America’s Costliest Reason for Hospitalization

Most Americans have never heard of sepsis, but the condition hospitalizes a million patients every year— more than heart attack and stroke hospitalizations combined— and is the nation’s costliest reason for hospitalization. Yet it’s hard to diagnose and many doctors don’t look for, let alone spot, the deadly condition. So what is it?

Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail.

If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death.

Anyone can develop sepsis, but it’s most common and most dangerous in older adults or those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival.

Many doctors view sepsis as a three-stage syndrome, starting with sepsis and progressing through severe sepsis to septic shock. The goal is to treat sepsis during its mild stage, before it becomes more dangerous.

Sepsis

To be diagnosed with sepsis, you must exhibit at least two of the following symptoms:

• Body temperature above 101 F (38.3 C) or below 96.8 F (36 C)
• Heart rate higher than 90 beats a minute
• Respiratory rate higher than 20 breaths a minute
• Probable or confirmed infection

Severe sepsis

Your diagnosis will be upgraded to severe sepsis if you also exhibit at least one of the following signs and symptoms, which indicate an organ may be failing:

• Significantly decreased urine output
• Abrupt change in mental status
• Decrease in platelet count
• Difficulty breathing
• Abnormal heart pumping function
• Abdominal pain

Septic shock

To be diagnosed with septic shock, you must have the signs and symptoms of severe sepsis — plus extremely low blood pressure that doesn’t adequately respond to simple fluid replacement.

When to see a doctor

Most often sepsis occurs in people who are hospitalized. People in the intensive care unit are especially vulnerable to developing infections, which can then lead to sepsis. If you get an infection or if you develop signs and symptoms of sepsis after surgery, hospitalization or an infection, seek medical care immediately.

Causes

While any type of infection — bacterial, viral or fungal — can lead to sepsis, the most likely varieties include:

• Pneumonia
• Abdominal infection
• Kidney infection
• Bloodstream infection (bacteremia)

Treatments and drugs

Early, aggressive treatment boosts your chances of surviving sepsis. People with severe sepsis require close monitoring and treatment in a hospital intensive care unit. If you have severe sepsis or septic shock, lifesaving measures may be needed to stabilize breathing and heart function.

Medications

A number of medications are used in treating sepsis. They include:

• Antibiotics. Treatment with antibiotics begins immediately — even before the infectious agent is identified. Initially you’ll receive broad-spectrum antibiotics, which are effective against a variety of bacteria. The antibiotics are administered intravenously (IV).

After learning the results of blood tests, your doctor may switch to a different antibiotic that’s more appropriate against the particular bacteria causing the infection.

• Vasopressors. If your blood pressure remains too low even      after receiving intravenous fluids, you may be given a vasopressor      medication, which constricts blood vessels and helps to increase blood      pressure.

Other medications you may receive include low doses of corticosteroids, insulin to help maintain stable blood sugar levels, drugs that modify the immune system responses, and painkillers or sedatives.

Supportive care

People with severe sepsis usually receive supportive care including oxygen and large amounts of intravenous fluids. Depending on your condition, you may need to have a machine help you breathe or another to provide dialysis for kidney failure.

Surgery

Surgery may be needed to remove sources of infection, such as collections of pus (abscesses).