Sepsis: symptoms, causes, diagnosis, treatment and prevention

Surgeon, coloproctologist

Skorkina

Irina Konstantinovna

14 years of experience

Doctor of the highest category, member of the European Society of Surgeons

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The infectious disease sepsis is very dangerous for humans. In the past, it was fatal in 80% of cases. Today, thanks to the achievements of modern medicine, this figure has decreased, but continues to remain quite high and amounts to 30-40%.

What is sepsis

What is sepsis in simple words? Sepsis (“rotting” in Greek) is a general infectious infection of the body, in which the infection spreads through the bloodstream. The disease does not affect a single organ, but the entire body.

Often sepsis becomes a continuation of the development of various local inflammations, for example, boils, phlegmon, abscess, meningitis caused by meningococcal infection, which can also lead to the development of meningococcal sepsis.

Patients with sepsis, as a rule, have immunity weakened by the primary inflammatory process. It is against the background of reduced protective functions of the body that the risk of developing sepsis, as a secondary inflammatory process, increases.

Symptoms of blood poisoning

Regardless of the activity of which particular pathogenic microorganism provoked the development of sepsis, the symptoms of blood poisoning are always the same:

weakness, loss of performance;
loss of appetite until it disappears completely;
chills, fever;
headache;
cardiopalmus;
decreased blood pressure;
shortness of breath, etc.

Signs of blood poisoning gradually increase - the patient may gradually develop kidney, heart, respiratory and other types of failure. A blood test reveals an increased concentration of white blood cells and a sharply increased ESR.

Classification

Classification of sepsis is carried out according to several criteria:

According to the pace of development:

fulminant – rapid development with the possibility of death within 1-2 days;
acute – development duration up to 4 weeks;
subacute – the duration of development of sepsis infection is 3-4 months;
recurrent – characterized by alternating exacerbations and attenuation of the disease, lasting up to six months;
chronic – lasting more than a year.

Forms of sepsis in adults of the secondary type according to the zone of localization of the primary focus:

tonsillogenic - develops against the background of sore throats that were caused by staphylococci and streptococci;
obstetric-gynecological – risk of development due to complications after abortion or childbirth;
surgical sepsis - infection in the blood from a postoperative wound;
pleuropulmonary – the primary focus is purulent lung diseases;
urosepsis - the organs of the urinary system become foci;
odontogenic – associated with diseases developing in the dental system;
skin – purulent skin diseases, as well as deep damage to the skin (burns, infected wounds, etc.);
otogenic – develops against the background of ear diseases (purulent otitis media, for example);
rhinogenic – develops against the background of the spread of infections in the body from the nasal cavity;
peritoneal – localization of primary foci in the abdominal organs.

Separately, neonatal sepsis should be highlighted - a systemic infectious disease in newborns during the first 28 days of life. The source is the formation of a purulent process in the tissues and vessels of the umbilical cord.

Key Recommendations

A. Initial therapy of sepsis

Sepsis and septic shock are medical emergencies and therefore initial therapy and resuscitation measures must be started immediately! (best practice guideline – BPS).
Patients with hypoperfusion should receive at least 30 mL/kg intravenous crystalloid solutions during the first 3 hours of resuscitation (strong recommendation, low-quality evidence).
Subsequent additional fluid resuscitation is adjusted based on frequent reassessment of hemodynamic status (best practice recommendation - BPS).
Further assessment of the patient's hemodynamics (eg, cardiovascular function) to determine the type of shock is recommended when the clinical picture does not lead to a clear diagnosis (best practice recommendation - BPS).
In patients with signs of septic shock who require vasopressors, the initial target mean arterial pressure (MAP) should be 65 mmHg. Art. (strong recommendation, moderate quality of evidence).
Dynamic hemodynamic parameters, as opposed to static ones, can be used as a predictor of response to fluid therapy, where possible (weak recommendations, low quality of evidence).
Resuscitation efforts should also aim to normalize lactate levels in patients with sepsis/septic shock, as a major marker of tissue hypoperfusion (weak recommendation, low-quality evidence).

B. Screening for sepsis and improving its quality

It is recommended that hospitals establish a program to improve the quality of care for sepsis, which would include screening for sepsis in patients with severe illness and in high-risk patients (best practice recommendation - BPS).

C. Diagnosis of sepsis

Microbiological culture samples (including blood) should be obtained before initiating antibacterial treatment in patients with suspected sepsis/septic shock; as long as it does not significantly delay the initiation of antimicrobial therapy (best practice recommendation - BPS).

