Disease: Sepsis (Blood Poisoning)

    Sepsis (blood poisoning) facts

    • Sepsis is a potentially life-threatening medical condition that's associated with an infection; the infection's signs and symptoms must fulfill a minimum of two criteria of a systemic inflammatory response syndrome (SIRS).
    • Blood poisoning is a nonmedical term that usually refers to the medical condition known as sepsis.
    • The major SIRS criteria are an increased heart rate, fever, and increased respiratory rate; the young and the elderly may show other early signs and symptoms of sepsis sometimes before exhibiting SIRS criteria.
    • The majority of cases of sepsis are due to bacterial infection.
    • Sepsis is treated with hospitalization, intravenous antibiotics, and therapy to support any organ dysfunction.
    • Prevention of infections and early diagnosis and treatment of sepsis are the best ways to prevent sepsis or reduce the problems sepsis causes.
    • The prognosis depends on the severity of sepsis as well as the underlying health status of the patient; in general, the elderly have the worst prognosis.

    What is blood poisoning?

    Blood poisoning is a nonspecific term used mainly by nonmedical individuals that describes, in the broadest sense, any adverse medical condition(s) due to the presence of any toxic agent in the blood. Usually, the layperson using the term blood poisoning is referring to the medical condition(s) that arise when bacteria or their products (or both) reach the blood. Blood poisoning is not a medical term and does not appear in many medical dictionaries or scientific publications. However, when it is used, the correct medical term that most closely matches its intended meaning is sepsis. Many medical authors consider the terms blood poisoning and sepsis to be interchangeable, but the trend in the medical literature is to use the term sepsis.

    What is sepsis?

    Sepsis is a potentially dangerous or life-threatening medical condition, found in association with a known or suspected infection (usually caused by but not limited to bacteria) whose signs and symptoms fulfill at least two of the following criteria of a systemic inflammatory response syndrome (SIRS):

    • elevated heart rate (tachycardia) >90 beats per minute at rest
    • body temperature either high (>100.4 F or 38 C) or low (20 breaths per minute or a reduced PaCO2 (partial pressure of carbon dioxide in arterial blood level)
    • abnormal white blood cell count (>12,000 cells/µL or 10% bands [an immature type of white blood cell])

    Patients who meet the above criteria have sepsis and are also termed septic. These criteria described above were proposed by several medical societies and may continue to be modified by other medical groups. For example, pediatric groups use the same four criteria listed above but modify the values for each to make the SIRS criteria for children. Other groups want to add criteria, but currently this is the most widely accepted definition.

    Terms that are often used in place of sepsis are bacteremia, septicemia, and blood poisoning. However, bacteremia means the presence of bacteria in the blood; this can occur without any of the criteria listed above and should not be confused with sepsis. For example, you can brush your teeth and get bacteremia for a short time and have no SIRS criteria occur. Unfortunately, septicemia has had multiple definitions over time; it has been defined as bacteremia, blood poisoning, bacteremia leading to sepsis, sepsis, and other variations. Although septicemia appears frequently in the medical literature, a reader must be sure which definition the author is using. Some experts suggest the terms blood poisoning and septicemia not be used since they are poorly defined, but it is difficult for the medical community to disregard such terms that have been used for many decades.

    Why are there so many diseases with "sepsis," "septic," "septicemia," or "blood poisoning" in their name?

    Unfortunately, both medical personnel and laypeople have used these terms interchangeably and then linked them to either a particular organism (usually bacterial) that can cause sepsis, to a site in the body in which an infection originates that leads to sepsis, or to a clinical situation that leads to sepsis as described above. For example, meningococcal sepsis, meningococcal septicemia, septic meningitis, and meningococcal blood poisoning can refer to the same entity, an infection of the patient by the bacteria Neisseria meningitidis that has spread from the meninges (brain membranes) to the bloodstream, resulting in the patient having at least two of the four criteria outlined above for sepsis. Common examples of a clinical situation used in the same way are puerperal sepsis, puerperal septicemia, puerperal or childbirth blood poisoning, and maternal septicemia postpartum. All four terms represent infection that occurs during the puerperium (time around the delivery of a baby) that leads to sepsis criteria for the patient. The infectious agent is not described when the body site or situation is linked to "sepsis" or the other terms. The following is a short partial list of both organism and organ system (and organ-related) terms that are seen in both the lay and medical literature:

