Understanding sepsis

By Alan Koenigsberg, M.D.

There has been some discussion of sepsis in the news recently as it relates to pregnant women. There was also considerable attention paid to septic shock a while ago in relation to women keeping tampons inserted for days. Then, I received a request from a reader to write an article about sepsis and septic shock as it may relate to indwelling catheters.

Most of this information I am deriving from the World Health Organization website (www.who.int) and anyone can easily access it for more details.

Sepsis is a medical emergency. It is the condition in which the body’s immune system has an extreme reaction to an infection and may cause multiple organs to fail. Common symptoms include fever, clammy and sweaty skin, rapid heart rate, confusion, pain, rapid breathing and low urine output. It can lead to septic shock and death.

Treatment requires antibiotics, fluids and careful monitoring to support the person.

Recent estimates are that there are 50 million cases of sepsis worldwide annually, 11 million deaths due to sepsis and this accounts for roughly 20% of deaths annually worldwide.

Sepsis can occur in anyone, but occurs most often in the very old, the very young, pregnant women and people with chronic medical conditions.

While most cases occur in low- and middle-income countries, sepsis can occur anywhere and in anyone.

Prevention includes good personal hygiene, avoiding unclean toilets, getting recommended vaccines. For those people with indwelling catheters, whether after surgery, for cancer treatments, ostomies or any other chronic medical condition, special attention must be paid to any signs of infection or soreness.

Treatment is most effective if begun immediately. Low blood pressure is treated with intravenous fluids; infection, with antibiotics. Given that sepsis is by definition a serious infection, it is often the result of bacteria which are resistant to common antibiotics. Intensive Care Unit treatment is often necessary.

According to the Center for Disease Control, at least 1.7 million people in the United States develop sepsis annually.

Annually, at least 350,000 people who develop sepsis die or are discharged to hospice care.

One in three people who die in a hospital had sepsis during their hospitalization.

The National Institutes of Health indicates that there has been considerable improvement of our understanding of the development of sepsis. The infection and the body’s immune response have been known for decades and treatment had been targeted to those areas.

More recently, we have learned that the body’s inflammation responses as well as blood clotting mechanisms are also intimately involved in the development of sepsis and septic shock.

Dilation of the blood vessels occurs, which causes low blood pressure, rapid heart rate and decreased blood flow to the body’s organs. Treatment is initially aimed at combating infection, increasing blood flow to organs and constriction of blood vessels.

This has to be extremely carefully monitored to achieve just the right amount and not too much constriction.

The bottom line is that sepsis is very much a serious concern for a targeted population. Management and care of people with sepsis has continually been improving, to the point where now, the outcomes are far better than had ever been expected.

The take-home is that prompt attention and intensive care are essential to achieving optimal care for people suspected of having this serious condition.

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at akoenigsberg@mac.com.

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