D. Antibacterial therapy

Intravenous antimicrobials should be started immediately after identification of the causative agent and/or within 1 hour of the first symptoms of sepsis/septic shock (strong recommendation, moderate quality of evidence, assessment applies to both conditions).
Empiric antimicrobial therapy in patients with sepsis/septic shock is recommended, including at least two classes of broad-spectrum antibiotics to target a broader range of microorganisms or suspected pathogens, including bacteria, potential fungi, and viruses (strong recommendation, moderate quality evidence).
Adjustment, in the form of tapering of empirical antibiotic therapy, should be made if the pathogen and its susceptibility are identified and/or if there is clinical improvement (best practice recommendation - BPS).
Prophylactic use of antibacterial drugs in patients with severe inflammatory diseases of non-infectious origin (severe pancreatitis, thermal skin burns, etc.) is not recommended (best practice recommendation - BPS).
Antimicrobial dosing strategy should be based on generally accepted pharmacokinetic/pharmacodynamic principles, as well as taking into account organ function and certain characteristics of antimicrobials in patients with sepsis or septic shock (best practice recommendation - BPS).
In the case of septic shock, initial empiric combination antibiotic therapy (using at least two classes of antibiotics) should be directed at the most likely pathogen (weak recommendation, low-quality evidence).
Combination antibiotic therapy for neutropenic fever/bacteremia is not recommended in routine clinical practice (strong recommendation, moderate quality of evidence).
The use of combination antibiotic therapy is not recommended for the chronic treatment of most other serious infections, including bacteremia and sepsis without signs of shock (weak recommendation, low-quality evidence).
The use of combination antibiotic therapy is not recommended for the routine treatment of neutropenic fever/bacteremia (strong recommendation, moderate quality of evidence).
When combination antimicrobial therapy is initially used to treat septic shock, it is recommended that it be de-escalated or discontinued within the first few days in response to clinical improvement and/or evidence of resolution of the infection. This applies to both etiotropic (positive culture of the pathogen) and empirical (in case of negative bacteriological study) antibiotic therapy (best practice recommendation - BPS).
The adequate duration of antibiotic therapy for most infections associated with sepsis/septic shock is 7–10 days (weak recommendation, low-quality evidence).
Longer use of antibacterial drugs may be justified in patients with a slow clinical response to therapy; bacteremia caused by Staphylococcus aureus; some fungal and viral infections, as well as in patients with neutropenia (weak recommendation, low quality of evidence).
In certain categories of patients, shorter courses of antibiotic therapy are possible, for example, in patients with a rapid clinical response, as well as after adequate sanitation of the source of infection in the case of abdominal / urinary sepsis or in uncomplicated pyelonephritis (weak recommendation, low quality of evidence).
Daily assessment of the ability to de-escalate antimicrobial therapy in patients with sepsis/septic shock is recommended (best practice guidelines - BPS).
Procalcitonin levels can be used to assess the duration of antimicrobial therapy in patients with sepsis (weak recommendation, low-quality evidence).
Procalcitonin levels can be used to predict discontinuation of empirical antibiotic therapy in patients who initially presented with symptoms of sepsis, but no evidence was found for localized infection (weak recommendation, low-quality evidence).

E. Sanitation of the source of infection

It is recommended that in patients with sepsis/septic shock, the specific anatomical source of infection be identified and treated and that any necessary management of that source be undertaken as soon as the diagnosis is established (Best Practice Guidelines - BPS).
It is recommended that any intravascular devices that may be a possible cause of sepsis/septic shock be immediately removed, but only after another device has been placed (Best Practice Guidelines - BPS).

F. Infusion therapy

It is recommended that fluid therapy be used as long as necessary in terms of basic hemodynamic parameters and their improvement over time (best practice guidelines - BPS).
The choice of fluid therapy should be crystalloid solutions, both initially in the treatment of sepsis/septic shock and subsequently for intravascular fluid resuscitation (strong recommendation, moderate quality of evidence).
It is possible to use other balanced crystalloid solutions or saline as fluid therapy in patients with sepsis/septic shock (weak recommendation, low-quality evidence).
Albumin may be used as a primary addition to crystalloid fluids during fluid resuscitation in patients with sepsis/septic shock for intravascular fluid resuscitation, particularly when patients require significant amounts of crystalloid (weak recommendation, low-quality evidence).
The use of hydroxyethyl starch (HES) for intravascular fluid volume replacement in patients with sepsis/septic shock is not recommended (strong recommendation, high-quality evidence).
Crystalloid solutions should be used preferentially over gelatin in fluid therapy for sepsis/septic shock (weak recommendation, low-quality evidence).

