Sepsis is a serious and potentially life-threatening condition that occurs when the body’s immune system overreacts to an infection. Sepsis can affect any organ or system in the body, causing inflammation, tissue damage, organ failure, and even death. According to the World Health Organization, sepsis affects more than 49 million people worldwide every year and causes 11 million deaths.
But what exactly happens when someone gets sepsis and how do you treat it? We asked four experts from Harvard Health Publishing and other reputable sources to share their insights on this topic.
Dr. Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
Dr. Shmerling explains that sepsis is not a specific disease, but a syndrome that results from a dysregulated immune response to an infection. He says that sepsis can be triggered by any type of infection, such as bacterial, viral, fungal, or parasitic, and that the most common sources of infection are the lungs, urinary tract, skin, and abdomen. He adds that some people are more vulnerable to sepsis than others, such as those who are elderly, have chronic diseases, have weakened immune systems, or have recently had surgery or trauma.
Dr. Shmerling says that the signs and symptoms of sepsis vary depending on the severity and the organs involved, but they may include fever, chills, rapid breathing, rapid heart rate, low blood pressure, confusion, altered mental status, reduced urine output, and skin rash. He warns that sepsis can quickly progress to septic shock, which is a life-threatening condition that causes dangerously low blood pressure, organ dysfunction, and tissue death.
Dr. Shmerling emphasizes that sepsis is a medical emergency that requires immediate treatment. He says that the main goals of treatment are to identify and treat the source of infection, to support the vital organs, and to prevent complications. He says that the treatment may include antibiotics, fluids, oxygen, vasopressors, steroids, blood transfusions, and mechanical ventilation. He also says that some patients may need surgery to remove infected or damaged tissue.
Dr. Shmerling advises that the best way to prevent sepsis is to prevent infections, by practicing good hygiene, getting vaccinated, and seeking medical attention for any signs of infection. He also recommends that people who are at high risk of sepsis should be aware of the warning signs and seek help as soon as possible.
Dr. Steven Q. Simpson, MD, Professor of Medicine and Director of the Medical Intensive Care Unit, University of Kansas Medical Center
Dr. Simpson agrees that sepsis is a complex and dynamic condition that involves a dysregulated immune response to an infection. He says that sepsis can cause a cascade of events that affect the blood vessels, the blood cells, the clotting system, and the organs. He says that sepsis can cause multiple organ dysfunction syndrome (MODS), which is the failure of two or more organs, such as the lungs, kidneys, liver, heart, brain, and skin.
Dr. Simpson says that the diagnosis of sepsis is based on a combination of clinical criteria, laboratory tests, and imaging studies. He says that the clinical criteria include the presence of infection, the systemic inflammatory response syndrome (SIRS), and the sequential organ failure assessment (SOFA) score. He says that the laboratory tests include blood cultures, lactate levels, procalcitonin levels, and inflammatory markers. He says that the imaging studies include chest x-rays, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).
Dr. Simpson says that the treatment of sepsis is guided by the Surviving Sepsis Campaign (SSC), which is a global initiative that provides evidence-based guidelines and best practices for the management of sepsis. He says that the SSC recommends a bundle of interventions that should be implemented within the first hour of recognition of sepsis, such as measuring lactate levels, obtaining blood cultures, administering broad-spectrum antibiotics, administering fluids, and administering vasopressors if needed. He says that the SSC also recommends monitoring the hemodynamics, the oxygenation, the renal function, and the source control of the infection.
Dr. Simpson says that the prognosis of sepsis depends on many factors, such as the age, the comorbidities, the type and severity of infection, the time to diagnosis and treatment, and the response to therapy. He says that the mortality rate of sepsis ranges from 10% to 50%, depending on the stage and the setting. He says that sepsis can also cause long-term complications, such as cognitive impairment, physical disability, and post-traumatic stress disorder.
