SEPSIS

- is a potentially deadly medical condition

characterized by a whole-body inflammatory state
(called a systemic inflammatory response syndrome
or SIRS) caused by severe infection.

Septicemia - is a related medical term referring to
the presence of pathogenic organisms in the
bloodstream, leading to sepsis

Bacteremia- is the presence of viable bacteria in
the bloodstream.
Different Levels of Sepsis
(according to American College of Chest Physicians and the Society of Critical
Care Medicine)
Systemic inflammatory response syndrome (SIRS) -
presence of two or more of the following: abnormal
body temperature, heart rate, respiratory rate or blood
gas, and white blood cell count.
Sepsis SIRS in response to an infectious process.
Severe sepsis - sepsis with sepsis-induced organ
dysfunction or tissue hypoperfusion (hypotension,
elevated lactate, or decreased urine output).
Septic shock - severe sepsis plus persistently low blood
pressure following the administration of intravenous
fluids.
Cause of Sepsis
The most common primary sources of infection
resulting in sepsis are the lungs, the abdomen, and
the urinary tract. The infectious agents are usually
bacteria but can also be fungi and viruses. While
gram-negative bacteria were previously the most
common cause of sepsis, in the last decade, gram-
positive bacteria, most commonly staphylococci, are
thought to cause more than 50% of cases of sepsis.
A bacterial infection anywhere in the body may set off the response
that leads to sepsis. Common places where an infection might start
include:
The bloodstream
The bones (common in children)
The bowel (usually seen with peritonitis)
The kidneys (upper urinary tract infection or pyelonephritis)
The lining of the brain (meningitis)
The liver or gallbladder
The lungs (bacterial pneumonia)
The skin (cellulitis)

Cause of Sepsis
Symptoms
Because sepsis can begin in different parts of the body, it can
have many different symptoms. Rapid breathing and a change
in mental status, such as reduced alertness or confusion, may
be the first signs that sepsis is starting. Other common
symptoms include:

Fever and shaking chills or, alternatively, a very low body
temperature
Decreased urination
Rapid pulse
Rapid breathing
Nausea and vomiting
Diarrhea

Diagnosis

SIRS Finding Value
Temperature : <36 C (96.8 F) or >38 C
(100.4 F)
Heart rate : >90/min
Respiratory rate : >20/min or PaCO2<32
mmHg (4.3 kPa)
WBC : <4x109/L (<4000/mm), >12x109/L
(>12,000/mm), or 10% bands

1
st
three hours - include measurement of serum lactate, obtaining
appropriate cultures before initiation of antimicrobial treatment, so
long as this does not delay antimicrobial treatment by more than 45
minutes.If other sources are suspected, cultures of these sources, such
as urine, cerebrospinal fluid, wounds, respiratory secretions, should be
obtained as well.

Within six hours - persistent hypotension despite initial fluid
resuscitation of 30ml/kg, or if initial lactate is 4 mmol/L (36 mg/dL),
central venous pressure and central venous oxygen saturation should
be measured.

Within twelve hours - exclude any source of infection that would
require emergent source control, such as necrotizing soft tissue
infection, peritonitis, cholangitis, intestinal infarction.
Diagnosis


Clinical diagnosis of sepsis is made by meeting at least
3 of the following criteria:

burn wound infection (>10
5
organisms/gm tissue) with
histologic or clinical evidence of invasion
thrombocytopenia (<50,000) or falling rapidly
leukocytosis or -penia (>20,000 or <3,000)
unexplained hypoxia, acidosis or hyper/hypoglycemia
prolonged paralytic ileus
hyper/hypothermia (>39C or <36.5C)
positive blood cultures
documented catheter or pulmonary infection
altered mental status
progressive renal failure or pulmonary dysfunction

Exams and Tests
The infection is often confirmed by a blood test. However, a
blood test may not reveal infection in people who have been
receiving antibiotics. Some infections that can cause sepsis
cannot be diagnosed by blood tests.

Other tests that may be done include:
Blood differential
Blood gases
Kidney function tests
Platelet count and fibrin degradation products, to check for
bleeding risk
White blood cell count
Prognosis
Approximately 2035% of people with severe
sepsis and 3070% of people with septic shock
die. Lactate is a useful method of determining
prognosis with those who have a level greater
than 4 mmol/L having a mortality of 40% and
those with a level of less than 2 mmol/L have a
mortality of less than 15%.
Permanent organ damage can occur in people
who survive sepsis. Death rates are 20% for sepsis
and over 60% for septic shock.
Epidemiology
In the United States sepsis affects approximately 3 in 1000
people and severe sepsis contributes to more than 200,000
deaths per year

It is the second-leading cause of death in non-coronary
intensive care unit (ICU) patients, and the tenth-most-
common cause of death overall (the first being heart
disease).

Children under 12 months and elderly have the highest
incidence of severe sepsis.[21] It occurs in 12% of all
hospitalizations and accounts for as much as 25% of ICU
bed utilization
Post Burn Infection and Sepsis
Infection is the most common and most serious
complication of a major burn injury related to burn
size. Sepsis accounts for 50-60% of deaths in burn
patients today despite improvements in antimicrobial
therapies.

Sepsis in burns is commonly due to
bronchopneumonia, pyelonephritis, thrombophlebitis,
or invasive wound infection. The burn wound is an
ideal substrate for bacterial growth and provides a
wide portal for microbial invasion.
Post Burn Infection and Sepsis
Local evidence of invasive wound infection includes:

black or brown patches of wound discoloration
rapid eschar separation
conversion of wounds to full-thickness
spreading peri-wound erythema
punctuate hemorrhagic sub-eschar lesions
violaceous or black lesions in unburned tissue
(ecthyma gangrenosum)

Sepsis Treatment

Sepsis treatment usually begins with:

Broad-spectrum antibiotics, which kill many types of
bacteria
IV fluids to maintain blood pressure
Oxygen to maintain normal blood oxygen

Once the infectious agent is identified, the doctor can switch
to a drug that targets that particular agent. Depending on the
severity and effects of sepsis, other types of treatment, such
as a breathing machine or kidney dialysis, may be needed.
Sometimes surgery is necessary to drain or clean an infection.