G. Vasoactive drugs

Norepinephrine is the first-line vasopressor drug of choice (strong recommendation, moderate quality of evidence).
It is possible to add either vasopressin (up to 0.03 units/min) (weak recommendation, moderate-quality evidence) or epinephrine (weak recommendation, low-quality evidence) to norepinephrine to increase mean arterial pressure to target, as well as adding vasopressin (up to 0.03 units/min) (weak recommendation, moderate quality of evidence) to reduce the dose of norepinephrine.
As an alternative to norepinephrine, dopamine may be recommended as a vasopressor only in certain patients (eg, patients at low risk of tachyarrhythmia and absolute/relative bradycardia) (weak recommendation, low quality of evidence).
The use of low-dose dopamine to preserve renal function is not recommended (strong recommendation, high-quality evidence).
The use of dobutamine is recommended when persistent tissue hypoperfusion persists despite adequate fluid resuscitation and the use of vasopressors (weak recommendation, low-quality evidence).
All patients who require vasopressors should have arterial access (catheter) when possible and resources available (weak recommendation, very low-quality evidence).

N. Corticosteroids

In patients with septic shock, the use of intravenous hydrocortisone is not recommended unless adequate fluid loading and vasopressor therapy are sufficient to stabilize hemodynamics. When, despite measures taken, stabilization does not occur, hydrocortisone 200 mg/day may be prescribed (weak recommendation, low-quality evidence).

I. Blood components

In adult patients, red blood cell (RBC) transfusion is recommended only when hemoglobin levels are <70 g/L and in the absence of other aggravating conditions such as myocardial ischemia, severe hypoxemia, or acute blood loss (strong recommendation, high-quality evidence).
The use of erythropoietin for the treatment of anemia associated with sepsis is not recommended (strong recommendation, moderate quality of evidence).
The use of fresh frozen plasma (FFP) for the correction of coagulation abnormalities in the absence of bleeding or planned invasive procedures is not recommended (weak recommendation, very low-quality evidence).
Prophylactic platelet transfusion is indicated when the platelet level is >10,000 mm3 (10x109/L) in the absence of obvious signs of bleeding or when the level is >20,000 mm3 (20x109/L) in patients at high risk of bleeding. A higher blood platelet level >50,000 mm3 (50 x 109/L) is acceptable during active bleeding, surgery or invasive procedures (weak recommendation, very low quality of evidence).

J. Immunoglobulins

The use of intravenous immunoglobulin in patients with sepsis/septic shock is not recommended (weak recommendation, low-quality evidence).

K. Hemosorption

There are no recommendations regarding hemosorption.

L. Anticoagulants

The use of antithrombin in the treatment of sepsis/septic shock is not recommended (strong recommendation, moderate quality of evidence).
There are no recommendations for the use of thrombomodulin or heparin in the treatment of sepsis/septic shock.

M. Artificial pulmonary ventilation (ALV)

For sepsis-induced acute respiratory distress syndrome (ARDS) in adults, a target tidal volume of 6 ml/kg body weight (BW) is recommended versus 12 ml/kg BW (strong recommendation, high-quality evidence).
In adults with severe ARDS due to sepsis, it is recommended to use an upper limit of plateau pressure (30 cmH2O) versus a higher plateau pressure (strong recommendation, moderate quality of evidence).
It is recommended to use high positive end expiratory pressure (PEEP) over low positive end expiratory pressure (PEEP) in adults with moderate/severe ARDS due to sepsis (weak recommendation, moderate quality of evidence).
In adult patients, the use of the alveolar opening maneuver is recommended for severe ARDS caused by sepsis (weak recommendation, moderate quality of evidence).
For patients with severe ARDS caused by sepsis, the optimal position is a prone position compared to the supine position and a PaO2 / FIO2 ratio <150 mmHg. (strong recommendation, moderate quality of evidence).
The use of high-frequency ventilation is not recommended in adults with ARDS due to sepsis (strong recommendation, moderate quality of evidence).
There are no recommendations for the use of noninvasive mechanical ventilation in adult patients with ARDS caused by sepsis.
It is recommended to use muscle relaxants (NMBAs) for ≤ 48 hours in adults with ARDS caused by sepsis and PaO2/FIO2 ratio <150 mmHg. (weak recommendation, moderate quality of evidence).
Conservative fluid resuscitation is recommended in patients with established sepsis-related ARDS who do not have evidence of tissue hypoperfusion (strong recommendation, moderate quality of evidence).
The use of ß2-agonists in the treatment of ARDS caused by sepsis in the absence of symptoms of bronchospasm is not recommended (strong recommendation, moderate quality of evidence).
In routine practice, pulmonary artery catheter placement is not recommended in patients with ARDS due to sepsis (strong recommendation, high-quality evidence).
It is recommended to use low versus high tidal volume in patients with respiratory failure due to sepsis but without symptoms of ARDS (weak recommendation, low-quality evidence).
To prevent aspiration, as well as to prevent the development of ventilator-associated pneumonia in patients receiving mechanical ventilation, a supine position with the head elevated at 30 to 45 degrees is recommended (strong recommendation, low-quality evidence).
Spontaneous breathing training is recommended for patients with sepsis who are mechanically ventilated but ready to wean (strong recommendation, high-quality evidence).
It is recommended to use a mechanically ventilated weaning protocol in patients with respiratory failure due to sepsis who are ready to wean (strong recommendation, moderate quality of evidence).

