Sepsis

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
• Identified by an acute change in the total SOFA score ≥2 points consequent to the infection.
• Can progress to septic shock if not treated promptly.

• Sepsis affects approximately 245,000 people each year in the UK.
• Incidence is higher in the elderly, immunocompromised, and those with chronic illnesses.
• Mortality rate ranges from 25% to 40% depending on severity.

• Common causative organisms include bacteria (e.g., E. coli, Staphylococcus aureus), viruses, fungi, and parasites.
• Pathophysiology involves a complex interplay between the infecting pathogen and the host’s immune response.
• Key factors: inflammatory mediators, endothelial dysfunction, coagulation abnormalities, and microcirculatory failure.
• Leads to multi-organ dysfunction.

• Sepsis: Organ dysfunction due to infection.
• Septic shock: Sepsis with persistent hypotension requiring vasopressors and elevated lactate levels despite fluid resuscitation.
• Severe sepsis: No longer a formal definition but often used to describe sepsis with organ failure.

• Fever, chills, and rigors
• Altered mental state, confusion
• Shortness of breath, tachypnoea
• Nausea, vomiting, diarrhoea
• Muscle pain, general discomfort

• Tachycardia, hypotension
• Fever or hypothermia
• Decreased urine output
• Mottled or discoloured skin
• Cyanosis of extremities

• Full blood count: Leucocytosis or leucopenia.
• Blood cultures: To identify causative organisms.
• Lactate levels: Elevated in sepsis and septic shock.
• C-reactive protein (CRP) and Procalcitonin: Indicators of inflammation.
• Imaging: Chest X-ray, CT, or ultrasound to identify source of infection.

• Early identification and prompt treatment are crucial.
• Fluid resuscitation: IV fluids to maintain blood pressure and perfusion.
• Antibiotics: Broad-spectrum antibiotics initially, tailored once causative organism identified.
• Vasopressors: For patients with persistent hypotension.
• Supportive care: Oxygen therapy, mechanical ventilation if needed.
• Monitoring: Regular assessment of vital signs, organ function.

• Patients presenting with signs of sepsis can be investigated and managed using the principles from the Sepsis 6 bundle. The steps should be initiated within 1 hour.
  • Take blood cultures
  • Measure urine output
  • Measure serum lactate
  • Give oxygen
  • Give antibiotics 
  • Give IV fluids

• Septic shock
• Multiple organ failure
• Acute respiratory distress syndrome (ARDS)
• Disseminated intravascular coagulation (DIC)
• Death

• Prognosis depends on the severity of sepsis, underlying health conditions, and the promptness of treatment.
• Mortality rates are high, especially for septic shock.
• Survivors may experience long-term physical, psychological, and cognitive impairments.

• Early recognition and treatment of sepsis are critical to improve outcomes.
• Use a systematic approach: ABCDE assessment and sepsis screening tools.
• Multidisciplinary team involvement is essential for comprehensive care.
• Patient education on early signs and preventive measures is important.

https://cks.nice.org.uk/topics/sepsis/management/management/