    • MRSA sepsis: sepsis caused by methicillin-resistant Staphylococcus aureus bacteria
    • VRE sepsis: sepsis caused by vancomycin-resistant Enterococcus species of bacteria
    • urosepsis: sepsis originating from a urinary tract infection (UTI)
    • wound sepsis: sepsis originating from an infection of a wound
    • neonatal sepsis or septicemia: sepsis seen in newborns, usually in the first four weeks after birth; sepsis neonatorum means the same as neonatal sepsis
    • septic abortion: an abortion due to infection with sepsis in the mother

    There are many more examples of linking terms to sepsis (for example, AIDS, tattoo, spider bite). Occasionally, terms like hemorrhagic septicemia are used to describe a symptom (internal bleeding) that occurs with sepsis. The trend in medicine currently is to decrease the use of the terms septicemia and blood poisoning in favor of the terms sepsis or septic, because sepsis is defined most concisely.

    What causes sepsis?

    The majority of cases of sepsis are due to bacterial infections, some are due to fungal infections, and very few are due to other causes of infection or agents that may cause SIRS. The infectious agents, usually bacteria, begin infecting almost any organ location or implanted device (for example, skin, lung, gastrointestinal tract, surgical site, intravenous catheter, etc.). The infecting agents or their toxins (or both) then spread directly or indirectly into the bloodstream. This allows them to spread to almost any other organ system. SIRS criteria result as the body tries to counteract the damage done by these blood-borne agents.

    Common bacterial causes of sepsis are gram-negative bacilli (for example, E. coli, P. aeruginosa, E. corrodens, and Haemophilus influenzae in neonates). Other bacteria also causing sepsis are S. aureus, Streptococcus species, Enterococcus species and Neisseria; however, there are large numbers of bacterial genera that have been known to cause sepsis. Candida species are some of the most frequent fungi that cause sepsis. In general, a person with sepsis can be contagious, so precautions such as hand washing, sterile gloves, masks, and clothing coverage should be considered depending on the patient's infection source.

    What are the risk factors for sepsis?

    The following groups are at increased risk for sepsis:

    • The very young and the elderly are at greatest risk
    • People who are very ill due to an infectious agent
    • People in an intensive-care unit
    • People with weakened or compromised immune systems
    • People with devices such as IV catheters, breathing tubes, or other devices
    • People with extensive burns
    • People with severe trauma

    What are the signs or symptoms of sepsis (blood poisoning)?

    The adult patient should have a proven or suspected source of an infection (usually bacterial) and have at least two of the following problems: an elevated heart rate (tachycardia), either a high (fever) or low temperature (hypothermia), rapid breathing (>20 breaths per minute or a reduced PaCO2 level), or a white blood cell count that is either high, low, or composed of >10% band (immature) cells. In most cases, it is fairly easy to ascertain heart rate (count pulse per minute), fever or hypothermia with a thermometer, and to count breaths per minute even at home. It may be more difficult to prove a source of infection, but if the person has symptoms of infection such as productive cough, dysuria, fevers, or a wound with pus, it is fairly easy to suspect that a person with an infection may have sepsis. However, determination of the white blood cell count and PaCO2 is usually done by a lab. In most cases, the definitive diagnosis of sepsis is made by a physician in conjunction with laboratory tests.

    Elderly patients have similar symptoms to those stated for adults, but the first apparent symptoms are often confusion along with chills, weakness, possibly faster breathing, and a dusky skin appearance. Pediatric patients (infants, toddlers, and children) also may develop similar symptoms to those in adults, but the most common symptoms are fever and reduced urine output. Children may show signs of lethargy and decreased age-appropriate mental status. Neonatal sepsis (sepsis neonatorum) is suspected in neonates up to 28 days old if the rectal temperature is 100.4 F or higher. Other signs and symptoms for neonatal sepsis include fever in the mother at time of delivery, cloudy or smelly amniotic fluid, abnormal vital signs, seizures, and projectile vomiting.

    Some authors consider red lines or red streaks on the skin to be signs of sepsis. However, these streaks are due to local inflammatory changes in either local blood vessels or lymphatic vessels (lymphangitis). The red streaks or lines are worrisome as they usually indicate a spreading infection that can result in sepsis.

    Septic shock is a condition in which overwhelming infection causes a dangerous drop in systolic blood pressure (hypotension). Additional symptoms that may accompany the low blood pressure may include cool and pale extremities, dizziness or lightheadedness, low or absent urine output, shortness of breath, rapid heart rate, behavioral changes, and low or high body temperature.

    What is the prognosis (outcome) with sepsis?