N. Sedation and analgesia

In mechanically ventilated patients with sepsis, it is recommended to minimize prolonged or intermittent sedation, targeting specific titration points (best practice recommendation - BPS).

A. Glucose control

In the intensive care unit, in patients with sepsis, it is recommended to use a documented approach to monitoring blood glucose levels - in the case when the glycemia on two tests performed is > 10 mmol/l, it is recommended to start insulin injections. This approach would maintain an upper blood glucose level of ≤ 10 mmol/L rather than an upper blood glucose level of ≤ 6.1 mmol/L (strong recommendation, high-quality evidence).
Glycemic monitoring is recommended every 1 to 2 hours until glucose levels and insulin infusion rates are stable, then every 4 hours in patients receiving insulin infusions (best practice recommendation - BPS).
Interpretation of glucose levels from capillary blood testing should be done with caution, as such measurements may not accurately reflect the true level of glycemia in both arterial blood and plasma (best practice guideline - BPS).
When the patient has arterial access (catheter) for glucose testing, it is recommended to use arterial blood rather than capillary blood (weak recommendation, low-quality evidence).

P. Renal replacement therapy

In patients with sepsis and/or acute kidney injury, both long-acting and intermittent renal replacement therapy (RRT) are options (weak recommendation, moderate-quality evidence).
In patients with sepsis and haemodynamic instability, the use of long-acting renal replacement therapy is recommended to control fluid balance (weak recommendation, very low-quality evidence).
In patients with sepsis and/or acute kidney injury, when there are no other indications for dialysis other than high creatinine and oliguria, the use of renal replacement therapy is not recommended (weak recommendation, low quality of evidence).

Q. Bicarbonate infusion

The use of sodium bicarbonate is not recommended to improve hemodynamics or reduce the need for vasopressors in patients with lactic acidosis, pH ≥ 7.15 caused by hypoperfusion (weak recommendation, moderate quality of evidence).

R. Prevention of venous thromboembolism (VTE)

For the prevention of venous thromboembolic complications (VTEC), the use of both unfractionated heparins (UFH) and low molecular weight herparins (LMWH) is recommended, provided there are no contraindications to their use (strong recommendation, moderate quality of evidence).
For the prevention of VTEC, the greatest preference is given to LMWH compared to UFH, provided there are no contraindications to the use of the former (strong recommendation, moderate quality of evidence).
In situations where possible, a combination of drug prophylaxis of VTE with mechanical (physical) prophylaxis is recommended (weak recommendation, low quality of evidence).
The use of mechanical prophylaxis of VTE is recommended when medicinal (pharmacological) is contraindicated (weak recommendation, low quality of evidence).

S. Prevention of steroid ulcers

Steroid ulcer prophylaxis is recommended for patients with sepsis/septic shock at high risk of gastrointestinal bleeding (strong recommendation, low-quality evidence).
The use of both proton pump antagonists (PPIs) and histamine H2 receptor antagonists (H2RAs) is recommended for the prevention of steroid ulcers (weak recommendation, low-quality evidence).
Steroid ulcer prophylaxis is not recommended in the absence of risk factors for gastrointestinal bleeding (BPS).

T. Nutrition

It is not recommended to use parenteral nutrition alone or in combination with enteral nutrition in patients with sepsis/septic shock who can be fed enterally (strong recommendation, moderate quality of evidence).
It is not recommended to use parenteral nutrition alone or in combination with enteral nutrition (but rather start an intravenous glucose infusion as soon as possible and try to establish enteral nutrition) for the first 7 days in severely ill patients with sepsis/septic shock for whom enteral nutrition has previously been impossible (strong). recommendation, moderate quality of evidence).
It is recommended to initiate earlier enteral nutrition rather than intravenous glucose infusion alone in severely ill patients with sepsis/septic shock who can be fed enterally (weak recommendation, low-quality evidence).
It is recommended to use either early low-calorie or early total enteral nutrition in severely ill patients with sepsis/septic shock; If a low-calorie diet is started, the diet should be modified according to the patient's tolerance (weak recommendation, moderate quality of evidence).
The use of omega-3 fatty acids as an immune supplement in severely ill patients with sepsis/septic shock is not recommended (strong recommendation, low-quality evidence).
Routine measurement of gastric residual volume in severely ill patients with sepsis/septic shock is not recommended (weak recommendation, low-quality evidence). However, measurement of gastric residual volume in patients with malabsorption or at high risk of aspiration is acceptable (weak recommendation, very low quality of evidence). Note: This recommendation applies to non-surgical severe patients with sepsis/septic shock.
It is recommended to use prokinetic agents in severely ill patients with sepsis/septic shock and malabsorption (weak recommendation, low-quality evidence).
It is recommended to place an intrastinal (post-pyloric) feeding tube in severely ill patients with sepsis/septic shock with malabsorption or a high risk of aspiration (weak recommendation, low-quality evidence).
The use of intravenous selenium in the treatment of sepsis and septic shock is not recommended (strong recommendation, moderate quality of evidence).
The use of arginine in the treatment of sepsis and septic shock is not recommended (weak recommendation, low quality of evidence).
The use of glutamine in the treatment of sepsis and septic shock is not recommended (strong recommendation, moderate quality of evidence).
There are no recommendations for the use of carnitine in the treatment of sepsis and septic shock.

