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Septicaemia

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Introduction


Sepsis is a life-threatening illness caused by the body overreacting to an infection.

The body's immune system goes into overdrive, setting off a series of reactions that can lead to widespread inflammation (swelling) and blood clotting in the body.

Sepsis occurs in three stages:

  • Uncomplicated sepsis is caused by infections, such as flu or dental abscesses. It is very common and does not usually require hospital treatment.
  • Severe sepsis occurs when the body's response to infection has started to interfere with the function of vital organs, such as the heart, kidneys, lungs or liver.
  • Septic shock occurs in severe cases of sepsis, when your blood pressure drops to a dangerously low level, preventing your vital organs from receiving enough oxygenated blood. See the Health A-Z topic on Septic shock for more information.

If it is not treated, sepsis can progress from uncomplicated sepsis to septic shock and can eventually lead to multiple organ failure and death.

How common is it?

It is estimated that there are over 30,000 cases of severe sepsis in the UK every year, and the number of cases seems to be rising.

Outlook

If sepsis is detected early enough and has not yet affected the vital organs, it may be possible to treat the infection at home with a course of antibiotic tablets. Most people with uncomplicated sepsis make a full recovery.

Severe sepsis and septic shock are considered medical emergencies and normally require admission to an intensive care unit, where the body's organs can be supported while the infection is treated.

Because of problems with vital organs, people with severe sepsis are likely to be very ill, and approximately 30-50% will die because of the condition.


Symptoms of sepsis


The symptoms of sepsis may develop after a localised infection (infection limited to one part of the body) or injury. In some cases, sepsis may develop when you are already in hospital, for example if you have recently had surgery and a drip or catheter has been connected to your body. For more information, see Sepsis - causes.

The symptoms of sepsis usually develop quickly and include:

  • a fever or high temperature over 38C (100.4F)
  • chills
  • a fast heartbeat
  • fast breathing

Symptoms of severe sepsis or septic shock include:

  • low blood pressure that makes you feel dizzy when you stand up
  • a change in your mental state, such as confusion or disorientation
  • diarrhoea
  • nausea and vomiting
  • cold, clammy and pale skin

The most common sites of infection leading to sepsis are the lungs, urinary tract, abdomen and pelvis.

Severe sepsis and septic shock are medical emergencies. If you think that you or someone in your care has these conditions, phone 999 and ask for an ambulance.


Causes of sepsis


Sepsis can be triggered by an infection in any part of the body.

Usually, your immune system will keep the infection limited to one place (known as a localised infection). Your body will produce white blood cells, which travel to the site of the infection to destroy the germs causing infection. A series of biological processes occurs, such as tissue swelling, which helps fight the infection and prevent its spread. This process is known as inflammation.

If your immune system is weakened or if an infection is particularly severe, the infection can spread through the blood into other parts of the body. This causes the immune system to go into overdrive, and the process of inflammation affects the entire body.

This can cause more problems than the initial infection, as widespread inflammation damages tissue and interferes with the flow of blood, leading to a dangerous drop in blood pressure, which stops oxygen reaching your organs and tissue.

Sources of infection

The most common sites of infection leading to sepsis are the lungs, urinary tract, abdomen and pelvis. Types of infection associated with sepsis include:

  • lung infection (pneumonia)
  • flu (influenza)
  • appendicitis
  • infection of the lining of the digestive system (peritonitis)
  • an infection of the bladder, urethra or kidneys (urinary tract infection)
  • skin infections, often caused when an intravenous drip or catheter has been inserted into the body through the skin
  • post-surgical (after surgery) infections
  • infections of the nervous system, such as meningitis or encephalitis

In approximately one in five cases, the infection and source of sepsis cannot be detected.

People at risk

Everybody is potentially at risk of developing sepsis from minor infections, such as flu. However, some people are more vulnerable, including:

  • people who have a medical condition, such as HIV or leukaemia, that weakens their immune system
  • people receiving medical treatment, such as chemotherapy, that weakens their immune system
  • the very young or very old
  • people who have just had surgery or who have wounds or injuries as a result of an accident
  • people on mechanical ventilation
  • people with drips or catheters attached to their skin
  • people who are genetically prone to infection

Sepsis is a particular risk for people who are already in hospital due to another serious illness. Despite the best efforts of doctors and nurses, secondary infections acquired in hospital are always a potential risk.

