Sepsis

Sepsis is a life-threatening condition caused by the body’s overreaction to an infection.

Symptoms include fever, breathing difficulties, increased heart rate, low blood pressure, and mental confusion. Prompt treatment with antibiotics and intravenous fluids will aim to limit organ damage and prevent death.

It has been estimated that nearly 15,000 people in Australia and New Zealand are admitted to a hospital intensive care unit (ICU) each year with sepsis, and a 2018 study in the Waikato region indicates about 20 per cent of people die following admission.

Sepsis is often a result of blood stream infection (also known as septicaemia or blood poisoning). Blood stream infection is when a bacterial infection elsewhere in the body (such as pneumonia in the lungs or infection in the urine) enters the bloodstream, which can then trigger sepsis.

Causes

The body normally releases chemicals into the bloodstream to fight an infection. Sepsis occurs when the body’s immune system overreacts, and the chemicals intended to fight infection cause changes that damage the body’s tissues and vital organs.

In severe cases of sepsis, one or more organs fail. In the most serious cases, there is a massive drop in blood pressure and multiple organs fail quickly. This is known as septic shock, which has a considerable risk of death.

Sepsis can be triggered by an infection in any part of the body. Common sites of infection leading to sepsis are:

• Lungs (pneumonia)
• Digestive system, including the stomach and intestines (e.g. appendicitis, peritonitis)
• Kidneys, bladder, or urethra (urinary tract infection, nephrolithiasis)
• Nervous system (e.g. meningitis , encephalitis)
• Skin.

Risk factors

Although anyone can develop sepsis, the following factors increase the risk of sepsis:

• Immunodeficiency disorders
• Younger age (infants and children)
• Older age (65 years or older)
• Frailty
• Pregnancy
• Chronic illnesses, e.g. diabetes , cancer, kidney disease, liver cirrhosis
• Recent surgery or serious illness
• Having an invasive device in your body, such as a breathing tube or catheter
• Severe burns or other wounds or injuries.

Signs and symptoms

You should seek urgent medical attention if you think you have symptoms of sepsis, which can include:

• Fever (over 38°C or under 36°C)
• Chills and shivering
• Rapid (more than 22 breaths a minute) or laboured breathing
• Passing little or no urine
• Feeling unwell
• Rapid heart rate (over 100 beats per minute)
• Feeling lightheaded or dizzy when standing up
• Rash
• Confusion and disorientation
• Mottled, bluish discoloration of the skin, especially lips, fingers, toes.

Diagnosis

Initial steps in the diagnosis of sepsis involve measuring a person’s temperature, heart rate, breathing rate, and blood pressure. Doctors often order several tests to diagnose the underlying infection, depending on your symptoms. These may include blood tests, urine or stool tests, respiratory or wound secretion tests, and imaging studies x-rays, computerised tomography (CT) scans, ultrasound, and magnetic resonance imaging (MRI).

Treatment

Early and aggressive treatment of sepsis increases the chance of survival. Severe sepsis and septic shock require admission to hospital and some people may require admission to an intensive care unit. Because of problems with vital organs, people with severe sepsis are likely to be very ill and the condition can be fatal. Sepsis is a medical emergency and may need antibiotic therapy to be started within one hour of recognition.

Some people, especially those with pre-existing chronic diseases, may have permanent organ damage following recovery. Severe sepsis also disrupts a person’s immune system, making them more at risk for future infections.

Treatment for sepsis depends on the site and the cause of the initial infection, the organs affected, and the extent of organ and tissue damage. The main aims of treatment are to resolve the infection and sustain the vital organs. This may involve giving:

Intravenous (i.e. via a vein) antibiotics to stop the infection

Oxygen and intravenous fluids to maintain blood flow and the delivery of oxygen to tissues and body organs

Drugs that help to increase blood pressure.

Other medications may be given to moderate the body’s immune system response, reduce pain and inflammation, and maintain blood sugar (glucose) levels.

Supportive care, such as machines to help with breathing and kidney dialysis if the kidneys have been affected, may be necessary. Surgery is sometimes needed to remove infected tissues or gangrene (dead body tissue due to lack of blood flow).

Further information and support

Healthline

Freephone (24 hours): 0800 611 116

Web: www.healthline.govt.nz

Sepsis Trust NZ

Phone: 0800 764 915

Email: [email protected]

Web: www.sepsis.org.nz

References

Burrell, A., Huckson, S., Pilcher, D.V. (2018). ICU Admissions for Sepsis or Pneumonia in Australia and New Zealand in 2017. N Engl J Med. 2018;378(22):2138–2139.

Finfer, S., et al. (2004). Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 2004;30(4):589–96.

Mayo Clinic (2021). Sepsis (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214 [Accessed: 07/02/23]

National Institute of General Medical Sciences (2021). Sepsis (Web Page). Bethesda, MD: National Institutes of Health. https://www.nigms.nih.gov/Education/Pages/factsheet_sepsis.aspx [Accessed: 07/02/23]

NHS (2022). Sepsis (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/sepsis/ [Accessed: 07/02/23] Stuff (2018). Doctor estimates thousands are dying of sepsis every year. https://www.stuff.co.nz/national/health/106534220/sepsis-the-biggest-killer-youve-probably-never-heard-of [Accessed: 07/02/23]

BPAC New Zealand Guidelines (2018). Sepsis: recognition, diagnosis and early management. https://bpac.org.nz/guidelines/4/ [Accessed: 07/02/23]

Reviewed: February 2023