Symptoms and signs of sepsis

The signs and symptoms of sepsis in adults can be broad and varied. Common signs of sepsis include:

increased body temperature;
the appearance of severe chills;
formation of local abscesses;
profuse sweating;
pale skin and tired, detached appearance;
psycho-emotional changes – a state of euphoria or, conversely, complete apathy and passivity;
facial hyperemia.

With sepsis, petechial hemorrhages can be observed, which form on the surface of the legs and forearms and look like spots or stripes.

According to the symptoms of sepsis, experts distinguish the following forms:

systemic inflammatory response syndrome;
sepsis;
severe sepsis;
septic shock.

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3.Symptoms of sepsis

Because sepsis can start in different parts of the body, the symptoms of sepsis can vary. Rapid breathing, changes in mental state (confusion, for example) may be the first signs of sepsis

. Other common symptoms of sepsis are:

Fever, high temperature, chills or vice versa, very low body temperature;
Rare urination;
Rapid pulse;
Fast breathing;
Nausea and vomiting;
Diarrhea.

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Causes of sepsis development

The main condition for the development of purulent sepsis is the entry of infectious agents (viruses, fungi, bacteria) into the patient’s body. The immune system begins an active fight against pathogens, which results in an inflammatory process in the body - mass infection occurs with putrefactive products formed as a result of the destruction of pathogenic microorganisms. A weakened immune system leads to its inability to cope with the task of timely localization of pathogenic organisms. They enter the bloodstream, as a result of which sepsis in the blood spreads throughout the body, affecting all organs and systems.

The reasons for the development of sepsis lie in the creation of a number of favorable conditions in the patient’s body:

emergence of a primary source of infection;
spread of pathogenic pathogens with blood flow throughout the body;
the formation of secondary foci, which also become sources of spread of infection throughout the body;
development of the inflammatory process as a response of the immune system to infection;
weakening of the immune system and, as a result, its inability to localize the infection.

Types of sepsis

Bacteremia is characterized by the presence of bacteria in a person's blood, which are detected by blood culture. Develops against the background of anthrax, tularemia and typhoid fever. In meningitis and pneumonia, bacteremia is a severe form of complication.

Septicemia develops when the bacteria enters the bloodstream and the body reacts too violently. There are two types of this condition:

Septicopyemia
. Accompanied by the appearance of ulcers throughout the body. The patient's condition worsens.
Septic shock
. A severe form of sepsis, which is accompanied by dysfunction of the cardiovascular system and deterioration of the blood supply to internal organs. As a result, the body does not receive the required amount of oxygen and ceases to function normally. Patients with septic shock often die.

Sepsis is accompanied by various symptoms, which can be expressed to varying degrees. Due to its subtle symptoms, this condition can be difficult to recognize because it shares similarities with other conditions such as anaphylactic shock, pulmonary embolism, heart attack and stroke.

Doctors have identified a number of criteria with the help of which it is possible to diagnose early septicemia and take therapeutic measures:

body temperature above 38°C or below 36°C;
increased heart rate – more than 90 beats/min;
increase in respiratory rate more than 20 per minute;
a decrease in the level of white blood cells less than 4000 or an increase to 12000 per liter or more;
increase in partial pressure of carbon dioxide to 32 mm Hg. Art. and more.

A rapid qSOFA score has been developed to identify existing criteria for sepsis. If 2-3 items from the list above are present, then a suspicion arises that requires immediate diagnostic and treatment measures.

The main symptoms of sepsis include increased body temperature, excessive sweating, increased heart rate and rapid breathing. The patient's condition deteriorates sharply, blood pressure decreases, and consciousness becomes confused. The lower and upper extremities become cold, and the lips become bluish. This is followed by dysfunction of internal organs. When the lung is damaged, respiratory failure and shortness of breath are noted; when kidney dysfunction occurs, the daily volume of urine decreases.

