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Sepsis

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

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

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:

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:

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.

Open References

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.

  • Intensive care unit (ICU)

    Intensive care unit (ICU) - illustration

    An intensive care unit (ICU) is a section of a hospital or health care facility that provides care for patients with life-threatening health problems. These patients need constant monitoring and treatment, which may include support for vital functions. Common types of equipment used in the ICU include cardiac monitoring, mechanical ventilation, feeding tubes, intravenous lines, drains, and catheters. The ICU may also be called an intensive therapy unit or critical care unit.

    Intensive care unit (ICU)

    illustration

  • Intensive care unit (ICU)

    Intensive care unit (ICU) - illustration

    An intensive care unit (ICU) is a section of a hospital or health care facility that provides care for patients with life-threatening health problems. These patients need constant monitoring and treatment, which may include support for vital functions. Common types of equipment used in the ICU include cardiac monitoring, mechanical ventilation, feeding tubes, intravenous lines, drains, and catheters. The ICU may also be called an intensive therapy unit or critical care unit.

    Intensive care unit (ICU)

    illustration

 

Review Date: 9/10/2022

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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