What Is Sepsis?
Sepsis is when your body has a severe response to an infection. During sepsis, your immune system, which normally defends you from germs, starts to attack your body's tissues. This triggers inflammation that can lead to organ damage. It's also common for blood clots to form that lower blood flow to your internal organs, so they don't get the nutrients and oxygen they need.
In severe cases, sepsis causes a dangerous drop in blood pressure. Doctors call this "septic shock." It can quickly lead to organ failure in areas like your lungs, kidneys, and liver. This can be deadly.
Doctors used to categorize sepsis in three stages:
- Sepsis: Symptoms include fever, fast heart rate, fast breathing, confusion, and body pain.
- Severe sepsis: Symptoms of sepsis, plus difficulty breathing, abnormal liver tests, and peeing less or not at all.
- Septic shock: Symptoms of sepsis and severe sepsis, plus dangerously low blood pressure, which can cause organ damage and even death.
But these days, doctors diagnose the condition on a more flexible scale. On one end is a bacterial infection in your blood, and on the other end is septic shock. Your condition can fall anywhere between those two depending on your symptoms and how severe they are.
Infections can begin anywhere bacteria, parasites, fungi, or viruses enter your body. In people who are hospitalized, germs may enter through IV lines, surgical wounds, urinary catheters (tubes that connect to the bladder to help you pee), and bed sores.
Common infections that cause sepsis are:
- Urinary tract infections
- Infection in your appendix (appendicitis)
- Abdominal infection
- Infections of the liver or gallbladder
- Brain or spinal cord infections
What is the most common cause of sepsis?
For most people, a bacterial infection causes sepsis.
What bacteria causes sepsis?
Staphylococcus aureus (S. aureus), Streptococcus pyogenes (S. pyogenes), Klebsiella spp., Escherichia coli (E. coli), and Pseudomonas aeruginosa (P. aeruginosa) all cause sepsis.
This is a life-threatening condition that causes your entire body to react to an infection. It happens when you're both low on neutrophils ( a type of white blood cell) and have an infection. Doctors also call the condition febrile neutropenia.
Is sepsis contagious?
No. But you can spread some infections that are triggered by sepsis.
Sepsis Risk Factors
You are more likely to get sepsis if you:
- Have a weakened immune system
- Have health issues such as cancer, diabetes, lung disease, or kidney disease
- Are pregnant
- Have had sepsis before
- Are over 65, especially if you have other health problems
- Were recently hospitalized for severe illness or had surgery
- Use catheters or breathing tubes
- Have had treatment with antibiotics in the past 3 months
- Have severe injuries, such as large burns or wounds
Neonatal sepsis can happen when a baby is less than 28 days old and an infection enters their bloodstream. A baby who is diagnosed within 72 hours of being born has early-onset neonatal sepsis. When a baby is diagnosed after 72 hours of being born, they have late-onset neonatal sepsis. Early-onset sepsis can happen when an infection is passed from mother to baby in the womb or as a baby passes through the mother's vagina during birth. In late-onset sepsis, a baby might contract an infection from the environment after being born.
Neonatal sepsis is still a major cause of infant death globally, but with early diagnosis and treatment, most babies completely recover from it.
Sepsis symptoms are a result of very low blood pressure and low blood flow to organs. You might have:
- Fever and chills
- Rapid breathing
- Trouble breathing
- Very low body temperature
- Peeing less than usual or not at all
- Fast heartbeat
- Nausea and vomiting
- Fatigue or weakness
- Severe pain
- Skin rash
- Slurred speech
- Skin, lips, or tongue are blue, grey, pale, or blotchy (on brown or black skin, this may be more visible on the palms of your hands or soles of your feet)
Septic shock is the most severe risk of sepsis. It happens when your blood pressure drops dangerously low. If you have septic shock, you may:
Have difficulty standing up
Feel extremely sleepy and have difficulty staying awake
Have extreme confusion or other problems with thinking
When you have sepsis, it's likely that you'll form what's called a hemorrhagic rash. It's a group of small blood spots that resemble pinpricks. They'll continue to get bigger if you don't treat them, eventually looking like bruises.