Complications

Complications of sepsis can be very serious.

Septic shock - the functioning of all organs and systems is disrupted, blood flow and metabolism are disrupted. A special risk group among patients are people with weakened immune systems and the elderly. The mortality rate for this complication reaches 50%.
Thrombophlebitis – inflammation of the venous walls occurs, which is accompanied by the formation of blood clots. The patient may experience pain in the affected areas of the veins, redness is noted on the skin and swelling of the extremities appears.
Pulmonary embolism - in most cases develops as a complication against the background of thrombophlebitis. A part of the blood clot breaks off and travels through the blood currents, first to the heart, and then to the pulmonary vessels. Having reached a small vessel, the thrombus is able to block it. Symptoms can include shortness of breath, blueness of the fingertips, lips and nose, severe pain in the chest and behind the sternum, decreased blood pressure, loss of consciousness, fainting and even falling into a coma.
Thromboembolism of cerebral vessels is also one of the complications of thrombophlebitis, in which part of the blood clot enters the brain. This complication is characterized by the detachment of a blood clot at night. Thromboembolism of this type is accompanied by a state of stupor and impaired consciousness in the patient, there is a violation of movements and sensitivity of reflexes, loss of orientation in time and space. The symptoms are somewhat similar to meningitis.
Bleeding – as a result of vascular damage in various organs, areas of bleeding may open. The patient develops characteristic pallor and weakness.
Loss of body weight - according to statistics, each patient suffering from this disease loses about 20% of his body weight.

Complications of sepsis

As sepsis progresses, the blood supply to vital organs such as the brain, heart and kidneys is disrupted. Sepsis can cause blood clots to form in your organs, arms, legs, fingers, and toes, leading to varying degrees of organ failure and tissue death (gangrene).

Most people recover from mild sepsis, but septic shock has a mortality rate of about 40 percent. Additionally, an episode of severe sepsis may put you at greater risk for future infections.

Diagnosis of sepsis

Diagnosis of sepsis is carried out using a number of clinical and laboratory research methods. The specialist prescribes tests for sepsis and hardware studies:

general blood test to determine the overall picture of the inflammatory process;
blood culture (can be performed multiple times) makes it possible to take into account the life cycle of pathogenic pathogens for the treatment of sepsis;
bacterial culture from a purulent focus;
DNA isolation of a pathogenic pathogen using the PRC method;
hardware studies to identify primary foci of inflammation - ultrasound, x-ray, MRI, computed tomography, etc.

Diagnostic measures

If sepsis is suspected, it is necessary to find the cause of the infection, its causative agent. It is important to understand to what extent the functioning of the body’s functions is impaired, and then determine treatment tactics.

Among the diagnostic methods:

Tests to determine infection;
Coagulogram;
Analysis of platelet counts and electrolytes;
Analysis of kidney and liver activity;
Determining the sufficiency of oxygen supply to tissues;
Analysis of the activity of the cardiovascular system;
X-ray examination;
Ultrasound;
CT;
MRI.

Cirrhosis

Treatment of sepsis

Treatment of sepsis is prescribed in accordance with the established diagnosis and extends to the primary source of infection. An important factor for choosing intensive therapy is the presence of a risk of death.

Main methods of treatment:

intravenous administration of the maximum possible doses of antibiotics (the sensitivity and individual characteristics of the patient’s body are taken into account);
intensive therapy aimed against toxicosis;
stimulating the patient’s immune system, restoring its functions.

The key is to eliminate the infection from the primary sites. Antibiotics can be supplemented with hormonal therapy. In some cases, infusions of blood plasma, glucose and globulin may be required.

Conditions of isolation and rest are created for the patient. As an additional therapy, a special diet is prescribed. In critical cases, the patient is fed intravenously.

In the presence of secondary purulent foci, surgical intervention is used to treat sepsis - removing pus and washing the foci with special solutions, opening abscesses, surgical excision of the affected tissues along with adjacent healthy ones.

Detecting and treating blood poisoning

Diagnosis of this pathology, in addition to determining the patient’s signs of blood infection, involves various measures to identify infectious agents in the blood, as well as detect foci of infection in various tissues and organs. The sooner a correct diagnosis is made and qualified treatment for sepsis is started, the greater the likelihood that recovery will be complete and not delayed in time.

As for the treatment of blood poisoning, it certainly involves taking medications aimed at suppressing pathogenic bacteria or fungi, depending on what pathogens caused the infection. Therapy aimed at eliminating the symptoms of intoxication of the body is also necessary. Sometimes it is impossible to do without a blood transfusion. Without treatment for blood poisoning, there is a real risk to the patient's life and health.