Dr. Simpson says that the prevention of sepsis is a priority for public health and patient safety. He says that the prevention strategies include infection prevention and control, antimicrobial stewardship, sepsis awareness and education, early recognition and treatment, and quality improvement and research.
Dr. R. Phillip Dellinger, MD, Professor of Medicine and Senior Critical Care Attending, Cooper University Hospital
Dr. Dellinger defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. He says that sepsis can be classified into three stages: sepsis, severe sepsis, and septic shock. He says that sepsis is characterized by the presence of infection and organ dysfunction, severe sepsis is characterized by the presence of infection, organ dysfunction, and hypoperfusion, and septic shock is characterized by the presence of infection, organ dysfunction, hypoperfusion, and refractory hypotension.
Dr. Dellinger says that the pathophysiology of sepsis is complex and multifactorial, involving the interaction of the pathogen, the host, and the environment. He says that sepsis can trigger a series of inflammatory, immunological, coagulopathic, and metabolic responses that can lead to tissue injury, organ failure, and death. He says that sepsis can also cause endothelial dysfunction, microvascular dysfunction, and mitochondrial dysfunction, which can impair the delivery and utilization of oxygen and nutrients to the cells.
Dr. Dellinger says that the treatment of sepsis is based on the principles of early goal-directed therapy (EGDT), which is a protocol that aims to optimize the oxygen delivery and consumption, the tissue perfusion, and the organ function. He says that EGDT consists of four elements: resuscitation, source control, antimicrobial therapy, and supportive care. He says that resuscitation involves the administration of fluids, vasopressors, inotropes, and blood products to restore the hemodynamic stability. He says that source control involves the identification and elimination of the focus of infection, such as drainage, debridement, or removal of foreign bodies. He says that antimicrobial therapy involves the administration of appropriate and timely antibiotics, antifungals, or antivirals to eradicate the infection. He says that supportive care involves the provision of mechanical ventilation, renal replacement therapy, glycemic control, nutrition, and sedation to support the failing organs.
Dr. Dellinger says that the outcome of sepsis depends on the balance between the host response and the therapeutic intervention. He says that sepsis can cause significant morbidity and mortality, especially in the elderly, the immunocompromised, and the critically ill. He says that sepsis can also have long-term consequences, such as chronic pain, fatigue, depression, anxiety, and post-intensive care syndrome.
Dr. Dellinger says that the prevention of sepsis is essential to reduce the burden of this condition. He says that the prevention measures include infection prevention and control, vaccination, screening and surveillance, sepsis recognition and alert systems, sepsis bundles and checklists, and sepsis registries and audits.
Dr. Flavia R. Machado, MD, PhD, Professor and Head of the Intensive Care Session, Federal University of São Paulo
Dr. Machado describes sepsis as a syndrome that occurs when the body’s response to an infection is out of proportion and causes harm to the organs and tissues. She says that sepsis can be caused by any microorganism, such as bacteria, viruses, fungi, or parasites, and that the most common sites of infection are the lungs, the abdomen, the skin, and the bloodstream. She says that some people are more prone to sepsis than others, such as those who have diabetes, cancer, HIV, or malnutrition.
Dr. Machado says that the symptoms of sepsis can vary depending on the stage and the organ affected, but they may include fever, low body temperature, shivering, sweating, fast breathing, fast heart rate, low or high blood pressure, low or high blood sugar, confusion, drowsiness, nausea, vomiting, diarrhea, reduced urine output, and skin changes. She says that sepsis can lead to septic shock, which is a state of profound circulatory failure that requires vasopressors to maintain the blood pressure and is associated with a high risk of death.
Dr. Machado says that the treatment of sepsis is based on the concept of the golden hour, which is the first hour after the diagnosis of sepsis, when the interventions have the greatest impact on the survival. She says that the treatment consists of three main steps: resuscitation, infection control, and organ support. She says that resuscitation involves the administration of fluids, vasopressors, and oxygen to correct the hypovolemia, the hyp
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