    The prognosis of patients with sepsis is related to the severity or stage of sepsis as well as to the underlying health status of the patient. For example, patients with sepsis and no ongoing sign of organ failure at the time of diagnosis have about a 15%-30% chance of death. Patients with severe sepsis or septic shock have a mortality (death) rate of about 40%-60%, with the elderly having the highest death rates. Newborns and pediatric patients with sepsis have about a 9%-36% mortality rate. Investigators have developed a scoring system (MEDS score) based on the patient's symptoms to estimate prognosis.

    What are the complications of sepsis?

    There are a large number of complications that may occur with sepsis. The complications are related to the type of initial infection (for example, in lung infection [pneumonia] with sepsis, a potential complication could be a need for respiratory support) and the severity of sepsis (for example, septic shock related to a limb infection that could require limb amputation). Consequently, each patient is likely to have the potential for complications related to the source of sepsis; in general, the complications are due to organ dysfunction, damage, or loss. Death is usually due to multiorgan dysfunction (liver, kidney, or lung failure).

    Physicians agree that the faster the patient with sepsis is diagnosed and treated, the better the prognosis and fewer complications, if any, for the patient.

    How can sepsis (blood poisoning) be prevented?

    Risk factors that lead to sepsis can be reduced by many methods. Perhaps the most important way to reduce the chance for sepsis is to first prevent any infections. Vaccines, good hygiene, hand washing, and avoiding sources of infection are excellent preventive methods. If infection occurs, immediate treatment of any infection before it has a chance to spread into the blood is likely to prevent sepsis. This is especially important in patients that are at greater risk for infection such as those who have suppressed immune systems, those with cancer, people with diabetes, or elderly patients.

    What is sepsis?

    Sepsis is a potentially dangerous or life-threatening medical condition, found in association with a known or suspected infection (usually caused by but not limited to bacteria) whose signs and symptoms fulfill at least two of the following criteria of a systemic inflammatory response syndrome (SIRS):

    • elevated heart rate (tachycardia) >90 beats per minute at rest
    • body temperature either high (>100.4 F or 38 C) or low (20 breaths per minute or a reduced PaCO2 (partial pressure of carbon dioxide in arterial blood level)
    • abnormal white blood cell count (>12,000 cells/µL or 10% bands [an immature type of white blood cell])

    Patients who meet the above criteria have sepsis and are also termed septic. These criteria described above were proposed by several medical societies and may continue to be modified by other medical groups. For example, pediatric groups use the same four criteria listed above but modify the values for each to make the SIRS criteria for children. Other groups want to add criteria, but currently this is the most widely accepted definition.

    Terms that are often used in place of sepsis are bacteremia, septicemia, and blood poisoning. However, bacteremia means the presence of bacteria in the blood; this can occur without any of the criteria listed above and should not be confused with sepsis. For example, you can brush your teeth and get bacteremia for a short time and have no SIRS criteria occur. Unfortunately, septicemia has had multiple definitions over time; it has been defined as bacteremia, blood poisoning, bacteremia leading to sepsis, sepsis, and other variations. Although septicemia appears frequently in the medical literature, a reader must be sure which definition the author is using. Some experts suggest the terms blood poisoning and septicemia not be used since they are poorly defined, but it is difficult for the medical community to disregard such terms that have been used for many decades.

    Why are there so many diseases with "sepsis," "septic," "septicemia," or "blood poisoning" in their name?

    Unfortunately, both medical personnel and laypeople have used these terms interchangeably and then linked them to either a particular organism (usually bacterial) that can cause sepsis, to a site in the body in which an infection originates that leads to sepsis, or to a clinical situation that leads to sepsis as described above. For example, meningococcal sepsis, meningococcal septicemia, septic meningitis, and meningococcal blood poisoning can refer to the same entity, an infection of the patient by the bacteria Neisseria meningitidis that has spread from the meninges (brain membranes) to the bloodstream, resulting in the patient having at least two of the four criteria outlined above for sepsis. Common examples of a clinical situation used in the same way are puerperal sepsis, puerperal septicemia, puerperal or childbirth blood poisoning, and maternal septicemia postpartum. All four terms represent infection that occurs during the puerperium (time around the delivery of a baby) that leads to sepsis criteria for the patient. The infectious agent is not described when the body site or situation is linked to "sepsis" or the other terms. The following is a short partial list of both organism and organ system (and organ-related) terms that are seen in both the lay and medical literature:

    • MRSA sepsis: sepsis caused by methicillin-resistant Staphylococcus aureus bacteria
    • VRE sepsis: sepsis caused by vancomycin-resistant Enterococcus species of bacteria
    • urosepsis: sepsis originating from a urinary tract infection (UTI)
    • wound sepsis: sepsis originating from an infection of a wound
    • neonatal sepsis or septicemia: sepsis seen in newborns, usually in the first four weeks after birth; sepsis neonatorum means the same as neonatal sepsis
    • septic abortion: an abortion due to infection with sepsis in the mother

    There are many more examples of linking terms to sepsis (for example, AIDS, tattoo, spider bite). Occasionally, terms like hemorrhagic septicemia are used to describe a symptom (internal bleeding) that occurs with sepsis. The trend in medicine currently is to decrease the use of the terms septicemia and blood poisoning in favor of the terms sepsis or septic, because sepsis is defined most concisely.

