Sepsis refers to the body's systemic inflammatory response to infection. It is often seen in a patient with low blood pressure (hypotension), a rapid heart rate (tachycardia), and an abnormally high or low temperature in the context of a known active infection. Sepsis is considered a serious and possibly life-threatening phenomenon that warrants prompt treatment.
Causes
Sepsis commonly occurs as a result of bacterial infections, though fungal infections may rarely cause sepsis. Such pathogens induce sepsis when they are present in the bloodstream and come from many possible sources, including but not limited to pneumonia, kidney infection (pyelonephritis), peritonitis, bacterial endocarditis, wound infections, and bacterial meningitis. These infections may occur from the use of medical devices, such as urinary catheters, endotracheal tubes, intravenous catheters, and drainage tubes. Other factors that may contribute to sepsis include prior use of antibiotics creating bacterial resistance and a compromised immune system secondary to diabetes mellitus, corticosteroids, chemotherapy, and/or AIDS.
Pathophysiology
Typically, a local bacterial infection triggers the release of inflammatory mediators. This causes small arteries in the vicinity of the infection, a reaction that allows white blood cells to reach the pathogens more quickly. The mediators also induce other effects, such as fever and blood clotting.
In sepsis, this process occurs to a much greater degree because of bacteria in the blood (bacteremia) that constantly acts as a trigger. As a result of much dilation of small arteries, the blood pressure drops and the heart rate increases. It could be severe enough that certain organs become impaired due to inadequate blood flow (septic shock), including the kidneys, the heart, and the brain. Additionally, excessive blood clotting can deplete the clotting factors in the blood, which leads to spontaneous bleeding.
Treatment
Sepsis is treated in the intensive care unit. The first component of sepsis treatment is providing hemodynamic support. Intravenous fluids are given quickly to correct the blood pressure and, subsequently, the heart rate. If that is not enough, vasopressor medications are added to the regimen. Other supportive measures, such as oxygenation, must be provided as necessary.
Besides these immediate measures, the root of the problem, the infection itself, must be addressed. Antibiotics, often as combinations of multiple drugs, are given according to the possible pathogens involved. If the infection is an abscess, a collection of pathogens and fluid, it needs to be drained out through a procedure with a needle.
Final Words
Sepsis is the process that makes a person with infection appear very sick to doctors and the patient's loved ones. The importance of immediate medical attention cannot be overemphasized.
