Sepsis

Date Updated: 01/19/2021

Overview

Sepsis is a potentially life-threatening condition that occurs when the body's response to an infection damages its own tissues. When the infection-fighting processes turn on the body, they cause organs to function poorly and abnormally.

Sepsis may progress to septic shock. This is a dramatic drop in blood pressure that can lead to severe organ problems and death.

Early treatment with antibiotics and intravenous fluids improves chances for survival.

Symptoms

Signs and symptoms of sepsis

To be diagnosed with sepsis, you must have a probable or confirmed infection and all of the following signs:

Change in mental status
Systolic blood pressure — the first number in a blood pressure reading — less than or equal to 100 millimeters of mercury (mm Hg)
Respiratory rate higher than or equal to 22 breaths a minute

Signs and symptoms of septic shock

Septic shock is a severe drop in blood pressure that results in highly abnormal problems with how cells work and produce energy. Progression to septic shock increases the risk of death. Signs of progression to septic shock include:

The need for medication to maintain systolic blood pressure greater than or equal to 65 mm Hg.
High levels of lactic acid in your blood (serum lactate). Having too much lactic acid in your blood means that your cells aren't using oxygen properly.

When to see a doctor

Most often, sepsis occurs in people who are hospitalized or who have recently been hospitalized. People in an intensive care unit are more likely to develop infections that can then lead to sepsis.

Any infection, however, could lead to sepsis. See your doctor about an infection or wound that hasn't responded to treatment. Signs or symptoms, such as confusion or rapid breathing, require emergency care.

Causes

While any type of infection — bacterial, viral or fungal — can lead to sepsis, infections that more commonly result in sepsis include infections of:

Lungs, such as pneumonia
Kidney, bladder and other parts of the urinary system
Digestive system
Bloodstream (bacteremia)
Catheter sites
Wounds or burns

Risk factors

Several factors increase the risk of sepsis, including:

Older age
Infancy
Compromised immune system
Diabetes
Chronic kidney or liver disease
Admission to intensive care unit or longer hospital stays
Invasive devices, such as intravenous catheters or breathing tubes
Previous use of antibiotics or corticosteroids

Complications

As sepsis worsens, blood flow to vital organs, such as your brain, heart and kidneys, becomes impaired. Sepsis may cause abnormal blood clotting that results in small clots or burst blood vessels that damage or destroy tissues.

Most people recover from mild sepsis, but the mortality rate for septic shock is about 40%. Also, an episode of severe sepsis places you at higher risk of future infections.

Diagnosis

Doctors often order several tests to try to pinpoint underlying infection.

Blood tests

Blood samples are used to test for:

Evidence of infection
Clotting problems
Abnormal liver or kidney function
Impaired oxygen availability
Electrolyte imbalances

Other lab tests

Other lab tests to identify the source of the infection might include samples of:

Urine
Wound secretions
Respiratory secretions

Imaging tests

If the site of infection is not readily found, your doctor may order one or more of the following imaging tests:

X-ray. X-rays can identify infections in your lungs.
Ultrasound. This technology uses sound waves to produce real-time images on a video monitor. Ultrasound may be particularly useful to check for infections in your gallbladder and kidneys.
Computerized tomography (CT). This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your body's internal structures. Infections in your liver, pancreas or other abdominal organs are easier to see on CT scans.
Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnet to produce cross-sectional or 3D images of the internal structures of your body. MRIs may be helpful in identifying soft tissue or bone infections.

Treatment

Early, aggressive treatment increases the likelihood of recovery. People who have sepsis require close monitoring and treatment in a hospital intensive care unit. Lifesaving measures may be needed to stabilize breathing and heart function.

Medications

A number of medications are used in treating sepsis and septic shock. They include:

Antibiotics. Treatment with antibiotics begins as soon as possible. Broad-spectrum antibiotics, which are effective against a variety of bacteria, are usually used first. After learning the results of blood tests, your doctor may switch to a different antibiotic that's targeted to fight the particular bacteria causing the infection.
Intravenous fluids. The use of intravenous fluids begins as soon as possible.
Vasopressors. If your blood pressure remains too low even after receiving intravenous fluids, you may be given a vasopressor medication. This drug constricts blood vessels and helps increase blood pressure.

Other medications you may receive include low doses of corticosteroids, insulin to help maintain stable blood sugar levels, drugs that modify the immune system responses, and painkillers or sedatives.

Supportive care

People who have sepsis often receive supportive care that includes oxygen. Depending on your condition, you may need to have a machine help you breathe. If your kidneys have been affected, you may need to have dialysis.

Surgery

Surgery may be needed to remove sources of infection, such as collections of pus (abscesses), infected tissues or dead tissues (gangrene).