Sepsis refers to an infection accompanied by systemic inflammatory responses, such as changes in body temperature, respiration, and circulation. When sepsis is accompanied by signs of organ hypoperfusion, such as lactic acidosis, oliguria, and acute mental changes, it is considered severe sepsis. This condition carries a high risk of mortality, so patients experiencing these symptoms should seek medical attention promptly.
Epidemiology
Contagious
Not contagious.
High-risk population
1. This disease is more common in the elderly, pregnant women and children.
2. People with impaired immune systems are more susceptible to this disease.
High-incidence areas
The highest incidence and mortality rates are found in sub-Saharan Africa, Oceania, South Asia, East Asia, and Southeast Asia.
Causes
Overview
Infections typically occur after severe trauma and various suppurative infections, such as extensive burns, open fractures, carbuncles, diffuse peritonitis, and biliary or urinary tract infections. Incomplete localization of the infection lesion allows highly virulent pathogens and toxins to continuously invade the bloodstream. Local and systemic infection triggers the production and release of large amounts of inflammatory mediators, stimulating a systemic inflammatory response and causing sepsis.
Risk factors
1. Skin trauma or mucous membrane damage, such as burns and knife wounds, may cause serious infection and induce sepsis.
2. Sepsis may also occur when using invasive devices such as intravenous catheters or breathing tubes.
symptom
Overview
The main symptoms of sepsis are chills, shivering, and high fever, which can be accompanied by damage to multiple organs and tissues, including the digestive system, skin, joints, liver, spleen, etc. As the disease progresses, different complications may occur at different stages.
Typical symptoms
1. Systemic symptoms
Patients may experience high fever and chills, accompanied by muscle and joint pain in multiple parts of the body. Patients often have clinical manifestations such as headache, rapid breathing, rapid heartbeat, weakness, etc.
2. Local symptoms
(1) Digestive system symptoms
It may be accompanied by a variety of digestive system symptoms, such as nausea, vomiting, abdominal distension, abdominal pain, diarrhea, etc.
(2) Skin damage
The most common manifestations are petechiae, but it can also manifest as urticaria, scarlet fever-like rash, pustular rash, scald-like rash, ecchymosis, etc.
(3) Joint damage
Symptoms include redness, swelling, pain, and limited movement of large joints such as the knee joint, and in a few cases, joint effusion or pus.
(4) Hepatosplenomegaly
It is usually only slightly enlarged. When complicated by toxic hepatitis or liver abscess, the liver is significantly enlarged, accompanied by tenderness and jaundice.
complication
1. Osteomyelitis
It is more likely to occur in children and is mostly caused by Gram-positive bacteria.
2. Myocarditis
When infected with Gram-positive bacteria, bacterial toxins can invade myocardial tissue and cause myocarditis.
3. Gastrointestinal bleeding
Sepsis caused by fungal infection is prone to be complicated by gastrointestinal bleeding.
4. Septic shock
Gram-negative bacilli can easily cause septic shock.
examine
Scheduled inspection
Patients who suddenly experience symptoms of infection, such as chills, shivering, and high fever, should seek medical attention immediately. Doctors often perform routine blood tests, biochemistry tests, and blood oxygenation tests to understand the patient’s general condition. Procalcitonin and C-reactive protein levels are also helpful in confirming the diagnosis of this disease. Ultimately, patients will also need to undergo a combined etiological test to identify the underlying pathogen and guide subsequent treatment.
Laboratory tests
1. Blood routine, biochemistry, blood oxygen
Symptoms include an increased white blood cell count, a higher proportion of neutrophils, a left-shifted nucleus, an increase in immature cells, and the presence of toxic granules. In patients with weakened immune systems, white blood cell counts may also decrease. Patients with sepsis may also experience thrombocytopenia, hyperbilirubinemia, elevated serum creatinine, decreased arterial oxygen tension, and elevated blood lactate levels.
2. Procalcitonin (PCT)
Blood levels of procalcitonin (PCT) are abnormally elevated in sepsis caused by bacterial infection. Procalcitonin (PCT) is produced by immune and endocrine cells in response to endotoxins and other factors. It can maintain elevated blood levels or gradually decrease as the infection progresses. It is not elevated in healthy individuals, during localized infections, viral infections, or during non-infectious inflammation. Therefore, procalcitonin testing has a certain degree of specificity and sensitivity in diagnosing sepsis caused by bacterial infection.
3. C-reactive protein (CRP)
Blood levels rise during systemic inflammatory reactions. Blood CRP and procalcitonin exceeding 2 standard deviations above normal values are valuable for diagnosing SIRS.
