Dr. Bindu S. Mayi

Sepsis

At least 1.7 million people in the U.S. are diagnosed with sepsis each year and 258,000 die from it – more than from prostate cancer, breast cancer and AIDS combined.

Over 75,000 children in the U.S. develop sepsis every year, and almost 7,000 of these children die – more than from childhood cancers!

Sepsis can also be a problem for pregnant women and is among the top three causes of death in new mothers in the time surrounding childbirth. 

Just this year in the U.S., a five year old little girl, a 32 year old woman who had just given birth to her third child and a 54 year old former Wimbledon doubles champion, all died from sepsis. Sadly, thousands more have died from sepsis.

Can YOU get sepsis?

Any one of us can get sepsis. This life threatening condition starts with an infection that could begin anywhere in the body and continues to get worse, ultimately reaching the bloodstream. The patient’s immune reactions in combination with the infection itself, creates an excessive, ineffective and damaging scenario. If undiagnosed and untreated, the outcome is falling blood pressure, failing organs and ultimately death.

Real life STORIES.

Eleven year old Zachary Doubek’s ordeal started right after playing a double header baseball game. What started as a painful knee at the game turned into a limp the next day and two days later into a life threatening condition called sepsis. When Zach asked his mother about a flying water bottle she recognized his delirium and rushed him to the ER. Zach had a MRSA infection that had spread from his knee and into his blood. Luckily, this young boy survived, although it took six surgeries and a month long hospital stay before he could be released for an additional 8 weeks of rehab to regain his mobility and strength. For any of us, including young student athletes such as Zach, a red flag can be a part of the body that is red, swollen, warm to touch and painful. Such a person should see the doctor immediately. It is also common to mistake a MRSA infection for a spider bite. A spider bite doesn’t fill with pus, while a MRSA infection can, but not always, as in the case of Zach. If the area is filled with pus, cover it up with a Band-Aid or dressing, wash your hands and then see your doctor. Signs of fever point to the seriousness of the situation. The sooner you recognize the signs, the earlier you can get the help you need. This means you may even stop MRSA from reaching the bone, which will take much longer treatment and perhaps even surgeries to resolve the infection.
To read more about Zachary Doubek’s story, click HERE.

Most common CAUSES.

In adults, the most common infections that can lead to sepsis are respiratory infections such as pneumonia, followed by kidney or urinary tract infections, followed by GI infections and skin infections.

What are symptoms of pneumonia?

  • Cough, fever, and difficulty breathing

It is the leading infectious cause of death in children younger than 5 years old worldwide.

Who is at higher risk of pneumonia?

  • Elderly individuals
  • Infants
  • Smokers
  • People with chronic conditions such as diabetes, cardiopulmonary conditions, heart disease etc.

What are symptoms of kidney or urinary tract infections?

  • Urinary tract infections, commonly called UTIs, can affect several parts of the urinary tract, the most common type of UTI being a bladder infection (this infection is also called cystitis). 
  • Less often, the infection spreads to the kidneys – this is called pyelonephritis and it is more serious.

Common symptoms for a bladder infection:

  • Urinating more frequently
  • Feeling the urge to urinate in spite of having an empty bladder
  • Pain or burning while urinating
  • Cloudy or bloody urine
  • Low grade fever (less than 101°F)
  • Pressure or cramping in the groin or lower abdomen

Common symptoms for a kidney infection: 

  • Flank or lower back pain
  • High fever (101°F or above)
  • Nausea or vomiting
  • Mental status changes
  • Chills or 
  • Night sweats

Reasons for UTIs in children:

  • A structural problem in the urinary tract 
  • Not urinating often enough 
  • Wiping from back to front after a bowel movement (In girls this may cause bacteria to enter the urinary tract)

Symptoms of UTIs in children:

  • Unexplained fever 
  • Urine that smells different
  • Urine that looks different
  • Vomiting
  • Fussiness 
  • Change in appetite

Who is at higher risk of getting UTIs?
Women and girls are at a higher risk compared to men and boys.

  • This is because the female urethra is shorter and closer to the anus, which makes it easier for bacteria to enter the urinary tract. 
  • It is very important to teach young girls to wipe front to back after a bowel movement and to be conscious and conscientious of any activity that can potentially move fecal bacteria from the area surrounding the area to the urinary tract.

The following are risk factors for UTIs:

  • Structural problems in young children
  • Sexual activity
  • Use of spermicides
  • A new sexual partner
  • A previous UTI
  • Pregnancy
  • Kidney stones
  • Prostate enlargement
  • Older age 
  • Urinary incontinence
  • Menopause 
  • Reduced mobility due to surgery or prolonged bedrest
  • Urinary catheter placement

What are symptoms of GI infections?
The most common symptoms may be:

  • An upset stomach
  • Stomach cramps
  • Nausea
  • Vomiting
  • Diarrhea
  • Fever

Most of the time, the illness lasts a few hours to a few days. Hospitalization occurs when the person gets severely dehydrated or the infection becomes severe and needs to be treated. For example, the notorious E. coli O157:H7 bacterium can cause hemolytic uremic syndrome (HUS), which can cause kidney failure and even death.

