What you need to know about sepsis

What is sepsis?

Sepsis is an extreme immune response to an infection. In a person with sepsis, the immune system can injure tissues and organs, and it can be life threatening.

Sepsis may be a response to an infection that develops in the skin, lungs, urinary tract, or another part of the body.

A common cause is septicemia, a bacterial infection in the blood. Sometimes people confuse the terms “sepsis” and “septicemia,” but they are different issues.

Symptoms of sepsis

Anyone with an infection who develops the following sepsis symptoms needs urgent medical attention:

• a fever, chills, and shivering
• a rapid pulse, also known as tachycardia
• difficulty breathing
• clammy or sweaty skin
• extreme pain or discomfort
• redness or other color changes and swelling around a wound

When sepsis is severe, it can also cause:

• dizziness or faintness
• low urine volume
• pale, discolored, or mottled skin
• skin that feels unusually warm or cold, as with a fever
• cool, pale skin at the extremities
• confusion, reduced alertness, and other changes in the person’s mental state
• a feeling of doom or sudden fear of death
• slurred speech
• diarrhea, nausea, or vomiting
• severe pain and extreme general discomfort
• shortness of breath
• loss of consciousness

As sepsis progresses, septic shock can occur. This involves blood pressure falling dangerously low, meaning that oxygen can no longer reach the body’s organs.

Older adults and younger children have a particularly high risk of sepsis, and they are also more likely to experience a rapid worsening of sepsis symptoms. However, the issue can be harder to spot in these age groups.

Symptoms can also be harder to identify in people with:

• learning difficulties
• communication problems
• dementia

When a person requests medical help, the healthcare professional needs to know about:

• any symptoms
• any recent infections, traumas, or surgical procedures
• whether the person has a compromised immune system
• whether the person has diabetes or any other chronic condition

This may help speed up the diagnosis and allow for more rapid treatment.

Causes of sepsis

Causes of sepsis include:

• bacterial infections
• fungal infections
• viral infections, including COVID-19 and flu

The pathogen may enter the body through a wound or during or after surgery.

Risk factors of sepsis

Sepsis can affect anyone with an infection, but the risk is higher for:

• adults older than 65
• babies under 1 year of age
• people with weakened immune systems
• people with chronic illnesses, such as diabetes, lung disease, and cancer
• people who are pregnant or postpartum
• people who have had sepsis before
• people who have had a recent severe illnesses, undergone surgery, or been admitted to hospital

Vulnerability to sepsis is increasing. One reason for this may be antibiotic resistance — a term that refers to microbes becoming immune to drugs that once controlled many infections.

Treatments for sepsis

A doctor will provide rapid treatment for sepsis, including:

• treating the cause of the infection
• administering antibiotics, if the infection is bacterial
• providing oxygen and intravenous fluids to ensure blood flow to the organs
• providing a means of assisted breathing, if appropriate
• scheduling surgery, if necessary, to remove damaged tissue

Sepsis often requires treatment in a hospital, and some people need intensive care.

Older people, in particular, may also need treatment to:

• prevent pressure ulcers
• prevent deep vein thrombosis
• control glucose levels

Some severe cases of sepsis or septic shock do not respond to all disease-directed therapies. In these instances, healthcare professionals may need to provide end-of-life care.

Sepsis in newborns

Sepsis can develop within 24 hours of birth, and in newborns, the issue is called neonatal sepsis. A baby is considered a neonate up to 90 days after delivery.

There is a higher risk of neonatal sepsis if:

• The person had a group B streptococcal infection during pregnancy.
• Delivery is preterm.
• The water breaks more than 24 hours before delivery.

Late-onset neonatal sepsis starts 24 hours or more after delivery. It can stem from a bacterial, viral, or fungal infection.

There is a higher risk of late-onset sepsis if the infant spends time in the hospital to receive treatment for another problem or comes into contact with someone who has an infection.

Read more about sepsis in babies.

Sepsis in older adults

Older people have a higher risk of sepsis because they:

• often have other conditions, such as diabetes
• often have reduced immunity
• have more frequent infections, especially those that can lead to sepsis
• have a higher risk of malnutrition

Sepsis often stems from a urinary tract infection or an infection of the respiratory tract, such as pneumonia or the flu. In 2020, COVID-19 emerged as a risk factor for sepsis, especially in older adults.

The early signs of sepsis may be harder to spot in older adults than in younger people, and the issue can progress more rapidly.

According to Sepsis Alliance, people aged over 65 years are 13 times more likely to spend time in the hospital with sepsis than those aged under 65. In addition, 63% of people aged 60 and over have sepsis on entering intensive care.

After an older person recovers from sepsis, they may have an increased risk of:

• a repeat infection
• chronic pain and fatigue
• post-traumatic stress disorder, or PTSD
• organ damage

Overall, it is crucial for older people and their loved ones to recognize the signs of sepsis, ensure prompt treatment for any type of infection, and take steps to prevent sepsis from developing.

Diagnosing sepsis

A doctor diagnoses sepsis by:

1. taking a medical history, including details of any recent infections or other events
2. taking account of the person’s symptoms
3. performing a physical examination
4. evaluating blood pressure, temperature, heart rate, and other signs
5. doing laboratory tests to identify the infection

While it is essential to treat sepsis as soon as possible, early diagnosis can be challenging. Many symptoms, such as a high fever, occur with other conditions.

Preventing sepsis

Taking steps to prevent infections and receiving prompt treatment for any that arise can reduce the risk of sepsis.

Other strategies include:

• getting routine vaccinations, including those for the flu and pneumonia
• taking steps to prevent sores and wounds and keeping any that occur clean
• following handwashing guidelines
• seeking immediate medical attention if there are signs of an infection worsening

Outlook

Most people recover from sepsis with treatment. However, it can have a long-term effect on a person’s health, especially if it has damaged organs or the immune system.

The mortality rate for sepsis in the United States varies by severity, as the table below shows:

Death rates increase with age and are about five times higher for adults aged 85 and over.

Summary

Sepsis happens when the immune system has an extreme reaction to an infection. Early signs include a fever, difficulty breathing, and a rapid heartbeat.

Early treatment for sepsis is often effective, but it can progress and become harder to treat quickly.

Treat any infection right away, seek professional care if an infection worsens, and if signs of sepsis occur, go to an emergency room at once.