Hospital-acquired bacterial infections, such as MRSA, tend to be more serious as the bacteria causing the infection have often developed a resistance to antibiotics.


Diagnosing sepsis


There are three important goals when diagnosing sepsis. These are to determine:

  • the type of infection
  • the source of infection
  • which body functions have been affected and how badly

To diagnose sepsis, several tests may be carried out, including:

  • blood tests
  • urine tests
  • stool sample tests
  • blood pressure tests
  • a wound culture test (where a small sample of tissue, skin or fluid is taken from the affected area for testing)
  • respiratory secretion testing (which involves testing a sample of your saliva, phlegm or mucus)
  • imaging studies such as an X-ray or computerised tomography scan (CT scan)
  • kidney, liver and heart function tests
  • a spinal tap (where a sample of cerebrospinal fluid is extracted from your back for testing)

In the case of suspected sepsis, it is important to get a diagnosis as soon as possible so appropriate treatment can be given. This can help stop the progress of sepsis and any long-term damage to the body.


Treating sepsis


If your sepsis is detected early enough and has not affected organ or tissue function (uncomplicated sepsis), it may be possible to treat the condition at home. You will be prescribed a course of antibiotic tablets.

If the sepsis is severe or you develop septic shock, you will need emergency hospital treatment, usually in an intensive care unit (ICU). ICUs are able to support any affected body function, such as breathing or blood circulation, while the medical staff focus on treating the infection.

Treatment of severe sepsis will vary for each patient depending on the initial infection, the organs affected and the extent of damage.

Antibiotics

Severe sepsis is treated with intravenous antibiotics (given directly into a vein). There will usually not be time to wait until a specific type of infection has been identified, so 'broad-spectrum' antibiotics will initially be given. Broad-spectrum antibiotics are designed to work against a wide range of known infectious bacteria, and can also treat some fungal infections.

Once a specific bacterium has been identified, a more 'focused' antibiotic can be used. This has the advantage of reducing the chance of the bacteria becoming resistant to antibiotics.

Intravenous antibiotics usually have to be given for 7 to 10 days.

If the sepsis is caused by a virus, antibiotics will not work. However, it is likely that antibiotics will be started anyway. This is because it would be too dangerous to delay antibiotic treatment until an accurate diagnosis is made. You will then need to wait until your body develops resistance to the effects of the virus. In some cases, antiviral medication may be given.

Source control

Source control means treating the source of the infection, such as an abscess or infected wound. This may require draining pus from infected tissue. In more serious cases, surgery may be required to remove the infected tissue and repair any damage.

Vasopressors

Vasopressors are medicines used to treat low blood pressure. The two types of vasopressors used in the treatment of sepsis are dopamine and noradrenaline.

They can help to increase blood pressure by stimulating the muscles involved in pumping blood around the body and constricting (narrowing) the blood vessels.

Vasopressors are normally given intravenously. Extra fluids may also be given intravenously to help increase blood pressure.

Recombinant human activated protein C (rhAPC)

Recombinant human activated protein C (rhAPC) is a new type of medicine being used to treat some cases of severe sepsis. The type of rhAPC used in the UK is known as drotrecogin alfa. It contains a genetically modified type of protein molecule called protein C, which is known to reduce levels of inflammation (tissue swelling) and help prevent blood clots, both important goals in the treatment of sepsis.

RhAPC will only be used if your condition is very severe and you are at risk of dying. Drotrecogin alfa is known to cause internal bleeding in some people, so it may not be suitable if you have had a previous history of stroke or internal injury, or if you have recently had surgery.

Other treatments

Depending on your condition and the effect sepsis has had on your body, you may also require:

  • medication, such as steroids or insulin
  • a blood transfusion
  • mechanical ventilation to help you breathe
  • dialysis (a machine to filter your blood) to help with kidney function

The materials in this website are provided by Medicine Chest and NHS Choices.  Neither Co-operative Group Limited or Co-operative Healthcare Limited (trading as The Co-operative Pharmacy or otherwise) shall be in any way responsible or liable for its content.

The materials in this website are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor.  The website does not have answers to all problems and answers to specific problems may not apply to everyone.  If you notice medical symptoms or feel unwell, you should consult your doctor.  For further information, consult the terms and conditions.


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