4. Etiological examination
Blood cultures are crucial for diagnosis and treatment. Blood cultures should be obtained before antibiotic use and when chills or high fever occur. Ideally, a blood volume of 5-10 ml should be collected. Gram stain or culture of pus, puncture fluid, or petechiae specimens can provide preliminary identification or detection of pathogens for clinical reference.
diagnosis
Diagnostic principles
Physicians can make a preliminary diagnosis of sepsis based on the patient’s medical history and clinical presentation, but a definitive diagnosis requires laboratory test results. Etiological testing is crucial for determining the etiology and subsequent treatment options. Symptoms can sometimes mimic those of shock from various other causes and organ dysfunction due to noninfectious factors, necessitating active differential diagnosis.
Diagnostic basis
Sepsis refers to a systemic inflammatory response triggered by infection. The course and severity of the disease are closely related to the host’s response to the infection. Sepsis can lead to tissue hypoperfusion, organ dysfunction, and even shock, which are referred to as severe sepsis and septic shock.
1. Bacteremia and diagnostic basis
Blood culture positive.
2. Sepsis and its diagnostic basis
There is clinical evidence of infection and manifestations of systemic reaction syndrome.
3. Severe sepsis and its diagnostic basis
Any manifestation of sepsis combined with organ dysfunction: arterial hypoxemia; blood lactate level exceeding the upper limit of normal; acute oliguria (urine volume <25 ml/h), increased creatinine; abnormal coagulation mechanism, thrombocytopenia; hyperbilirubinemia; intestinal paralysis; changes in mental and consciousness status.
4. Diagnostic basis for septic shock
Sepsis complicated by hemodynamic changes: hypotension (systolic blood pressure <90 mmHg, or decrease >40 mmHg); early mixed venous oxygen saturation >70%; early cardiac index >3.5 L/(min·m 2 ).
Differential diagnosis
1. Hypovolemic shock
Circulatory failure occurs when blood volume decreases dramatically due to factors such as massive blood loss, fluid loss, and burns. This decreases venous pressure, reduces venous return, reduces cardiac output, and causes peripheral vascular constriction. This condition is quickly corrected with volume expansion.
2. Cardiogenic shock
Shock is caused by acute cardiac dysfunction leading to insufficient blood perfusion to tissues and organs. It often occurs in the setting of pre-existing heart disease, myocarditis, cardiac tamponade, severe arrhythmias, or heart failure. Elevated central venous pressure, decreased cardiac index, elevated pulmonary artery wedge pressure and central venous pressure, and abnormal electrocardiogram and hemodynamics can aid in differential diagnosis.
3. Anaphylactic shock
Anaphylactic shock is a type 1 hypersensitivity reaction caused by the interaction of external antigenic substances with corresponding antibodies. Anaphylactic shock is a type 1 hypersensitivity reaction that involves the massive release of histamine, bradykinin, serotonin, and platelet-activating factor, leading to systemic capillary dilation, increased permeability, plasma exudation, and a sharp decrease in circulating blood volume. Children often have a history of exposure to allergenic substances.
4. Neurogenic shock
Shock is caused by severe impairment of arterial resistance regulation, loss of vascular tone, and vasodilation, leading to decreased peripheral vascular resistance and a decrease in effective blood volume. This condition is often seen in cases of severe trauma, intense pain (such as thoracic, abdominal, or pericardial puncture), high-level spinal anesthesia, or injury.
5. Organ dysfunction caused by non-infectious factors
Such as acute left ventricular failure, chronic heart failure, chronic renal failure, chronic respiratory failure, etc.
treat
Treatment principles
Patients with this disease often require active symptomatic treatment to protect their vital signs and promptly administer antibiotics to control infection. Antibiotics can be used in the early stages of infection, and sensitive antibiotics can be selected after the bacterial species is identified.
Symptomatic treatment
1. If hemoglobin is lower than 70g/L, give blood transfusion.
2. Oxygen inhalation or protective low tidal volume (6 ml/kg body weight) pulmonary assisted ventilation helps maintain oxygen supply and tissue perfusion, improve respiratory function, and reduce the occurrence and development of organ dysfunction.
3. Intravenous insulin is used to control hyperglycemia in severe sepsis.
4. Give proton pump inhibitors to prevent stress ulcers.
General treatment
1. Thorough incision and drainage of purulent lesions;
2. Remove the indwelling catheter;
3. Sometimes it is necessary to remove the artificial joint or artificial valve.
Drug treatment
Patients with this condition often require antibiotic treatment. Because bacterial culture results may not be readily available in the early stages, empirical antibiotic treatment should be given as soon as possible. After obtaining the patient’s blood test results, antibiotics to which the bacteria are sensitive may be selected for specific bacteria.
