteria in the blood can begin an active infection that can spread throughout the body and organs. Bacteremia can also lead to sepsis.

  • Septicemia is a term some providers may still use to describe a widespread blood infection, blood poisoning, or a bloodstream infection. Bacteria are present, multiplying and spreading in the blood. In fact, septicemia is a narrow term that muddles the discussion and critical nature of sepsis. People incorrectly use the term septicemia in place of sepsis.

The truth is sepsis can occur without bacteria or other detectable microorganisms in the blood. Infection anywhere in the body can trigger sepsis.

Sepsis is one of the leading causes of hospital readmissions and hospital-related deaths. Every year, about 1.7 million Americans suffer from sepsis. It can kill 10 to 30% of those affected. The most severe form—septic shock—kills up to 50% of people who develop it. Sepsis is especially dangerous for the elderly, the very young, and people with chronic medical conditions. People who survive it can also develop post-sepsis syndrome, which is characterized by chronic physical and psychological problems.

Anyone can develop sepsis from an infection. This can happen rapidly and unpredictably, so it is important to know the signs and symptoms. When signs and symptoms develop, it is a medical emergency. Seek immediate medical attention (call 911) for any combination of fever, chills, rapid heart rate, shortness of breath, confusion, or disorientation. Without prompt treatment in a hospital, sepsis can swiftly lead to organ failure and death.

What are the signs and symptoms of sepsis?

There is no single symptom that points to sepsis. Instead, sepsis consists of a combination of signs and symptoms that appear with an infection. Recognizing sepsis symptoms early is vital to prevent organ damage and loss of life.

It’s important to know that most people who develop sepsis are already in the hospital. However, you can develop the condition outside the hospital, such as at home after surgery, after discharge from the hospital, or if you have other risk factors. Remember, you may not even realize you have an infection when sepsis symptoms develop.

How to spot sepsis

Symptoms can include any of the following:

  • Confusion or disorientation

  • Fever or chills

  • Pain or discomfort

  • Rapid heart rate, faster than 90 beats per minute. (Normal adult heart rate is 60 to 100 beats per minute.)

  • Rash

  • Shortness of breath or rapid breathing

  • Sweaty or clammy skin

Sepsis is progressive. The signs and symptoms can quickly become severe. Signs that the condition is progressing to serious organ problems can include:

  • Difficulty breathing

  • Liver enzyme problems, which is a laboratory finding

  • Low or no urine output

  • Mental status changes

Sepsis can also progress to septic shock, which is the most dangerous form of sepsis. Septic shock occurs when your blood pressure drops rapidly and dangerously low. This can lead to heart failure, other organ failure, and death.

Sepsis, even early sepsis, is a medical emergency. Seek immediate medical attention (call 911) if you suspect sepsis. Sepsis can be fatal in a short amount of time. It is better to be mistaken and call 911 than to delay potentially life-saving medical care.

What are the stages of sepsis?

Sepsis is a complex condition with overlapping phases rather than distinct stages. The clinical course is:

  • Infection without sepsis, marked by various criteria specific to the infection site, such as urinary tract, bone or soft tissue. While the infection can remain localized, sepsis is systemic, meaning it affects the entire body.

  • Sepsis, marked by infection and any or all of these signs and symptoms: mental status change, fever or chills, pain or discomfort, rapid heart rate, shortness of breath, and sweaty or clammy skin

  • Severe sepsis, marked by sepsis and signs of organ dysfunction or failure, such as a significant drop in blood pressure (hypotension)

  • Septic shock, defined as acute circulatory failure and persistent hypotension despite medication therapy

What causes sepsis?

Sepsis occurs when your body overreacts to an infection. While the infection can remain localized, sepsis is systemic, meaning it affects the entire body and progresses quickly.

Within minutes of encountering substances from an infection, the body pumps immune-related substances into your blood. These substances normally help your body fight infections. However, the extreme reaction triggers inflammation throughout your body including areas far from the original infection.

This overwhelming immune response leads to a cascade of dangerous events. The blood becomes more prone to clotting and blood vessels become leaky. Blood can’t flow to organs and tissues the way it should. Without adequate blood flow, tissues can’t get oxygen and nutrients. This leads to damage, tissue death, and eventually organ failure and death.

