Why aren’t ALL doctors trained to spot killer that claims 37,000 lives a year?
The infection that all but killed Anna Tilley, 26, three years ago couldn’t have started more innocuously. On a Monday in June 2012, the mother of two children, aged five and two, developed a sore throat. By the Tuesday, she was hot and achy, was vomiting and had diarrhoea. Over the next two days, two GPs reassured her she’d get over it soon.
‘One told me there was stomach bugs and flu going round — and I’d just been unlucky to get both,’ says Anna, an office administrator from West Sussex. ‘It seemed a reasonable diagnosis.’
But three days after she became ill, she was feeling much worse. When she phoned again to explain that she couldn’t keep down liquid, another GP prescribed anti-sickness tablets to be picked up from the pharmacy.
‘That night I couldn’t sleep, and I found myself drawn to my little boy harry’s bed,’ says Anna. ‘I remember sitting there for hours staring at him. I didn’t put my thoughts into words, but it was as though I knew I was dying.’
The next day, she’d come out in a rash and was having trouble breathing.
‘My mum drove me to the GP surgery, where I passed out for a few minutes.’
even then, her doctors remained sanguine. ‘My mum had to insist that they call an ambulance.’
At A&e, they still didn’t know what was wrong with her. ‘One doctor asked my mum to phone work to see if there had been any health scares. I remember hearing the team through the curtains, talking about what to do and whether to discharge me.’ Then came the moment that saved Anna’s life. A junior anaesthetist who happened to be passing by was asked for his opinion. he said: ‘It’s sepsis. I’ve just treated a young teenage girl with the same thing.
‘She needs to be transferred to intensive care and to get fluids and antibiotics immediately.’
Sepsis is one of the greatest — and possibly least well-known — health threats we face. It can be triggered by any bacterial or viral infection and causes the immune system to go into overdrive.
EVERY year, more than 100,000 people are admitted to hospital with sepsis and around 37,000 die — more than the number of deaths from breast cancer and bowel cancer combined.
The sepsis death rate ‘ makes even the horrific death toll from hospital acquired infections — 5,000 every year — pale into insignificance,’ says Dr Ron Daniels, consultant in critical care and anaesthesia at heart of england nhS Trust and chair of the charity the UK Sepsis Trust.
It can affect anyone from newborns to the elderly to hearty twenty-somethings following something as apparently harmless as a scratch or flu. It’s also relatively common after childbirth or surgery.
every hour that it goes untreated raises the risk of death by 8 per cent. One in five of those who do survive are left with long-term damage to organs such as the kidneys, lungs and the liver.
Sepsis starts innocuously enough with the immune system recognising invading bacteria and mounting its normal response.
‘If you cut a finger, the skin around it swells up and becomes hot and tender,’ says Fiona Lawrence, a senior nurse at heart of england Foundation Trust.
‘That’s the immune cells releasing signalling proteins called cytokines that help the body to overcome the invading bacteria.’
But with sepsis, for reasons not understood, the immune system goes into overdrive, releasing far more cytokines than needed.
‘All the extra immune molecules surging through the bloodstream are hugely damaging,’ says Lawrence. ‘They cause the blood vessels to slacken, thereby reducing blood pressure.
‘And there’s widespread inflammation causing swelling in the tissue surrounding the blood vessels, while the blood itself clots in the smallest vessels, preventing oxygen from reaching major organs. A key symptom is that you can feel as though you are dying.’
At that point, severe sepsis or septic shock kicks in: the heart is unable to supply the body’s cells, kidneys and other organs with oxygen, and blood pressure cannot be raised even with large amounts of intravenous fluids and drugs.
Treatment for sepsis is a combination of antibiotics to get rid of the infection, drugs to counteract the drop in blood pressure and, if necessary, a ventilator to raise oxygen levels. Unfortunately, it sometimes doesn’t work.
‘Sepsis consistently kills as many as one in three people who get prompt treatment in modern hospitals with antibiotics that should be effective,’ says Jon Cohen, professor of infectious diseases at Brighton & Sussex Medical School. he recently co- authored a paper in the journal Lancet Infectious Diseases calling on universities and the pharmaceutical industry to carry on the search for anti-sepsis medication and thereby improve diagnosis and treatment.
‘Sepsis is an immune function problem — and that’s why research into drug treatments must continue,’ says Professor Cohen.
BUT while effective new drugs could make a huge difference, experts are furious about the failure to get to the root of the problem: the fact that only around one in three people with severe sepsis or septic shock get the basic treatment that could save their life within the safe timescale of one hour.
‘If we had a similar record with getting heart attack patients to a specialist cardiac centre there would be uproar,’ says Dr Daniels.
The issue is a lack of awareness of sepsis and the damage it wreaks. Six out of ten people have never heard the term sepsis, according to a recent YouGov poll of 2,000 people for the Sepsis Trust, and eight out of ten don’t realise it’s a medical emergency.
even doctors may not be much better informed. ‘ They learn about sepsis in medical school, but they can easily miss early signs — high temperature, high pulse rate, chills, low blood pressure, confusion, light-headedness — because they mimic other disorders,’ says Dr Julian hull, an nhS consultant in intensive care medicine, and trustee of the UK Sepsis Trust.
There’s also a lack of clarity on what to do if sepsis is suspected. Dr Daniels has led the development of the ‘Sepsis 6 bundle’: six actions that if taken in the first hour that someone is suspected of having sepsis can double their chance of survival.
It includes blood tests, administering antibiotics and giving fluids to protect organs and low blood pressure — as well as measuring urine produced every hour (to check if more fluids are needed).
But getting the treatment quickly is key. The Sepsis Trust slogan summarises this priority: ‘Suspect sepsis. Say sepsis. Save someone’s life today.’
At the beginning of 2015, health Secretary Jeremy hunt said that hospitals that fail to tackle sepsis will be financially penalised, and announced a national education and awareness programme aimed at healthcare workers and the public.
Anna Tilley has since contacted the young anaesthetist who diagnosed her to thank him.
‘That young doctor saved my life just by suggesting that I had sepsis,’ she says.
‘I was taken to intensive care where I was put on a drip and pumped full of antibiotics. If I had gone to sleep that night, I would almost certainly have gone into a coma and not woken up again.’
sepsistrust.org