Don't Let Severe Infection Take Over Your Body!
According to the National Institutes of Health (NIH), severe sepsis strikes about 750,000 Americans every year, and the estimated death rate among those stricken with severe sepsis is greater than the number of annual deaths from prostate cancer, breast cancer and AIDS combined. Yet most Americans don't even know what sepsis is.
"Sepsis is a potentially life-threatening condition which occurs when the body has a severe infection coupled with an overly robust or 'dysregulated' immune response to that infection," says Dr. Daniel Sweeney, a specialist in critical care medicine and infectious disease on the medical staff at Washington Hospital.
"The immune system releases molecules into the blood to combat infections," he explains. "It is believed that an overload of those molecules can cause widespread inflammation and impaired blood flow that damages the body's organs. There are basically three degrees of the condition, starting with sepsis and progressing through severe sepsis to septic shock."
Sepsis can progress rapidly. If the condition becomes severe, the patient can experience failure of one or more organs. The body's blood pressure can drop dramatically, sending the patient into septic shock, at which point multiple organs may fail and the patient can die.
"Anyone can get sepsis, but it is important to understand who is more likely to get it, and which patients are more likely to die," says Dr. Sweeney. "The elderly, infants and people who have weak immune systems or are undergoing chemotherapy are most vulnerable. People with diabetes or cancer or chronic illnesses such as kidney, lung or liver disease also are at increased risk."
Any type of infection can lead to sepsis. Pneumonia and urinary tract infections are the most common causes of sepsis. Other common sources of sepsis are infections of the gastrointestinal tract and central nervous system infections such as meningitis. Even a person with an infected wound can develop sepsis, which is a special concern with patients who have diabetes because they may have poor blood circulation and an increased risk of non-healing wounds.
"Early diagnosis and treatment is as important in saving lives for people with sepsis as it is for victims of heart attacks and strokes," Dr. Sweeney asserts. "That's why it's important for people to be aware of the causes, risk factors and symptoms of sepsis."
To help people in the community learn more about sepsis, Washington Hospital is sponsoring a free seminar on the topic on Tuesday, May 13 from 1 to 3 p.m. The seminar will feature presentations by Dr. Sweeney and Dr. Kadeer Halimi, an emergency medicine specialist on staff in the Emergency Department at Washington Hospital. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium at the Washington West Building, 2500 Mowry Avenue in Fremont.
Sepsis usually presents a constellation of symptoms that might include a fever above 101.3¼ F or, conversely, a body temperature below 95? F; chills and shaking; rapid or difficult breathing; a fast heart rate higher than 90 beats per minute; confusion or disorientation; low blood pressure, and a probable or confirmed infection.
"Some symptoms of sepsis can be a sign of other conditions, which can make it difficult to diagnose sepsis in the early stages," notes Dr. Sweeney, who has conducted preclinical research in sepsis.
"If a patient is having severe chest pain, it's fairly obvious that it could be a heart attack," he observes. "Or, if a patient is experiencing sudden arm or leg weakness and/or slurred speech, it's highly likely the patient is having a stroke. But with sepsis, we have to evaluate a combination of more vague or nonspecific symptoms, and they can vary from case to case. For example, many - if not most - patients with sepsis will have a fever, but this not always the case. In fact, some patients with sepsis actually can have an abnormally low body temperature. The symptoms also can vary depending on the original source of infection."
Many sepsis cases are first encountered in hospital emergency rooms.
"When a patient in the ER shows signs of sepsis, and we know the person has a chronic condition, we are very vigilant," Dr. Halimi says. "Sometimes, though, we are surprised to see sepsis in people who are generally quite healthy. Recently, for example, we saw a 34-year-old patient with symptoms of a respiratory infection that turned out to be a serious case of influenza. He had no other risk factors for developing sepsis, yet he quickly went into full-blown sepsis."
If sepsis is suspected, blood tests can be used to evaluate a number of factors that are common with sepsis:
* A high white blood cell count indicating infection.
* A low red blood cell count (anemia).
* Various chemicals in the blood that may be evidence of poor liver or kidney function caused by organ failure.
* An abnormally high blood level of lactate, an acid that is produced when oxygen levels in the body drop.
* Blood clots.
"We also use blood tests to figure out what types of bacteria are growing in the body and which antibiotics are appropriate to treat the specific underlying infections," Halimi says.
Other tests might include urine analysis for urinary tract infections, mucus sample testing for respiratory infections or sampling of wound secretions in infected wounds. If the original site of infection is not obvious, the doctor may order diagnostic imaging tests such as X-rays, computerized tomography (CT) scans, ultrasound or magnetic resonance imaging (MRI).
Early Treatment Is Key
"In patients with suspected sepsis, we may start treatment right away with intravenous fluids to raise the patient's blood pressure and broad-spectrum antibiotics that kill many types of bacteria," says Dr. Halimi. "Timing is of upmost importance, and we generally have to initiate therapy as soon as possible, administering fluids and antibiotics within three hours."
After initial treatment in the ER, sepsis patients generally are admitted to the Intensive Care Unit (ICU) or to medical wards or for continued care. After learning the results of blood testing, the physician may switch the patient from a broad-spectrum antibiotic to one that is specifically effective against the particular bacteria causing the infection.
If the patient's blood pressure remains too low, even after receiving IV fluids, the doctor may order a vasopressor medication to constrict the blood vessels and help increase blood pressure. Other medications to treat sepsis patients might include corticosteroids to control inflammation, insulin to maintain stable blood sugar levels, and drugs that modify the immune system's responses.
Some patients with severe sepsis-related problems may require additional treatment such as a ventilator to help them breathe or dialysis for kidney failure. Surgery may be needed to remove abscesses (collections of pus) or other local sites of infection. Patients also may require ongoing treatment for underlying conditions such as diabetes.
Working to Reduce Sepsis Mortality
Washington Hospital has taken an aggressive approach to reducing the number of deaths due to sepsis, focusing especially on efforts in the ER and ICU, developing protocols and instructing staff to recognize the signs of sepsis and treat it aggressively.
"We have a standard protocol of screening for sepsis in every patient who is admitted to the hospital," says Dr. Halimi. "That even includes patients who are admitted for a surgical procedure, whether or not they show any signs of infection."
The hospital also works in partnership with other organizations to promote better management of patients with severe sepsis.
"Most recently, we just completed a study in collaboration with Highland Hospital to evaluate how we can teach paramedics to assess patients for sepsis while they are on the way to the ER," Dr. Halimi says. "We want to train paramedics to begin treating patients who may have sepsis right away with fluids to stabilize their blood pressure and cooling measures to reduce fevers. We also want to establish a 'code sepsis' warning for paramedics to promptly alert the receiving hospital that the incoming patient may have sepsis."
Dr. Halimi says that not all people who think they might have early sepsis need to rush to the ER, however.
"Most primary care physicians should be aware of the symptoms of sepsis, and they usually know their patients well, including their medications and any chronic conditions," he says. "If you have any reason to suspect sepsis, you might want to call your primary care provider or advice nurse first before rushing to the hospital. It really is important to catch sepsis early, though. I tell patients that they know their own bodies better than anyone else. If you get a cough or cold, and it continues to get worse instead of better, see your doctor. And people with chronic conditions or other risk factors for sepsis need to be even more aware."
To register for the upcoming seminar at on sepsis at Washington Hospital on May 13, visit www.whhs.com/event/class-registration. For more information about sepsis, visit the Sepsis Alliance Web site at www.sepsisalliance.org.