    What causes sepsis?

    The majority of cases of sepsis are due to bacterial infections, some are due to fungal infections, and very few are due to other causes of infection or agents that may cause SIRS. The infectious agents, usually bacteria, begin infecting almost any organ location or implanted device (for example, skin, lung, gastrointestinal tract, surgical site, intravenous catheter, etc.). The infecting agents or their toxins (or both) then spread directly or indirectly into the bloodstream. This allows them to spread to almost any other organ system. SIRS criteria result as the body tries to counteract the damage done by these blood-borne agents.

    Common bacterial causes of sepsis are gram-negative bacilli (for example, E. coli, P. aeruginosa, E. corrodens, and Haemophilus influenzae in neonates). Other bacteria also causing sepsis are S. aureus, Streptococcus species, Enterococcus species and Neisseria; however, there are large numbers of bacterial genera that have been known to cause sepsis. Candida species are some of the most frequent fungi that cause sepsis. In general, a person with sepsis can be contagious, so precautions such as hand washing, sterile gloves, masks, and clothing coverage should be considered depending on the patient's infection source.

    What are the risk factors for sepsis?

    The following groups are at increased risk for sepsis:

    • The very young and the elderly are at greatest risk
    • People who are very ill due to an infectious agent
    • People in an intensive-care unit
    • People with weakened or compromised immune systems
    • People with devices such as IV catheters, breathing tubes, or other devices
    • People with extensive burns
    • People with severe trauma

    What are the signs or symptoms of sepsis (blood poisoning)?

    The adult patient should have a proven or suspected source of an infection (usually bacterial) and have at least two of the following problems: an elevated heart rate (tachycardia), either a high (fever) or low temperature (hypothermia), rapid breathing (>20 breaths per minute or a reduced PaCO2 level), or a white blood cell count that is either high, low, or composed of >10% band (immature) cells. In most cases, it is fairly easy to ascertain heart rate (count pulse per minute), fever or hypothermia with a thermometer, and to count breaths per minute even at home. It may be more difficult to prove a source of infection, but if the person has symptoms of infection such as productive cough, dysuria, fevers, or a wound with pus, it is fairly easy to suspect that a person with an infection may have sepsis. However, determination of the white blood cell count and PaCO2 is usually done by a lab. In most cases, the definitive diagnosis of sepsis is made by a physician in conjunction with laboratory tests.

    Elderly patients have similar symptoms to those stated for adults, but the first apparent symptoms are often confusion along with chills, weakness, possibly faster breathing, and a dusky skin appearance. Pediatric patients (infants, toddlers, and children) also may develop similar symptoms to those in adults, but the most common symptoms are fever and reduced urine output. Children may show signs of lethargy and decreased age-appropriate mental status. Neonatal sepsis (sepsis neonatorum) is suspected in neonates up to 28 days old if the rectal temperature is 100.4 F or higher. Other signs and symptoms for neonatal sepsis include fever in the mother at time of delivery, cloudy or smelly amniotic fluid, abnormal vital signs, seizures, and projectile vomiting.

    Some authors consider red lines or red streaks on the skin to be signs of sepsis. However, these streaks are due to local inflammatory changes in either local blood vessels or lymphatic vessels (lymphangitis). The red streaks or lines are worrisome as they usually indicate a spreading infection that can result in sepsis.

    Septic shock is a condition in which overwhelming infection causes a dangerous drop in systolic blood pressure (hypotension). Additional symptoms that may accompany the low blood pressure may include cool and pale extremities, dizziness or lightheadedness, low or absent urine output, shortness of breath, rapid heart rate, behavioral changes, and low or high body temperature.

    How is sepsis diagnosed?

