What Is Sepsis?
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Medically reviewed by Michael Menna, DO
Sepsis is the body’s extreme physical response to infection or injury, causing a dangerous whole-body immune reaction (inflammatory response). Pregnant people, adults over 65, infants, and those with compromised immunity or chronic disease are at more risk of developing it. About 1.7 million people in the United States develop sepsis every year, leading to approximately 350,000 deaths.
The symptoms of sepsis vary based on severity and type. In some cases, it leads to septic shock, a potentially fatal condition in which blood pressure drops and multiple organ systems fail. Septic shock is a medical emergency that must be treated in the intensive care unit (ICU). Though this condition is challenging, in-hospital treatments can reverse the course of sepsis in many cases.
Sepsis Symptoms
Since sepsis is a whole-body inflammatory response, it can take many different shapes. The symptoms can resemble those of other infections or diseases, especially in their early course. They vary based on the location and type of infection or injury that’s causing the condition. The symptoms of sepsis include:
Fever
Chills
Sweaty, warm, or clammy skin
Rapid, shallow breathing
Shortness of breath
Weak pulse
Confusion, and/or disorientation
Severe lethargy (lack of energy) or agitation
Severe pain or discomfort, with the location dependent on the site of injury or infection
Rash, typically small patches of red or discolored skin
Difficulty urinating and/or a lack of urine
Whatever form it takes, sepsis is a medical emergency. Get immediate help and call 9-1-1 if you suspect you or a loved one has sepsis. Since this condition progresses rapidly, prompt medical attention is critical. In severe cases, or if untreated, this can lead to septic shock, which can cause:
Cardiac failure
Lasting organ and tissue damage
Organ failure in multiple systems, known as multi-organ dysfunction syndrome (MODS)
Dangerously low blood pressure
What Causes Sepsis?
Sepsis is a system-wide immune or inflammatory response triggered by an infection or traumatic injury. To defend the body, the immune system releases proteins, called cytokines, into the blood. In sepsis cases, the injury or infection is so severe that these chemicals spread and flood the system, causing what’s called a cytokine storm. This can result in blood clots and leaky vessels, which can damage tissues and organs.
A wide range of infections and medical conditions can cause sepsis, the most common of which are:
Bacterial infections: The most common cause of sepsis is infection of bacteria, primarily Staphylococcus aureus (staph), Escherichia coli (E. coli), and Streptococcus pyogenes (S. pyogenes).
Viruses: Sepsis can also be a response to a viral infection, such as influenza or COVID-19.
Post-surgery complications: Many cases of sepsis arise due to infection following surgery, or even a cut or wound.
Traumatic injury: Since injuries also trigger strong immune reactions, they can also set off sepsis.
Most commonly, however, sepsis is triggered by an infection of the urinary tract, lungs, kidneys, or stomach.
Risk Factors
The chances of developing sepsis increase if you have a weakened immune system. There are several risk factors for this condition:
Age over 65
Younger age, especially infancy
Diabetes
Lung disease
Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
Long-term antibiotic use
Recent surgery or infection
Recent organ or bone marrow transplant
Diagnosis
Since sepsis is a medical emergency, diagnosis of the condition occurs as you are being stabilized in the hospital. In addition to assessing your medical history and any test results, your healthcare provider may use the following several diagnostic tests:
Complete blood count (CBC): This panel of blood tests is used to count different types of white blood cells, liver function, and measure clotting ability. This helps support diagnosis and establish severity.
Serum lactate: This blood test measures the amount of lactic acid in your system, which is produced by your muscles and red blood cells; elevated levels can be a sign of sepsis.
Cultures and other tests: Additional tests, including blood, urine (urinalysis), saliva, or microscopic evaluation of samples from suspected sites of infection may be used to determine the underlying cause of the sepsis.
Arterial blood gas: This test measures the levels of oxygen and carbon dioxide in the blood. Low oxygen levels and high carbon dioxide levels can be a sign of sepsis.
Imaging: In some cases, healthcare providers may employ imaging techniques, such as chest X-ray or computerized tomography (CT) scan, to assess infection in the lungs.
Stages of Sepsis
Based on their evaluation, your healthcare will stage the disease:
Sepsis: The mildest form causes systemic inflammatory response syndrome (SIRS). This is defined by two of the following: a body temperature above 100.4º Fahrenheit (F) or below 96.8º F, heart rate above 90 beats per minute, rapid breathing (taking over 20 breaths a minute), white blood cell count above 12,000 per cubic milliliter (ml) or below 4,000.
Severe sepsis: Severe sepsis occurs when one or more organs are showing signs of damage; blood pressure drops dangerously low, and the lack of oxygen damages tissues in the body. Mental confusion, severe abdominal pain, muscle cramping, lethargy, and breathing difficulties result.
Septic shock: The most advanced and severe form of sepsis is septic shock. This is when, despite treatment, blood pressure remains dangerously low. This type can cause organ failure in multiple systems and can be fatal.
Treatments for Sepsis
As noted, sepsis is a medical emergency, with treatment typically taken on in the intensive care unit (ICU) of a hospital. The goals are three-fold: to stop the spread of infection, protect organs that are being damaged, and stop blood pressure from dropping. This involves several procedures.