Your doctor will do a physical exam and run tests, such as blood tests and imaging tests.
Blood tests look for:
- Signs of infection
- Problems with how your blood clots
- Unbalanced levels of electrolytes
- Kidney or liver problems
- Low blood oxygen
Your doctor might order other lab tests to examine:
- Your pee (urinalysis)
- Liquid from a wound
- Mucus from your respiratory tract
If those tests aren't enough for your doctor to make a diagnosis, they might order imaging tests, such as:
Doctors will look for at least 2 of the following criteria to make a sepsis diagnosis:
- Temperature higher than 100.4°F or less than 96.8°F
- Heart rate faster than 90 beats per minute
- Respiratory rate greater than 20 breaths per minute or partial pressure of carbon dioxide less than 32 mm Hg
- White blood cell count greater than 12,000 per μL (12 × 109 per L), less than 4,000 per μL (4 × 109 per L), or greater than 10% immature forms.
Sepsis SOFA score
The Sequential Organ Failure Assessment (SOFA) score helps doctors to make a diagnosis of sepsis. They look for 2 out of 3 criteria:
- A respiratory rate of 22 breaths per minute or more
- A change in mental status
- Systolic blood pressure of 100 or less.
Your doctor will probably keep you in the hospital's intensive care unit (ICU). Your medical team will try to stop the infection, keep your organs working, and manage your blood pressure.
Some treatments you might get are:
- Intravenous (IV) fluids
- Extra oxygen
- Vasopressor medication (to narrow your blood vessels and raise your blood pressure)
- Insulin to control your blood sugar
- A breathing machine (ventilator)
- Dialysis to help your kidneys work better
- Surgery to drain or clean out an infection
As sepsis gets worse, it causes more problems throughout your body. These may include:
- Kidney failure
- Dead tissue (gangrene) in your fingers and toes, which may need surgical removal (amputation)
- Permanent damage to the lungs, brain, and heart
- A higher risk of future infections
- 30% to 40% chance of death if you have septic shock
After sepsis treatment, there is a chance you could experience long-term effects. This is called post-sepsis syndrome (PSS). Problems can last for years after having sepsis and may include:
- Organ damage
- Joint and muscle pain
- Muscle loss
- Kidney disease
- Difficulty learning, remembering, concentrating, and making decisions
- Fatigue and weakness
- Increased risk of heart problems
Preventing infection is the best way to prevent sepsis. Take these steps:
- Wash your hands often with soap and water for at least 20 seconds.
- Get recommended vaccines for things like flu and chickenpox.
- Keep up with treatment for chronic health conditions.
- Clean a skin wound as soon as possible. Keep it clean and covered as it heals, and watch for signs of infection.
- Treat any infections. Get medical care right away if they don't get better or if they seem like they're getting worse.
Sepsis is a severe body response to infection, which causes the immune system to attack tissues and leads to inflammation and potential organ damage. It can advance to septic shock with dangerously low blood pressure and organ failure. Common causes of sepsis include pneumonia, urinary tract infections, and abdominal infections. Treatment in the ICU focuses on stopping the infection, supporting organ function, and managing blood pressure.
Can a person recover from sepsis?
If your doctor quickly diagnoses sepsis and you get treatment, it's likely that you'll survive.
How long can you survive with sepsis?
If you have septic shock, it can cause death as soon as 12 hours after you get it. There are different ranges for how long you can expect to live after surviving sepsis, but usually, more than half of all sepsis survivors lose their lives within five years.
Can you be discharged from the hospital with sepsis?
After your initial recovery, you could continue to manage the condition at home. This may involve taking medication and watching for physical and mental symptoms that call for a doctor's visit.
What’s the "golden hour" of sepsis?
These are guidelines that direct health care professionals to treat life-threatening sepsis within 1 hour after diagnosis.