Sepsis acquired in a healthcare setting is an adverse event that impacts millions of patients. According to the World Health Organization, sepsis globally kills 11 million people annually and disables millions more. Over 1.7 million adults in the US develop sepsis each year with many of them being children. While sepsis can impact anyone, older adults, young children, pregnant women, and those with underlying health issues are at a higher risk.
The life-threatening condition occurs when an existing infection triggers a dangerous chain reaction throughout the body causing the person’s immune system to overreact. Although sepsis primarily spawns from bacterial infections, it can also result from viral, parasitic, or fungal infections. If left untreated, sepsis can progress to “Septic Shock”, which causes a drastic drop in blood pressure and potentially serious damage to the lungs, kidneys, liver, and other organs.
Shockingly one-in-three individuals who died in a hospital had sepsis during their hospitalization. But most cases of sepsis begin before a patient even reaches the hospital with infections that originate in the lungs, urinary tract, skin, or gastrointestinal tract. Moreover, healthcare-associated infections are particularly concerning as the pathogens involved are often resistant to drugs and cause treatments to be more challenging.
Preventive measures and timely treatment…
More than 350,000 adults in the US who develop sepsis, die during their hospital stay or are transferred to hospice care. So, preventive measures are vital in reducing the occurrence of sepsis. These include promoting good hygiene practices, ensuring access to vaccination programs, improving sanitation and water quality, and implementing infection prevention and control measures in both community and healthcare settings.
To prevent sepsis, it’s crucial to promptly treat initial infections while maintaining good hygiene in the home and at all medical facilities. Hospitals and clinics must adhere to effective infection prevention and control protocols and antibiotics should be used responsibly to combat infections, as antibiotic resistance can complicate treatment. While sepsis isn’t contagious, infections that can lead to sepsis may be transmissible.
Medical care is essential for treating sepsis. Early diagnosis and appropriate clinical management, such as optimal antimicrobial use and fluid resuscitation, significantly increase the chances of survival. It is also important to note that although sepsis can cause immediate mortality, it can also result in long-term health issues that require outpatient treatment and support. Patients with sepsis caused by resistant pathogens also have a higher risk of mortality.
Patients at Higher Risk for Sepsis
Sepsis is not directly caused by germs, but most often by the body’s release of chemicals in response to a bacterial infection. Factors such as an aging population, increased use of immunosuppression, invasive procedures, and drug-resistant pathogens contribute to the rise in sepsis cases. While anyone can develop sepsis, certain individuals are at a higher risk, including:
- Weakened Immune System – Autoimmune diseases do not cause sepsis. But, people with certain types are at higher risk of developing infections that can lead to sepsis. In addition, medications used to treat certain autoimmune disorders (e.g. – prednisone) can weaken the immune system.
- Chronic Conditions – Sepsis can worsen cognitive and physical impairments as well as increases risk of chronic diseases, such as chronic kidney disease and cardiovascular disease. Negative changes in overall health may persist for months or years after a severe episode of sepsis.
- Adults 65 or Older – Sepsis can be particularly devastating for seniors. Elderly patients with severe sepsis and septic shock have high mortality rates of around 50% to 60%. In elderly patients, the most common source of sepsis is the respiratory tract followed by genitourinary infections.
- Children under 1-year – Children under 1 year of age are at increased risk of developing pediatric sepsis, especially if they were born prematurely or the mother had an infection while pregnant. Symptoms like shivering, fever, low body temp, fast breathing, or a racing heartbeat can suddenly occur together.
- Serious Infections – While sepsis is always a serious condition, individuals living with HIV, tuberculosis, malaria, and other infectious diseases face a higher risk. Prompt use of antimicrobials targeting bacteria, parasites, fungi, or viruses is essential for improving sepsis outcomes.
- Recent Hospitalization – For hospitalized patients who were recently discharged after their recovery, the most common culprits of sepsis infection include intravenous lines, surgical wounds, surgical drains, and incapacitated skin breaks, such as bedsores or pressure ulcers.
- Sepsis Survivors – Survivors may have chronic conditions that persist for years after their initial episode. Older survivors are three times more likely to see a decline in cognitive abilities, which can make it difficult for them to return to their previous living arrangements without additional care.
Without prompt treatment, sepsis can be more deadly than breast cancer, lung cancer, or heart attack, and can even lead to death within the first twelve hours. Changes in mental status and rapid breathing are early signs of sepsis. Additionally, sepsis can lead to a drop in blood pressure that results in “Septic Shock”. Major organs and body systems, such as the kidneys, liver, lungs, and central nervous system, may shut down or not function properly due to inadequate blood flow.
New Sepsis Control Measures
Stopping the initial infection from progressing can prevent the onset of sepsis. Healthcare providers must closely monitor for concerning signs and use diagnostic tests to identify the condition. Common signs of sepsis include fever, rapid heart rate, fast breathing, confusion, and body pain. Since sepsis can have long-term consequences, it often necessitates a multidisciplinary approach. If not treated promptly, sepsis can lead to “Septic Shock” with multiple organ failures and death.
Statistics suggest that one-fourth to one-third of sepsis patients had a healthcare visit in the weeks prior to their hospitalization. However, by prioritizing infection treatment regimens, hygiene practices, and access to vaccinations, healthcare communities worldwide can reduce or eliminate the occurrence of sepsis to protect the well-being of individuals receiving care through prompt primary therapeutic intervention and better ongoing support.
Monitoring Sepsis in ICU
Sepsis is a major concern in intensive care units (ICU) as it can lead to high mortality rates and a significant drain on healthcare resources. The number of severe sepsis cases is projected to increase by 1.5% annually, with a corresponding rise in older patients. The elderly population faces a higher risk of sepsis due to various factors, such as pre-existing medical conditions, weakened immune systems, frailty, and malnutrition.
Effectively managing sepsis in ICU requires thorough consideration of the unique challenges posed by a comprehensive evaluation of prognostic factors and renewed focus on improving both survival rates and quality of life for survivors. New therapeutic approaches, such as immunomodulatory therapies, aim to address abnormal immune responses and may play a crucial role in managing initial infections as well as other factors that contribute to a higher incidence of sepsis.
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Dr. Hans Wolf devoted decades to developing WOLFPACC’s Methodology for helping medical students understand how to apply the basic sciences that they learned in medical school to the practice of medicine. If you’re ready to be the best physician you can be, contact us today to schedule a USMLE or COMLEX review program.