    Clinically, the patient needs to fit at least two of the SIRS criteria listed above and have a suspected or proven infection. This is a screening tool to help physicians presumptively diagnose sepsis early in the disease process. Definitive diagnosis depends on a positive blood culture for an infectious agent and at least two of the SIRS criteria. However, two subsets of the four criteria depend on lab analysis: white blood cell examinations and PaCO2. These subset criteria, like blood cultures, are measured in clinical laboratories. Researchers are currently investigating other blood tests to diagnose early sepsis.

    There are other diagnoses that indicate the severity of the patient's sepsis. Severe sepsis is diagnosed when the septic patient has organ dysfunction (for example, low or no urine flow, altered mental status). Severe sepsis can also include sepsis-induced hypotension (also termed septic shock) when the patient's blood pressure falls.

    What is the treatment for sepsis?

    In almost every case of sepsis, patients need to be hospitalized, treated with appropriate intravenous antibiotics, and given therapy to support any organ dysfunction. Sepsis can quickly cause organ damage and death; therapy should not be delayed as statistics suggest as high as a 7% mortality increase per hour if antibiotics are delayed in severe sepsis. Most cases of sepsis are treated in an intensive-care unit (ICU) of the hospital.

    Appropriate antibiotics to treat sepsis are combinations of two or three antibiotics given at the same time; most combinations usually include vancomycin to treat many MRSA infections. However, once the infecting organism is isolated, labs can determine which antibiotics are most effective against the organisms, and those antibiotics should be used to treat the patient. In addition to antibiotics, two other major therapeutic interventions, organ-system support and surgery, may be needed. First, if an organ system needs support, the intensive-care unit can often provide it (for example, intubation to support lung function or dialysis to support kidney function). Secondly, surgery may be needed to drain or remove the source of infection. Amputation of extremities has been done to save some patients' lives.

    A recent research report may alter a common treatment for septic shock. Because of the low blood pressure seen with septic shock, IV fluid boluses have been used to support the patient's blood pressure. However, a 2011 study in over 3,000 children in Africa with impaired perfusion (shock) showed that the fluid bolus treatments actually increased mortality (death rate) in the children. This surprising result has raised questions about how clinicians can best manage septic shock in the future. For example, in 2004, guidelines were published that "bundled" therapeutic methods (for example, blood cultures, antibiotic therapy, and fluid therapy) to treat sepsis in an initial six-hour period that included fluid boluses. This septic treatment bundle of techniques may need revision or reexamination.

    What is the prognosis (outcome) with sepsis?

    The prognosis of patients with sepsis is related to the severity or stage of sepsis as well as to the underlying health status of the patient. For example, patients with sepsis and no ongoing sign of organ failure at the time of diagnosis have about a 15%-30% chance of death. Patients with severe sepsis or septic shock have a mortality (death) rate of about 40%-60%, with the elderly having the highest death rates. Newborns and pediatric patients with sepsis have about a 9%-36% mortality rate. Investigators have developed a scoring system (MEDS score) based on the patient's symptoms to estimate prognosis.

    What are the complications of sepsis?

    There are a large number of complications that may occur with sepsis. The complications are related to the type of initial infection (for example, in lung infection [pneumonia] with sepsis, a potential complication could be a need for respiratory support) and the severity of sepsis (for example, septic shock related to a limb infection that could require limb amputation). Consequently, each patient is likely to have the potential for complications related to the source of sepsis; in general, the complications are due to organ dysfunction, damage, or loss. Death is usually due to multiorgan dysfunction (liver, kidney, or lung failure).

    Physicians agree that the faster the patient with sepsis is diagnosed and treated, the better the prognosis and fewer complications, if any, for the patient.

    How can sepsis (blood poisoning) be prevented?

    Risk factors that lead to sepsis can be reduced by many methods. Perhaps the most important way to reduce the chance for sepsis is to first prevent any infections. Vaccines, good hygiene, hand washing, and avoiding sources of infection are excellent preventive methods. If infection occurs, immediate treatment of any infection before it has a chance to spread into the blood is likely to prevent sepsis. This is especially important in patients that are at greater risk for infection such as those who have suppressed immune systems, those with cancer, people with diabetes, or elderly patients.

    Source: http://www.rxlist.com

    Risk factors that lead to sepsis can be reduced by many methods. Perhaps the most important way to reduce the chance for sepsis is to first prevent any infections. Vaccines, good hygiene, hand washing, and avoiding sources of infection are excellent preventive methods. If infection occurs, immediate treatment of any infection before it has a chance to spread into the blood is likely to prevent sepsis. This is especially important in patients that are at greater risk for infection such as those who have suppressed immune systems, those with cancer, people with diabetes, or elderly patients.

    Source: http://www.rxlist.com

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