1. Gram-positive coccal sepsis is most common in Staphylococcus aureus and Staphylococcus epidermidis. However, Staphylococcus aureus is generally resistant to penicillin G, and in recent years, it has also been found to be resistant to oxacillin. Therefore, it is recommended to use cephalothin, vancomycin or tebuconazole.
2. The best treatments for Gram-negative bacterial sepsis are third-generation cephalosporins and fluoroquinolones.
Related drugs
Cephalothin, vancomycin, tebuconazole, cephalosporins, fluoroquinolones
Surgical treatment
This disease usually does not require surgical treatment.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, treatment timing, age and physical condition, and may vary from person to person.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
Sepsis is a serious disease with a high mortality rate, and patients often have a poor prognosis.
Hazards
Patients with this disease may experience systemic multi-organ dysfunction, which may eventually lead to death.
Curative
The patient may be cured through active treatment.
Cure rate
There are currently no valid statistics on cure rates.
daily
Overview
Good psychological care is crucial for recovery. Family members should provide care and comfort to patients, encouraging them to actively cooperate with treatment and build confidence in overcoming the disease. Patients should also follow their doctor’s instructions for medication, develop healthy lifestyle habits, and undergo regular checkups to prevent disease progression or recurrence.
Psychological care
1. Psychological characteristics
Sepsis causes great trauma to patients. Patients have a longer recovery period and may experience great discomfort. They may also become depressed and pessimistic.
2. Nursing measures
(1) Patient’s family members: The family members’ understanding and attitude towards the disease have a great impact on the patient’s psychology. Family members should pay more attention to and care for the patient, create a good emotional environment, and make the patient stay in a good mood and recover soon.
(2) Patients themselves: Maintain a good attitude, be optimistic, and actively accept and cooperate with treatment.
Life Management
1. Do appropriate exercise to enhance the body’s immunity.
2. Maintain a regular work and rest schedule, ensure adequate sleep, and avoid staying up late and overwork.
3. Keep the rest environment clean, quiet and comfortable, and maintain a relaxed and happy mood.
diet
Dietary adjustment
This disease has a great impact on the patient’s physical functions. A scientific and reasonable diet during the recovery period may have a certain effect on the recovery of the patient’s body functions or promote recovery from the disease.
Dietary recommendations
1. A reasonable and balanced dietary nutrition structure, giving priority to foods rich in unsaturated fatty acids and supplementing plant sterols.
2. Increase the intake of whole grains, cereals, beans and potatoes.
3. Increase the intake of vegetables and fruits, and eat fish, eggs, soy products, and dairy products in moderation.
Dietary taboos
1. Quit smoking and limit alcohol consumption.
2. Reduce the intake of high-fat foods to avoid increasing the burden on the patient’s digestive tract.
3. Avoid raw, cold, spicy and irritating foods.
prevention
Preventive measures
High-risk groups may be able to prevent the occurrence of this disease by paying attention to the following:
1. Actively treat primary infection lesions and use antibiotics rationally;
2. For long-term intravenous catheterization and urinary tract catheterization, local skin cleaning and disinfection should be strengthened;
3. Patients who use glucocorticoids, immunosuppressants and anticancer drugs for a long time have low disease resistance. While strengthening nutrition and improving physical fitness, they should also do a good job of protective isolation.
Medical Guide
Emergency (120) indications
1. The patient experiences unexplained chills and high fever.
2. Accompanied by impaired consciousness and coma.
If the above situation occurs, you must immediately call the emergency number for medical treatment.
Treatment department
Patients who experience chills and high fever often need to go to the emergency department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. If you have taken any medicine recently, you can record the name, usage and dosage to facilitate communication with your doctor.
3. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
4. Family members may accompany the patient to the clinic and should be prepared with questions they wish to ask.
Questions your doctor may ask
1. When did these symptoms appear?
2. Do you have any other underlying diseases?
3. Is there any external injury?
4. Have you been to other hospitals? What tests and treatments did you receive?
5. Have you taken any medicine? What is the usage and dosage?
What questions can patients ask?
What is causing my symptoms? Are there other possible causes?
2. What tests do I need to undergo? How long will it take for the test results to be available?
3. Is my condition serious? Do I need to be hospitalized?
4. What treatments are available? Are there any risks associated with these treatments?
5. How long does treatment take? Can it be cured? Will it recur?
6. I have other diseases. Will it affect the treatment effect?