Prevention of sepsis

The main method of preventing sepsis is timely and correct treatment of infections that caused the development of primary foci.

The second important point is strict adherence to aseptic and antiseptic rules for conducting any medical operations.

The use of antibacterial agents must be competent. Viruses, fungi and microbes have the ability to adapt. Unjustified use of strong antibiotics leads to infections adapting, becoming smarter and becoming more difficult to fight. Self-medication should be excluded as a matter of principle. The best solution is to contact a specialist.

Gram-positive and gram-negative sepsis

Depending on how bacteria are stained after treatment with special dyes, they are divided into gram-positive and gram-negative. Accordingly, sepsis, depending on the nature of the pathogen, can also be gram-positive and gram-negative, and this division plays an important role in clinical practice.

Among the gram-positive bacteria in sepsis, the most common are staphylococci and streptococci. These bacteria secrete exotoxins - proteins that disrupt important processes in human cells and poison the body. Staphylococcal sepsis in 95% of cases occurs in the form of septicopyemia, and streptococcal sepsis most often occurs as severe septicemia with dysfunction of internal organs.

Gram-negative sepsis is most often caused by Escherichia coli, Klebsiella, Proteus, Enterobacteriaceae, and Pseudomonas aeruginosa. These bacteria contain very powerful endotoxins. They differ from exotoxins in that they are structural components of bacterial cells and are released only after their death. The structure of endotoxins is lipopolysaccharides. They cause serious pathological changes in the human body:

Increased production of cytokines - substances involved in the inflammatory process. A vicious circle can arise when the body produces a huge amount of cytokines, they activate immune cells, and they produce new cytokines. This condition is called a cytokine storm, and it can lead to the death of the patient.
Necrosis (death) of cells lining the walls of blood vessels (endotheliocytes), and the formation of blood clots.
Endotoxemia is poisoning of the body with toxic metabolic products.
Multiple organ failure is a deadly dysfunction of all organs.

Gram-negative sepsis is usually severe. Septic shock often develops early on, and many patients die. Particularly dangerous situations occur when there is a nosocomial infection caused by multidrug-resistant bacteria (resistant to two or more different antibiotics).

How to make an appointment with a specialist

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All studies are carried out using modern equipment in the shortest possible time. When prescribing treatment, doctors always use an individual approach to overcome the disease in the most gentle way possible for the body. Remember that the sooner you see a doctor, the simpler and shorter the treatment will be.

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Course of septic shock

In septic shock, hypercytokinemia increases the activity of nitric oxide synthetase in endothelial and other cells. As a result, the resistance of resistive vessels and venules decreases. A decrease in the tone of these microvessels reduces overall peripheral vascular resistance. During septic shock, some of the body's cells suffer from ischemia caused by peripheral circulatory disorders. Peripheral circulation disorders in sepsis and septic shock are consequences of systemic activation of endothelial cells, polymorphonuclear neutrophils and mononuclear phagocytes.

Inflammation of this origin is purely pathological in nature and occurs in all organs and tissues. A critical drop in the number of structural and functional elements of most effector organs is the main link in the pathogenesis of the so-called multiple system failure.

According to traditional and correct ideas, sepsis and a systemic inflammatory response are caused by the pathogenic action of gram-negative microorganisms.

In the occurrence of a systemic pathological reaction to invasion into the internal environment and blood of gram-negative microorganisms, the decisive role is played by:

• Endotoxin (lipid A, lipopolysaccharide, LPS). This heat-stable lipopolysaccharide forms the outer coating of gram-negative bacteria. Endotoxin, acting on neutrophils, causes the release of endogenous pyrogens by polymorphonuclear leukocytes.

• LPS-binding protein (LPBP), traces of which are determined in plasma under physiological conditions. This protein forms a molecular complex with endotoxin that circulates in the blood.

• Cell surface receptor of mononuclear phagocytes and endothelial cells. Its specific element is a molecular complex consisting of LPS and LPSSB (LPS-LPSSB).

Currently, the frequency of sepsis caused by invasion of gram-positive bacteria into the internal environment is increasing. The induction of sepsis by Gram-positive bacteria is usually not associated with their release of endotoxin. Peptidoglycan precursors and other wall components of Gram-positive bacteria are known to trigger the release of tumor necrosis factor-alpha and interleukin-1 by immune cells. Peptidoglycan and other components of the walls of gram-positive bacteria activate the complement system through the alternative pathway. Activation of the complement system at the whole body level causes systemic pathogenic inflammation and contributes to endotoxicosis in sepsis and the systemic inflammatory response.