An infection anywhere in the body can lead to sepsis. But there are four types of infections that most commonly lead to sepsis:

  • Abdominal or gut infections

  • Lung infections

  • Skin infections

  • Urinary tract or kidney infections

A variety of microorganisms can cause these infections, including bacteria, fungi and viruses. However, bacteria are the most common culprits leading to sepsis. Common microbes causing sepsis include the bacteria Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), and Group A and B Streptococcus, which includes the germ that causes strep throat. Certain viral and fungal infections can cause sepsis too, but this is much less common.

Bacteremia—bacteria in the blood—is a risk factor for sepsis progressing to severe sepsis and septic shock. Any of the four types of infections above can spread to the bloodstream.

What are the risk factors for sepsis?

Sepsis can affect anyone. Why some people and not others get sepsis is not fully known. However, certain people have an increased risk of developing sepsis. People who get sepsis at a higher rate compared to the general population include:

  • Adults 65 year of age and older

  • Children younger than one year

  • People with chronic medical conditions, such as cancer, diabetes, or kidney, lung or liver disease

  • People with a compromised or weak immune system, such as those with HIV or AIDS

  • People with wounds including surgical wounds, injuries, or invasive devices such as catheters

Genetics may influence the development of sepsis and its outcome, as certain genes appear to be linked to sepsis, septic shock, and sepsis survival.

The specific pathogen causing the infection is also a factor. More toxic and damaging microorganisms are linked to more severe sepsis.

How do you prevent sepsis?

Sepsis can develop from any type of infection, even what appears to be a mild one. It is not always possible to prevent sepsis because you cannot prevent all infections, but you may be able to lower your risk of sepsis by:

  • Caring for wounds and keeping cuts clean

  • Keeping vaccinations up to date and getting adult vaccines as recommended by your doctor

  • Practicing good hygiene including frequent and proper hand washing

  • Treating chronic medical conditions

Ask your doctor about your personal risk of developing sepsis, especially when facing surgery or after hospitalization. Remember that sepsis is often hard to diagnose in the early stages because many things can cause the same symptoms.

If you know you have risk factors, tell your doctor if you are concerned about sepsis. Make sure you are familiar with the warning signs if you are at risk or you care for someone at risk. Time is vital once the symptoms begin.

Sepsis warning signs include:

  • Confusion or disorientation

  • Fever or chills (shivering)

  • Pain or discomfort

  • Rapid heart rate

  • Rash

  • Shortness of breath or rapid breathing

  • Sweaty or clammy skin

The Sepsis Alliance created a mnemonic, It’s About TIME™:

  • Temperature: higher or lower than normal

  • Infection: may or may not have signs of infection

  • Mental decline: confused, sleepy, lethargic

  • Extremely ill: feeling terrible, like you might die from pain or discomfort

What are some conditions related to sepsis?

Conditions related to sepsis include:

  • Systemic inflammatory response syndrome (SIRS), a condition like sepsis, but which can occur in the absence of infection or organ failure

  • Toxic shock syndrome, a type of septic shock caused by the release of bacterial toxins into the bloodstream

How do doctors diagnose sepsis?

Sepsis is diagnosed based on the presence of an infection (suspected or confirmed) and signs of organ damage or failure. A doctor who suspects sepsis reviews the patient’s symptoms, vital signs, and test results including:

  • Bacterial cultures and other tests to check for infection. These tests require samples of urine, chest sputum, blood, or samples of secretions from a wound or incision.

  • Blood tests to check for abnormal blood cell counts, increased blood clotting, and organ damage or failure

  • Imaging, such as a CT scan, MRI, X-ray, or ultrasound to look for infection

In 2016, a sepsis task force developed a set of criteria for medical professionals to identify septic patients, the Sequential Organ Failure Assessment (SOFA). The criteria are complex, so the task force simplified it to quick SOFA (qSOFA).

A qSOFA of at least two points indicates organ failure and signals the need for additional testing. Each of the following is one point:

  • Change in mental status

  • Respiratory rate of more than 22 breaths per minute. (Normal adult rate is 12 to 20 breaths per minute.)

  • Systolic blood pressure less than or equal to 100 mmHg. (This is the top number of a blood pressure reading.)

How is sepsis treated?

