Sepsis

Sepsis is a serious medical condition caused by an overwhelming immune response to infection. Immune chemicals released into the blood to combat the infection trigger widespread inflammation, which leads to blood clots and leaky vessels. This results in impaired blood flow, which damages the body’s organs by depriving them of nutrients and oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops, the heart weakens and the patient spirals toward septic shock. Once this happens, multiple organs—lungs, kidneys, liver—may quickly fail and the patient can die. Sepsis is a major challenge in the intensive care unit, where it’s one of the leading causes of death. It arises unpredictably and can progress rapidly. Sepsis can be defined as the body's response to an infection. An infection is caused by micro-organisms or "germs" (usually bacteria, fungi and viruses,but bacteria are the most common culprits) invading the body, and can be limited to a particular body region (e.g., a tooth abscess) or can be widespread in the bloodstream (often called "septicemia" or "blood poisoning"). It stems from another medical condition such as an infection in the lungs, urinary tract, skin, abdomen (such as appendicitis) or other part of the body. Invasive medical procedures like the insertion of a vascular catheter can introduce bacteria into the bloodstream and bring on the condition. 

Although everybody is at potential risk of developing sepsis from minor infections (e.g., flu, urinary tract infections, gastroenteritis, etc.), sepsis is most likely to develop in people who:

• Are very young (e.g. premature babies) or very old
• Have a weakened ("compromised") immune system, often because of treatments such as chemotherapy for cancer, steroids (e.g. cortisone) for inflammatory conditions, etc.
• Have wounds or injuries, such as those from burns, a car crash, or a bullet
• Have certain addictive habits, such as alcohol or drugs
• Are receiving certain treatments or examinations (e.g., intravenous catheters [a small tube for dripping fluids into the vein], wound drainage, urinary catheters [a small tube inserted into the bladder]
• Are more prone to develop sepsis than others because of genetic factors (or their "genes")

Patients who are admitted to the hospital with serious diseases are at the highest risk of developing sepsis because of: 

• Their underlying disease 
• Their previous use of antibiotics 
• The presence of drug-resistant bacteria in the hospital
•  The fact that they often require an intravenous tube, urinary catheter, or wound drainage

The infection leading to sepsis can be acquired outside the hospital (known as community acquired) or in the hospital (known as nosocomial). Hospital-acquired infections are generally more difficult to manage than those acquired in the community, because:

• The infecting microorganism is more dangerous to the patient
• The patient is often already sick
• The microorganism may be resistant to common treatments due to the widespread use of antibiotics in hospitals

THE OCCURRENCE OF SEPSIS

Every year, severe sepsis strikes about 750,000 Americans. It’s been estimated that between 28 and 50 percent of these people die—far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. The number of sepsis cases per year has been on the rise in the United States. This may be due to an aging population, the increased longevity of people with chronic diseases, the spread of antibiotic-resistant organisms, an upsurge in invasive procedures and broader use of immunosuppressive and chemotherapeutic agents.

Sepsis occurs in three different forms or stages, called:

# Uncomplicated sepsis

# Severe sepsis

# Septic shock

The disease progresses in some people through all three stages. Despite optimal (best or most favourable) care, some patients may not respond to treatment, and may develop multiple organ disease and eventually die.

1. UNCOMPLICATED SEPSIS:

Uncomplicated sepsis, such as that caused by flu and other viral infections, gastroenteritis, or dental abscesses, is very common and is experienced by millions of people each year. The majority of these people will not need hospital treatment.

    2.SEVERE SEPSIS:

Severe sepsis arises when sepsis occurs in combination with problems in one or more of the vital organs, such as the heart, kidneys, lungs, or liver. Because of problems with their vital organs, people with severe sepsis are likely to be very ill and are more likely to die (in 30-35 % of cases) than those with uncomplicated sepsis.

   3.SEPTIC SHOCK

Septic shock occurs when sepsis is complicated by low blood pressure that does not respond to standard treatment (fluid administration) and leads to problems in one or more of the vital organs as described above. The condition means that the body does not receive enough oxygen to properly function and drugs called vasopressors are used to raise the blood pressure. Septic shock patients are very ill and need rapid emergency admission to the hospital intensive care unit (ICU). Despite active treatment in the ICU, the death rate is around 50%.

What are the symptoms of sepsis?

Common symptoms of sepsis are fever, chills, rapid breathing and heart rate, rash, confusion and disorientation. Many of these symptoms, such as fever and difficulty breathing, mimic other conditions, making sepsis hard to diagnose in its early stages. 

HOW IS SEPSIS TREATED?

The treatment of severe sepsis and septic shock may include:

• Antibiotics to treat the infection
• Surgery to control the source of the infection
• Fluids through the intravenous or IV catheter (drip) - these fluids may sometimes include nutritional liquids if the patient cannot eat normally
• Drugs to raise the blood pressure or improve the function of the heart
• Organ support, such as artificial ventilation for the lungs (breathing machine), kidney support (kidney machine), etc

Despite the best possible care, some patients may not respond to treatment, and but rather develop further organ failure and die. Research into better treatment methods continues. Recent studies have shown that survival in some patients with severe sepsis can be improved with medications that alter blood clotting, reduce inflammation, or support the stress response, and by new approaches to support organ function. These treatments are not appropriate in all patients. These therapies may include:

- Activated protein C

- Steroids

- Using modest breath sizes

- Maintaining blood sugar

Ref: http://www.nigms.nih.gov/Education/factsheet_sepsis.htm