It was previously thought that septic shock was always caused by endotoxin (a lipopolysaccharide of bacterial origin) released by gram-negative bacteria. It is now generally accepted that less than 50% of cases of septic shock are caused by Gram-positive pathogens.

Disorders of peripheral circulation during septic shock, adhesion of activated polymorphonuclear leukocytes to activated endothelial cells - all this leads to the release of neutrophils into the interstitium and inflammatory alteration of cells and tissues. At the same time, endotoxin, tumor necrosis factor-alpha, and interleukin-1 increase the formation and release of tissue coagulation factor by endothelial cells. As a result, mechanisms of external hemostasis are activated, which causes fibrin deposition and disseminated intravascular coagulation.

Arterial hypotension in septic shock is mainly a consequence of a decrease in total peripheral vascular resistance. Hypercytokinemia and an increase in the concentration of nitric oxide in the blood during septic shock causes dilatation of arterioles. At the same time, through tachycardia, the minute volume of blood circulation increases compensatoryly. Arterial hypotension in septic shock occurs despite a compensatory increase in cardiac output. Total pulmonary vascular resistance increases during septic shock, which can be partly attributed to the adhesion of activated neutrophils to activated endothelial cells of the pulmonary microvessels.

The following main links in the pathogenesis of peripheral circulatory disorders in septic shock are distinguished:

1) increased permeability of the microvascular wall;

2) an increase in microvascular resistance, which is enhanced by cell adhesion in their lumen;

3) low response of microvessels to vasodilating influences;

4) arteriolo-venular shunting;

5) drop in blood fluidity.

Hypovolemia is one of the factors of arterial hypotension in septic shock.

The following causes of hypovolemia (a drop in cardiac preload) in patients in a state of septic shock are identified:

1) dilatation of capacitive vessels;

2) loss of the liquid part of the blood plasma in the interstitium due to a pathological increase in capillary permeability.

It can be assumed that in most patients in a state of septic shock, the drop in oxygen consumption by the body is mainly due to primary disorders of tissue respiration. In septic shock, moderate lactic acidosis develops with normal oxygen tension in the mixed venous blood.

Lactic acidosis in septic shock is considered to be a consequence of decreased pyruvate dehydrogenase activity and secondary accumulation of lactate, rather than a decrease in blood flow in the periphery.

Peripheral circulatory disorders in sepsis are systemic in nature and develop with arterial normotension, which is supported by an increase in minute volume of blood circulation. Systemic microcirculation disorders manifest themselves as a decrease in pH in the gastric mucosa and a decrease in oxygen saturation of blood hemoglobin in the hepatic veins. Hypoergosis of intestinal barrier cells, the action of immunosuppressive links in the pathogenesis of septic shock - all this reduces the protective potential of the intestinal wall, which is another cause of endotoxemia in septic shock.

What is sepsis and what is not?

To understand this issue, let's talk about some common misconceptions:

"Sepsis is an infection"

This is true, but only half. A person constantly encounters infections in everyday life. For example, you can touch a door handle in a supermarket that contains ARVI viruses, and then transfer them to the mucous membrane by scratching your nose. But this will not lead to sepsis. You will just get a cold, or in the worst case, the flu or COVID-19. Even within the normal microflora of the human body there are bacteria that, under certain conditions, cause dangerous infections and sepsis. However, for most people this does not happen.

If pathogenic bacteria enter the bloodstream, this condition is called bacteremia. But this is not sepsis yet.

Sepsis is a combination of infection and the body's overreaction to it.

“Most often people contract sepsis in the hospital because there are a lot of bacteria resistant to antibiotics there.”

Firstly, you cannot catch sepsis. Only some infections that lead to sepsis can be contracted directly from a patient. If your immune system is functioning normally, you will only develop the corresponding infection. Secondly, according to experts from the Sepsis Alliance (USA), in 80% of cases, sepsis develops in people who are not in a hospital.

“There are now many good antibiotics, infections are generally not dangerous, and sepsis is very rare.”

Despite the fact that modern doctors have many antibiotics in their arsenal, sepsis is still difficult to fight. For example, in the United States, it claims more lives each year than breast, prostate and AIDS cancers combined. The rise of antibiotic-resistant bacteria is a huge problem in modern health care. And in general, as we have already discussed above, it is not only about infections, but also about the characteristics of the immune response. Some people are at increased risk. For example, cancer patients.

Symptoms of chronic sepsis

Chronic sepsis occurs over a long period of time and is characterized by a sluggish course, the symptoms are mild. Therefore, diagnosing chronic sepsis is often difficult.

There is an opinion among experts that even acute sepsis should be considered as a two-phase disease with a chronic component. Even if the patient can be cured in the acute period, the disease often does not go away without a trace. Disorders persist that lead to chronic critical illnesses and can cause death.