Sepsis is a medical emergency that requires treatment in a hospital’s intensive care unit (ICU). Sepsis treatment consists of intravenous (IV) antibiotics to halt the infection while supportive measures are administered to keep organs functioning, prevent further damage, and sustain blood pressure. Doctors maintain blood flow to organs and tissues with IV fluids. Supplemental oxygen is also important to make sure the blood flowing to the organs has enough oxygen. When sepsis becomes severe, other treatments may be necessary.

Treatments include:

  • IV (intravenous) antibiotics and antimicrobials to treat the cause of the infection

  • IV fluids to increase blood volume and boost blood pressure

  • Vasopressor medication to increase blood pressure if IV fluids are not enough

  • Supplemental oxygen to help with breathing. A breathing tube and mechanical ventilation may be necessary.

  • Surgery and other procedures to remove the infection, such as draining an abscess or skin surgery to remove dead tissue

Unfortunately, there is no treatment to directly target the extreme immune response that causes sepsis. Doctors use a variety of medicines to try to calm the immune system and support the organs. This can include corticosteroids, kidney dialysis, insulin for blood sugar control, pain medicines, and medicines to increase blood pressure.

What are the diet and nutrition tips for sepsis?

A healthy, nutritious diet packed with protein is essential for healing, building back muscle mass, and regaining strength after sepsis. However, many people do not feel like eating after recovering from a serious illness or long hospital stay. Working with a dietitian can help with food choices and loss of appetite after sepsis.

A post-sepsis diet includes:

  • Complex carbohydrates, including whole grains, vegetables, peas, and beans

  • Fruit, either fresh or frozen

  • Healthy fats, such as those found in salmon, tuna, nuts, soy, tofu, and olives

  • Protein, including eggs, dairy, nut butters, lean cuts of meat, and protein supplements if necessary

  • Vitamin and mineral supplements as directed by your care team

How does sepsis affect quality of life?

Many people recover completely from sepsis without obvious problems. But, many survivors develop new symptoms after recovering from sepsis. People who survive sepsis can suffer from post-sepsis syndrome (PSS). PSS symptoms include:

These chronic physical and psychological problems can affect up to 50% of survivors. PSS tends to strike older people and people who spent time in an intensive care unit. Researchers have linked sepsis to a similar disorder, PTSD (post-traumatic stress disorder). If you notice symptoms of PSS that persist, talk with your doctor. Mental health providers can assist you with counseling. Physical therapy and other forms of rehabilitation can also help you recover.

Children who recover from sepsis can also experience new symptoms, including PSS, and increased risk of infection and readmission to the hospital. In about 25% of pediatric survivors, their health affects their physical, mental, emotional, and social quality of life.

What are the potential complications of sepsis?

It is possible to completely recover from sepsis, especially when it is mild. But blood clots and decreased blood flow can lead to permanent organ or tissue damage in some people. This can lead to amputation and the need for lifelong organ support, such as dialysis or breathing assistance. These problems are more likely to occur in people who already had chronic medical problems before developing sepsis.

People who have recovered from sepsis may also be at increased risk of future infections. Researchers believe sepsis disrupts a person’s normal immune function. This makes infections more likely, and the body’s reaction to any given infection more volatile.

What is the survival rate and prognosis for sepsis?

Sepsis is fatal in 10 to 30% of those affected. The most severe form—septic shock—kills up to 50% of people who develop it. Overall, about 270,000 people die from sepsis each year. Sepsis is especially dangerous for the elderly, the very young, and people with chronic medical conditions.

Half of patients who survive sepsis hospitalization nearly or completely recover within two years. Some people develop post-sepsis syndrome, which is characterized by chronic physical and psychological problems.

Recovering from a critical illness involves follow-up appointments with your primary care doctor and may involve referrals for specialty care. Early diagnosis and treatment of post-sepsis syndrome and other problems improve the chances of a good prognosis. Follow-up care after sepsis may include:

  • Exercise and fitness training

  • Medication review 

  • Mental health counseling and sepsis support programs

  • Nutritional counseling

  • Organ function tests 

  • Physical therapy

  • Speech therapy

Sepsis awareness

September is Sepsis Awareness Month. Learn more about sepsis and the Get Ahead of Sepsis campaign from the Centers for Disease Control and Prevention.

Many healthcare organizations from the local to national level have taken steps to reduce sepsis and sepsis deaths. Hospitals with programs for sepsis, including sepsis screening for very ill, high-risk patients, see fewer patients dying from sepsis.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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