Sepsis

Definition

Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.

Alternative Names

Septicemia; Sepsis syndrome; Systemic inflammatory response syndrome; SIRS; Septic shock

Causes

The symptoms of sepsis are not caused by the germs themselves. Instead, chemicals the body releases cause the response.

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
Bones (common in children)
Bowel (usually seen with peritonitis)
Kidneys (upper urinary tract infection, pyelonephritis or urosepsis)
Lining of the brain (meningitis)
Liver or gallbladder
Lungs (bacterial pneumonia)
Skin (cellulitis)

For people in or recently discharged from the hospital, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown, known as bedsores or pressure ulcers.

Sepsis commonly affects infants or older adults.

Symptoms

In sepsis, blood pressure drops, resulting in shock. Major organs and body systems, including the kidneys, liver, lungs, and central nervous system may stop working properly because of poor blood flow.

A change in mental status and very fast breathing may be the earliest signs of sepsis.

In general, symptoms of sepsis can include:

Chills
Confusion or delirium
Fever or low body temperature (hypothermia)
Lightheadedness due to low blood pressure
Rapid heartbeat
Skin rash or mottled skin
Warm skin

Exams and Tests

The health care provider will examine the person and ask about the person's medical history.

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

Other tests that may be done include:

Blood gases
Kidney function tests
Platelet count, fibrin degradation products, and coagulation times (PT and PTT) to check for bleeding risk
White blood cell count
White blood cell differential

Treatment

A person with sepsis will be admitted to a hospital, usually in the intensive care unit (ICU). Antibiotics are usually given through a vein (intravenously).

Other medical treatments include:

Oxygen to help with breathing
Fluids given through a vein
Medicines that increase blood pressure
Dialysis if there is kidney failure
A breathing machine (mechanical ventilation) if there is lung failure

Outlook (Prognosis)

Sepsis is often life threatening, especially in people with a weak immune system or a long-term (chronic) illness.

Damage caused by a decrease in blood flow to vital organs such as the brain, heart, and kidneys may take time to improve. There may be long-term problems with these organs.

Prevention

The risk of sepsis can be reduced by getting all recommended vaccines.

In the hospital, careful hand washing can help prevent hospital-acquired infections that lead to sepsis. Prompt removal of urinary catheters and IV lines when they are no longer needed can also help prevent infections that lead to sepsis.

References

Shapiro NI, Jones AE. Sepsis syndrome. In: Walls RM, Hockberger RS, Gausche-Hill M, Erickson TB, Wilcox SR, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 127.

Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801-810. PMID 26903338 pubmed.ncbi.nlm.nih.gov/26903338/.

van der Poll T, Wiersinga WJ. Sepsis and septic shock. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 73.