Stabilizing Respiration
If you present with suspected sepsis, the first goal is to stabilize your breathing. Levels of oxygen in the blood and breathing are carefully monitored, and you’ll be placed on a respirator to ensure you’re at stable levels.
Establishing Venous Access
Alongside work to preserve breathing ability, healthcare providers will also work to gain access to your veins. This is done primarily by connecting a central venous catheter tube to major veins in your chest. This intravenous (IV) tube will be inserted into your vein and used to deliver specialized fluids and medications to your body.
Intravenous Fluids
Sepsis causes a loss of fluid and blood from the vessels, known as hypovolemia, which can lead to shock. The central venous catheter is used to deliver fluid and medications called vasopressors, which serve to raise blood pressure. The solutions used are typically either crystalloid—a kind of saline solution—or contain albumin, a protein produced in the liver.
Antibiotic Therapy
Using the IV, high doses of antibiotics or antimicrobial medicines are introduced to kill bacteria and fight off any infection. Specific approaches depend on the individual case, but if bacterial infection is suspected, healthcare providers use broad-spectrum antibiotics or combinations of them that can take on a wider range of cases. Antibiotics that may be used include:
Doribax (carbapenem)
Zosyn (piperacillin-tazobactam)
Firvanq (vancomycin)
Rocephin (ceftriaxone)
Claforan (cefotaxime)
Cephalexin (cephalosporin)
Primaxin (imipenem)
Merrem (meropenem)
If a fungus is causing sepsis, treatment depends on your underlying health factors as well as the type of infection. The following antifungal medications may be considered:
Diflucan (fluconazole)
Nizoral (ketoconazole)
Eraxis (anidulafungin)
Cancidas (caspofungin)
Mycamine (micafungin)
AmBisome (amphotericin B)
Related:When Would You Need Antibiotics?
Other Therapies
If initial treatments aren’t yielding results, several other medications may be attempted to stabilize blood pressure and reduce the inflammatory response:
Vasostrict (vasopressin)
Levophed (norepinephrine)
Adrenaclick or Epi-Pen (epinephrine)
Dobutrex (dobutamine)
Surgery
In severe cases, tissue and organ damage from sepsis can be so severe as to warrant surgery. This may mean amputation of an infected limb, or using methods to drain fluids from infected areas.
Prevention
At its core, preventing sepsis means maintaining good health, being vigilant about any chronic diseases or infections, and being aware of the signs and symptoms of the condition. Strategies for prevention include:
Keeping up to date on vaccinations
Washing your hands properly to prevent infection
Cleaning and covering any cuts you have on the skin
Seeking care for any chronic conditions you have
Knowing the signs and symptoms of sepsis
Seeking immediate, emergency care if you suspect you or a loved one has sepsis
Related Conditions
By its nature, sepsis is associated with a range of infections and injuries. In particular, conditions that affect immune responses often are comorbid, meaning they arise at the same time. The most common of these include:
Type 2 diabetes mellitus: A disease that affects the body’s ability to process sugars, diabetes mellitus has been found in 17% of sepsis cases.
Congestive heart failure: Congestive heart failure, in which the heart muscles aren’t pumping enough blood, can be triggered by changes in cardiac structure and function due to sepsis.
Cardiovascular conditions: Conditions affecting the health of arteries, including coronary artery disease (diseased arteries in the heart) and peripheral artery disease (diseased arteries in the rest of the body), and other cardiac issues are seen in 32% of sepsis cases.
End-stage renal disease: The systemic damage caused by sepsis can also cause kidneys to fail, known as end-stage renal disease, which has been found in approximately 23% of people hospitalized for sepsis.
Chronic obstructive pulmonary disease (COPD): COPD refers to a group of diseases affecting the lungs, including emphysema and chronic bronchitis; about one in five (20%) of those with sepsis experience this condition.
Dementia: Sepsis is also associated with dementia—a condition that impacts memory, thinking, and decision-making—and researchers found about 11.3% of people with sepsis have dementia.
Living With Sepsis
Depending on the individual case, and with prompt medical attention, sepsis can be effectively treated. Full recovery is expected for many people. However, this condition can progress rapidly; it’s fatal in 15% of sepsis cases without shock, which rises to 56% due to septic shock. Mortality due to sepsis can be impacted by the presence of other diseases.
Those who’ve had sepsis may also experience lingering effects, which may require additional care. These include:
Insomnia, a difficulty getting to or staying asleep
Panic attacks, hallucinations, and nightmares
Muscle and joint pain
Reduced cognitive (mental) function
Loss of self-esteem
Organ failure, especially kidney or lung problems
Loss of a limb (to prevent the spread of infection)
Those who have had sepsis treatment may have a reduced ability to take care of themselves. To promote recovery at home, there are several steps you can take:
Setting achievable goals for yourself, such as making sure you bathe or climb stairs independently
Prioritizing rest
Seeking support from family and friends
Keeping a journal logging your experiences, milestones, and feelings
Eating a well-balanced diet, which emphasizes carbohydrates, lean proteins, healthy fats, fruits, vegetables, and hydration
Try to incorporate regular physical activity and exercise into your lifestyle
Learning as much as you can about sepsis
Ensuring regular medical monitoring
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