Derek C. Angus, MD, MPH, the Mitchell P. Fink Endowed Chair in Critical Care Medicine and professor of critical care medicine, medicine, health policy and management, and clinical and translational science at University of Pittsburgh School of Medicine.
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Sepsis is the tenth-leading cause of death in the US. It doesn’t have to be. The challenge: There isn’t a single test that can diagnose sepsis. Because its symptoms can be very similar to those caused by the original infection, the diagnosis sometimes is overlooked—and even a brief delay in treatment can be deadly.
Every year, at least 750,000 Americans develop sepsis and about 40% of patients with sepsis will die from it. The death rate approaches 50% in patients who develop septic shock (a dangerous drop in blood pressure that can lead to organ failure), which can’t be reversed by the administration of intravenous (IV) fluids.
Who’s At Risk
Sepsis often is triggered by a bacterial infection. It also can be caused by viral or fungal infections. Pneumonia is the infection most likely to lead to sepsis.
The risk for sepsis is highest among adults age 65 and older, particularly those in the hospital who get IV lines, urinary catheters or other invasive devices. But you don’t have to be elderly or seriously ill or be in a hospital to develop sepsis. About half of all cases occur in nonhospital settings. If you have any type of infection—an infected cut, a urinary tract infection, the flu—it can progress to sepsis.
Examples: Many of the 18,000 deaths that were linked to the swine flu outbreak in 2009 actually were caused by sepsis. Recently, a New York sixth-grader cut his arm during a basketball game and got an infection. He died from sepsis three days later.
For reasons that still aren’t clear, some infections are accompanied by an exaggerated immune response. It’s normal for the body to respond to an infection with local inflammation. In patients with sepsis, the inflammation is systemic—it spreads throughout the body and often causes a loss of fluids that leads to plummeting blood pressure and shock. It also triggers microscopic blood clots that can block circulation to the heart, kidneys and other organs.
You’re sicker than expected. Suppose that you have a bladder infection or an infected cut. If the severity of your symptoms seems to be out of proportion to the illness, call your doctor.
Go to the emergency room if you or a loved one also has two or more of the following symptoms…
Rapid heartbeat. Patients who are developing sepsis usually will have tachycardia, a rapid heartbeat that exceeds 90 beats/minute.
High or low temperature. Both hypothermia (a body temperature below 96.8˚F) and fever (above 100.4˚F) can indicate sepsis.
Rapid breathing, or tachypnea. Patients with sepsis may have a respiration rate of 20 breaths/minute or higher.
Mucus. The common cold is unlikely to cause sepsis, but it’s not impossible. Call your doctor if a cold or other respiratory infection is accompanied by foul-smelling, discolored (rather than clear) mucus. This could indicate that you have developed a more serious infection.
Mental confusion. When sepsis has reached the stage that it’s interfering with circulation, it often will cause mental confusion.
Mottled skin. There may be blue patches on the skin. Or if you press on the skin, there might be a delay before it returns to its normal color. Both of these changes indicate that circulation is impaired—a sign of sepsis.
Important: When patients begin to develop signs and symptoms suggesting that vital organ function is compromised, sepsis already is an emergency. For example, altered mental status, falling blood pressure, difficulty breathing or mottled skin all suggest that the inflammatory response intended to help is now, in fact, causing life-threatening harm.
What Comes Next
Sepsis always is treated in the hospital. To confirm that you have it, your doctor will do a variety of tests, including a blood pressure check and a white blood cell count. You also will need blood cultures to identify the organism that is causing the infection so that your doctor can choose the most effective treatment.
Treat first, diagnose later. A study in Critical Care Medicine reported that the risk of dying from sepsis increases by 7.6% for every hour that passes without treatment. If your doctor suspects that you have sepsis, he/she will immediately start treatment with an antibiotic—usually a broad-spectrum antibiotic that’s effective against a wide variety of organisms. Later the drug may be changed, depending on what the blood cultures show.
Intravenous fluids. They often are needed to counteract the capillary leakage that causes blood pressure to drop.
Vasopressor treatment. Depending on the severity of sepsis, you might be given dopamine or norepinephrine—medications that increase blood pressure and improve circulation to the heart, kidneys and other organs.
Other treatments may include supplemental oxygen, anti-inflammatory steroids and sometimes kidney dialysis.
There’s no way to predict who will get sepsis or the type of infection that’s most likely to cause it in a particular person. So don’t watch and wait. If you suspect sepsis, call your doctor. And to build up your defense against sepsis in the future…
Get a pneumococcal pneumonia vaccination if you’re 65 years old or older…have chronic health problems…take medications that lower immunity …or you’re a smoker. Most people should get a pneumonia vaccination every five years.
Get an annual flu shot. The rate of sepsis increases by about 16% during flu season. Getting an annual flu shot—along with washing your hands several times a day—reduces your risk for sepsis.
Clean wounds thoroughly. If you have a cut, scrape or burn and are taking care of it yourself, wash it several times a day with soap and water, and apply an antibacterial ointment. Call your doctor immediately if there is pus, increased or streaking redness, or if the wound feels warm.