Sepsis Calls for Early Treatment by an Infectious Disease Specialist

By Dr. Sneha Thatipelli

Sepsis is a life-threatening medical emergency that occurs when the body has a dysregulated response to infection. It causes the body’s normal infection fighting response to malfunction, resulting in poor organ function and a highly increased chance of death.

Sepsis is not an infection, rather it is a reaction to infection(s). With this dangerous syndrome, early consultation is key to better outcomes. The Infectious Diseases Society of America (IDSA) cites a study showing that early consultation with an infectious disease specialist is associated with a 40% reduction in death from the disease.

In the United States about 1.7 million people get sepsis each year, according to the Centers for Disease Control and Prevention (CDC). Worldwide an estimated 15% of hospitalized patients get sepsis.

Infectious disease doctors are often consulted to help manage and treat patients with sepsis. 

What causes sepsis and septic shock?

When an infection normally occurs from viruses, bacteria, fungi or parasites, your immune system tries to fight it off. Antibiotic, antiviral, antifungal and antiparasitic medications can be used to help.

Sometimes – and we are not exactly sure why – as the immune system fights the invading germs, it also results in a dysregulated response leading to dysfunction and injury of other critical organs. This is how sepsis begins.

Infections that commonly result in this syndrome are those occurring in the lungs, urinary tract system, bloodstream, digestive system, wounds and burns.

A sepsis case is considered severe when signs appear of a malfunctioning organ, like difficulty breathing. The next stage is septic shock.

Septic shock

When the disease progresses to septic shock, it causes a serious drop in blood pressure. This damages the patient’s organs such as the lungs, heart, brain, liver and kidneys.

Severe organ damage from the condition can lead to death. It is the third leading cause of death in U.S. hospitals, with sepsis patients often considered to be the sickest patients in the hospital. Most people do survive mild cases of sepsis. But those with septic shock have a 30%-40% chance of dying from the disease.

Be aware of sepsis symptoms

Early intervention can depend on when medical professionals spot symptoms of the syndrome. This isn’t always easy, as symptoms vary by individuals and are often not specific. Common symptoms of the condition include:

• Increased heart rate.
• Difficulty breathing, with fast, shallow breaths.
• Fever, and sweating for no obvious reason.
• Mental changes.
• Lightheadedness.
• Other symptoms can be specific to the infection underlying sepsis, such as a cough from pneumonia.

When to seek medical help

You should see a doctor if you experience any of the sepsis symptoms above or if you have an infection that isn’t getting better. Remember, any infection can lead to this condition, so being proactive with infections can be life-saving.

Always seek help if you have symptoms of severe septic shock

• Inability to stand on your own.
• Extreme mental confusion.
• Lightheadedness.
• Having a difficult time staying awake or difficulty being awakened.

If you’re hospitalized with severe sepsis or septic shock, seek out consultation by an infectious disease specialist. The IDSA study noted above shows that in-hospital mortality was significantly lower for patients who had an infectious disease consultation within 12 hours of arrival.

Who has elevated sepsis risk factors?

Anyone can get this syndrome, but most people who get it have at least one underlying medical condition like a weak immune system that makes them susceptible to infection. Others with higher sepsis risk factors include:

• People with reduced immune response, which includes individuals with HIV or undergoing cancer treatment.
• Infants and people over age 65.
• Those with a chronic disease like diabetes and heart disease.
• People with catheters, breathing tubes or other devices in the body for treatment.
• Those in the ICU or who experience long hospital stays.

Sepsis diagnosis

Early diagnosis and treatment are key to survival. Infectious disease specialists are uniquely qualified to fight the infections that cause this condition and its snowballing effects. Experts estimate that every hour of delay in treatment increases the risk of death.

Arriving at a diagnosis of sepsis is a major delay in treating sepsis. It’s not easy to pinpoint, as symptoms of early sepsis can mimic other health conditions.

In conjunction with evaluating patients’ symptoms, doctors use several means to try to identify the underlying infection. Diagnostic tests may include blood and urine samples along with X-rays, ultrasounds and MRIs to identify the source of infection.

Sepsis treatment

Sepsis patients need close monitoring. Medications are the primary form of treatment in most cases. This includes IV fluids as soon as possible.

Antibiotics are also started quickly when an infection and/or sepsis are identified. When the source of infection is not known, antibiotics that are effective against a range of bacteria may be given first. Once the cause of infection is known, the antibiotics most effective for that infection will be given.

Vasopressors & adjunctive measures

Medications called vasopressors may be used in order to help increase dangerously low blood pressure. Insulin can also be given to keep blood sugar levels at appropriate levels.

Adjunctive measures are used to support patients with sepsis. These can include oxygen supplementation and dialysis. Some patients may even need procedures or surgeries to help remove sources of the infection.

How can you prevent sepsis or the risk of getting it?

The #1 way to prevent sepsis is to prevent infections that can lead to it.

• Practice good hygiene.
• Work with your doctors to manage chronic health conditions.
• Get recommended vaccinations.
• If you’re a cancer patient, follow all precautions to prevent developing an infection from treatments.
• Know the symptoms.
• Seek help as soon as possible when you have an infection that isn’t getting better – particularly if you are in a high-risk group.

Hospital staff can also help prevent infections by implementing comprehensive epidemiology and antibiotic stewardship programs.