Alternate Names: Septic shock; Systemic inflammatory response syndrome (SIRS)

Causes and Risks:

Sepsis occurs in 2 of every 100 hospital admissions. It is a result of a bacterial infection that can originate anywhere in the body. Common sites are the kidneys (upper urinary tract infection), the liver or gall bladder, the bowel (usually seen with peritonitis), the skin (cellulitis) and the lungs (bacterial pneumonia).

Meningitis may also be accompanied by sepsis. In children, sepsis may accompany infection of the bone (osteomyelitis). In hospitalized patients, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as decubitus ulcers or bedsores.

The infection is often confirmed by a positive blood culture, though blood cultures may be negative in individuals who have been receiving antibiotics. In sepsis, blood pressure drops resulting in shock. Major organ systems, including the kidneys, liver, lungs, and central nervous system, stop functioning normally. A change in mental status and hyperventilation may be the earliest signs of impending sepsis.

Sepsis is often life-threatening, especially in people with a weakened immune system or other medical illnesses.

Prevention: Many cases are not preventable. Awareness of risk may allow earlier detection.

Symptoms:

• Fever or hypothermia (low body temperature)
• Hyperventilation
• Chills
• Shaking
• Warm skin
• Skin rash
• Rapid heart beat (tachycardia)
• Confusion or delirium
• Decreased urine output

Signs and Tests:

• White blood cell count that is low or high
• Platelet count is often low
• Blood culture that is positive for bacteria
• Blood gases that reveal acidosis
• Kidney function tests often become abnormal early in the course of disease

• Peripheral smear may demonstrate a low platelet count and destruction of red blood cells
• Fibrin degradation products are often elevated, a condition that may be associated with a tendency to bleed
• Blood differential, with immature white blood cells seen

Treatment:

Individuals frequently require monitoring in an intensive care unit setting. "Broad spectrum" intravenous antibiotic therapy should be initiated as soon as the diagnosis is suspected.

The number of antibiotics administered may be decreased when the results of blood cultures become available. The source of the infection should be identified if possible, which may mean further diagnostic testing. Sources such as infected intravenous lines or surgical drains can be removed, and sources such as abscesses can be surgically drained.

Supportive therapy with oxygen, intravenous fluids, and medications that increase blood pressure may be required for a good outcome. In the event of kidney failure, dialysis may be necessary, and mechanical ventilation is often required if respiratory failure occurs.

Prognosis: The death rate can be as high as 60% for people with underlying medical problems. Mortality is less (but still significant) in individuals without other medical problems.

Complications:

• Septic shock
• Impaired blood flow to vital organs (brain, heart, kidneys)
• Disseminated intravascular coagulation

Call your health care provider if symptoms of sepsis occur. This condition can rapidly progress to become an emergency situation.