Overwhelmed by toxins
Sepsis is a life-threatening condition in which the body is fighting a severe infection that has spread via the bloodstream.
World Sepsis Day (Sept 13) is a global initiative to raise awareness of sepsis, a leading cause of death and disability for millions every year.
SEPSIS is a global healthcare problem. Globally, 20 to 30 million patients are estimated to be affected every year.
It is a life-threatening medical condition that arises when the body’s attempt to fight an infection results in the immune system damaging tissues and organs.
It is more common than a heart attack and claims more lives than any cancer, yet even in the most developed countries, fewer than half of the adult population have heard of it.
In the least developed countries, sepsis remains a leading cause of death overall. And it remains the primary cause of death from infection despite advances in modern medicine like vaccines, antibiotics and intensive care.
Globally, the number of hospital admissions for sepsis following healthcare-associated, as well as community-acquired, infections has increased over the last decade.
The reason for the rise in cases is likely due to a combination of factors, including poor socioeconomic conditions, an ageing population with more chronic diseases, an increase in major surgical interventions and invasive procedures, broader use of immunosuppressive and chemotherapeutic agents, as well as the spread of antibioticresistant organisms.
Causes of sepsis
Sepsis is always triggered by an infection. Although bacteria are by far the most common causative microorganisms, others include fungi, viruses and parasites.
Sepsis occurs as a result of infections acquired both in the community, and in hospitals and other healthcare facilities. The majority of cases are caused by infections we all know about: pneumonia, urinary tract infections, skin infections like cellulitis and infections in the abdomen like appendicitis.
Invasive medical procedures like the insertion of a catheter into a blood vessel can also introduce bacteria into the blood and trigger sepsis.
When infection occurs, the body’s immune system is triggered to fight the invading organisms.
Sepsis is best thought of as this process in overdrive: inflammation is no longer localised to the site of infection, but is now widespread affecting all of the body’s organs and tissues.
This chaotic response causes widespread inflammation, leaky blood vessels and abnormal blood clotting, resulting in organ damage.
In severe cases, blood pressure drops, multiple organ failure ensues, and the patient can die rapidly from septic shock.
Patients vary in their response; the severity of sepsis and the speed with which it progresses are affected by their genetic characteristics and the presence of coexisting illnesses, as well as the numbers and virulence of the infecting microorganism.
Some patients seem not to deteriorate until late in their illness; in others, sepsis progresses rapidly and can be fatal within a few hours.
Sepsis is the final common pathway in the vast majority of deaths from infection worldwide.
Who gets sepsis?
Sepsis does not discriminate and it affects all age groups.
Vulnerable groups such as newborn babies, small children and the elderly are most at risk, as are those with chronic disease and weakened immune systems.
It is not a disease confined to healthcare settings, although most patients with established sepsis will be cared for in hospital.
People with chronic illnesses, such as diabetes, cancer, AIDS, kidney or liver disease, are also at increased risk, as are pregnant women and those who have experienced severe burns or physical injuries.
The diagnosis and treatment of sepsis is often delayed because early symptoms may not be recognised by patients, healthcare workers or physicians.
A common feature of patients with sepsis is that they feel sick as never before. In children and elderly people, the signs and symptoms may be subtle and deterioration can be rapid.
The most common warning signs of sepsis are fever, chills, rapid heart rate, difficulty in breathing, rapid breathing, low blood pressure, change in behaviour (confusion, drowsiness), and changes in skin colour.
The clinical manifestations of sepsis are variable, depending on the site of infection, the causative microorganism, and the age and underlying health status of the patient.
Other early symptoms of sepsis can include severe headache, weakness, dehydration, fatigue, diarrhoea, nausea, vomiting, abdominal pain and unexplained bruising or bleeding.
Many of the symptoms of sepsis mimic other conditions, making it hard to diagnose in its early stages if physicians and healthcare workers are not adequately educated about sepsis.
How is sepsis treated?
Sepsis must be treated as an emergency. Many of these cases are admitted to the intensive care unit. Prompt recognition of the condition followed by the administration of intravenous fluids and antibiotics are key to survival.
The primary aims of treatment are to treat the infection and to maintain good blood flow to the vital organs.
The underlying infection is treated with either antibiotics, anti-virals, anti-fungals or a combination of agents, depending on the suspected causative organisms. If laboratory tests can identify the infectious organism, then the antimicrobial that specifically targets that organism will be administered.
Many patients receive oxygen and intravenous fluids to maintain blood oxygen levels and blood pressure.
In some cases, other drugs may be used to treat sepsis or to revive those who have gone into septic shock. Depending on the patient’s status, mechanical ventilation or kidney dialysis may be necessary.
Sometimes, surgery is required to clear a local site of infection that will not respond to antimicrobials alone.
Specific treatments that focus on the removal of microbial toxins from the bloodstream or aim to dampen the exaggerated immune response to sepsis have so far not yet been proven to be effective.
Many people who survive sepsis recover completely and their lives return to normal. However, patients who survive to hospital discharge after sepsis remain at increased risk for death in the following months and years.
Those who survive may have impaired physical or neurocognitive function, mood disorders and a low quality of life.
It is not known for certain how many people are affected by such problems, but it is likely to be at least one in five survivors.
There is also some evidence that an episode of sepsis disrupts a person’s immune system, making him or her more vulnerable to future infections.
Economic cost of sepsis
Early identification and treatment of sepsis will have tremendous economic benefits, apart from saving lives and reducing the negative impacts of sepsis.
Treatment for sepsis often involves a prolonged stay in the intensive care unit and complex therapies, which incur high costs.
The costs related to long-term impacts of sepsis have not been quantified, but are likely very substantial, including subsequent medical care. The true fiscal burden, considering delayed return to work, the need for families to adjust lifestyles, and rehabilitation costs is likely to be huge.
To stem the rising tide and take appropriate steps to ultimately reverse the increase in the numbers of deaths from sepsis, the global sepsis community is issuing a call of action to bring the tragedy of sepsis mortality to the attention of health policymakers at a national, regional and global level.
Last May, the 70th World Health Assembly made sepsis a global health priority, by adopting a resolution to improve, prevent, diagnose, and manage sepsis. This resolution marks a quantum leap in the global fight against sepsis.
Adapted by the Malaysian Society of Intensive Care from the World Sepsis Day factsheet by the Global Sepsis Alliance.