Who is at high risk of severe GI infections?

  • Infants
  • Elderly
  • Immunocompromised individuals (i.e. weak immune system)
  • Pregnant women
  • Individuals who travel to countries that are overcrowded and with poor hygiene and sanitation

What are symptoms of skin infections?

  • A part of the body that is red, swollen, warm to touch, and painful
  • Fever indicates enhanced seriousness of the infection
  • It is common to mistake a MRSA infection for a spider bite. However, a spider bite does not typically fill with pus, while a MRSA infection usually does.

What puts you at high risk of skin infections?

  • Disruption to the skin barrier due to insect bites, cuts, scrapes, penetrating wounds, or injection drug use
  • Trauma from accidents, hurricanes, earthquakes, war or other mass-casualty conditions
  • Burns
  • Surgical and postpartum wound infections
  • Circumcision in the newborn
  • Skin inflammation due to eczema or radiation therapy
  • Another skin infection such as impetigo or tinea pedis
  • Varicella (chicken pox) 
  • Blunt trauma
  • Edema (due to venous insufficiency)
  • Breaks in the skin between the toes (“toe web intertrigo”) 
  • Diabetes
  • Immunocompromised conditions

These signs are common in many other conditions, making diagnosis of sepsis very tricky. An alert healthcare provider or family member will be key to early diagnosis. Sepsis progresses rapidly and can kill within the day. Even an hour of delayed treatment can increase risk of death by 8%!

How do you DIAGNOSE sepsis?

Remember that it is an underlying infection that has gone undiagnosed and untreated, which leads to sepsis. 
Diagnosis is done using the following: 

  • Symptoms 
  • Abnormal number of white blood cells in blood or 
  • Presence of infectious agents in blood 
  • Chest X-ray or a CT scan to help locate the underlying infection
  • Special tests such as
    • Vidas Brahms PCT Assay
      • Treatment decisions should NOT rely solely on PCT test results
      • Test results should be interpreted along with patient’s clinical status and other lab results
    • T2Bacteria Panel
      • Any antibiotics already in the patient’s bloodstream will not interfere with this test
      • Takes ~5 hours to run this test and get results back
      • More than 2.5 days faster than traditional, blood culture-dependent tests 
    • Newer tests that when FDA approved will identify the infectious agent AND any potential antibiotic resistance – allowing us to administer the right, narrow spectrum antibiotic early in treatment.

In addition to symptoms, other clues may be:

  • “Something just doesn’t seem right” in a patient with a seemingly routine infection or suspected infection
  • Tachypnea (higher breathing rate) with a clear chest and normal oxygenation (indicating lack of respiratory problems)
  • Blood lactate levels > 2 mmol/L in patients with suspected sepsis but normal or mildly abnormal vital signs

What is sepsis TREATMENT?
Sepsis is the most expensive condition treated in U.S. hospitals: bill close to $24 billion in 2013.
Sepsis treatment is expensive due to the need for

  • complex therapies that are expensive 
  • antibiotics to treat the infection
  • vasopressors to get blood flowing through the veins and arteries again 
  • fluid resuscitation to that the organs in the body get adequate fluids and nutrients again

In addition, depending on the underlying infection that led to sepsis, patient may also need

  • a mechanical ventilator to help with breathing, or
  • kidney dialysis 
  • maybe even a fecal transplant
  • an experimental strategy only so far tested on 2 elderly patients 

Management of above therapies necessitates a prolonged stay in hospital ICU, which is also expensive.

Are there sequelae that sepsis patients suffer from? 

  • YES. 
  • Survivors often have long-term physical, psychological, and cognitive disabilities, which in turn have to be treated appropriately.
  • A research study (JAMA Psychiatry 2016) suggests a link between sepsis and development of psychiatric disorders and suicidal behavior. 
  • We need large-scale studies to investigate the effects of infection on risks of suicide.

How do you PREVENT sepsis?

Manage chronic conditions so they don’t make the patient vulnerable to infections.

Engage in basic infection prevention steps such as

  • Hand hygiene
  • Covering cuts and scrapes, until healed

Pay attention to

  • Food safety
  • Stop smoking
  • Early diagnosis of infections
  • Early treatment of bloodstream infections to prevent progression to sepsis
  • Vaccinate with age-appropriate vaccines
    • To look at the CDC recommendations for vaccination schedules:
      • Click HERE for childhood (birth to 18 years) vaccines
      • Click HERE for adult (19 – 64 years) vaccines
      • Click HERE for elderly (65 years and older) vaccines 

Pregnant women should receive an inactivated flu vaccine as well as the Tdap vaccine (for protection against tetanus, diphtheria and pertussis). Pregnant women and infants are at high risk of experiencing severe flu.