All about Sepsis

In the UK, every year 245,000 people are affected by sepsis with at least 48,000 people losing their lives from sepsis related illnesses. Worldwide, someone dies from sepsis every 3 seconds.

What is sepsis?

Sepsis is a potentially life-threatening condition which occurs when the body’s response to an infection overwhelms the body, damaging its own tissues and organs. In serious cases, and if not treated quickly, it can lead to organ failure and even death.

Sepsis is your body’s overactive and toxic response to an infection, and is a medical emergency, as it requires fast diagnosis and treatment. Infections that lead to sepsis often start in the lungs, urinary tract, skin, or gastrointestinal tract. Sepsis is not contagious.

Sepsis is sometimes called septicaemia or blood poisoning; however, blood poisoning is not an accurate description of sepsis, and the two terms should not be used interchangeably.

If left untreated, sepsis can lead to severe sepsis and septic shock.

Who is at risk of sepsis?

Anyone who has an infection can develop sepsis. Some people have an increased risk of getting an infection which increases the risk of developing sepsis.

These include:

• People over the age of 75.
• People with diabetes, obesity, cancer or kidney disease.
• People with a weakened immune system, including those having chemotherapy or who have recently had an organ transplant.
• People who have recently had surgery or a serious illness.
• People who are in hospital.
• People who have severe injuries, such as large burns or wounds.
• Babies under the age of one, particularly if they are born prematurely or their mother had an infection while pregnant.
• Women who have recently given birth.
• People who have survived sepsis previously.

What causes sepsis?

Sepsis occurs when your immune system has a dangerous reaction to an infection. When you have an infection, your immune system works to fight the infection. Sometimes your immune system stops fighting the infection and begins to cause damage to your tissues and organs and causes inflammation throughout your body. Blood clots can also form in your blood vessels which reduces the blood flow to your organs; this can cause organ damage or organ failure.

There are three stages of sepsis.

 These are:

• Sepsis.
• Severe sepsis.
• Septic shock.

More recently a more fluid scale is used which identifies infection and bacteraemia (which is bacteria in your bloodstream), then sepsis and septic shock. Septic shock is a serious complication of sepsis that can include very low blood pressure, an altered mental state, and organ dysfunction/organ failure.

The inflammation caused by sepsis leads to a dangerous drop in blood pressure and a decrease in blood flow to vital organs such as the brain, heart and kidneys. The complications of septic shock can be fatal if it is not treated quickly.

What are the signs of sepsis?

The symptoms of sepsis can vary between people, but some common signs and symptoms include:

• Fever, chills or a very high or low temperature.
• Feeling very hot or cold to touch.
• Having blue, grey, pale or blotchy red skin, lips or tongue. On brown or black skin, this may be easier to see on the palms of the hands or soles of the feet.
• Feeling very unwell.
• Have swelling or pain around a cut or wound.
• Rapid heartbeat.
• Rapid breathing, difficulty breathing or breathlessness.
• Not urinating or reduced urination.
• Clammy skin or a rash.
• A rash that does not fade under a glass, similar to that of meningitis.
• Pain or discomfort in the muscles or joints.
• Nausea or vomiting.
• Weakness or fatigue.
• Reduced mental function.
• Behaving as though they are confused or disorientated.
• Slurred speech.

A baby or young child may also:

• Have an unusual, weak or high-pitched cry that is different to their normal cry.
• Not be responding like they normally do, or may not be interested in feeding or doing normal activities.
• Be sleepier than normal or difficult to wake up.

A person may not have all of these symptoms; however, if you think that you or someone else may have sepsis, it is important not to wait. Call for an ambulance or go straight to A&E.

Sepsis can be particularly hard to spot in:

• Babies.
• Young children.
• People who have difficulty in communicating.
• People with learning difficulties.
• People with dementia.

If you are unsure, you can call 111 who can offer you advice or call you an ambulance if needed.

Sources of infection

Infections that can lead to sepsis can start in a number of ways and can be triggered by an infection in any part of the body.

The most common sites of infection that can lead to sepsis are the:

• Lungs.
• Urinary tract.
• Abdomen.
• Pelvis.

Bacterial infections can lead to sepsis and are usually the most common cause.

Some examples of bacterial infections that can lead to sepsis include:

• Pneumonia.
• Urinary tract infections.
• Skin infections.
• Meningitis.

Infections can also occur as a result of medical procedures, such as surgeries or catheterisation, as this can introduce bacteria into the body. Open wounds, particularly those that are not properly cleaned and treated, can also become infected and lead to sepsis. Finally, intravenous drug use can introduce bacteria and other pathogens into the bloodstream, leading to sepsis.

Sepsis can also be a result of other infections, including viral infections, such as the flu, COVID-19, or fungal infections such as athlete’s foot or ringworm.

It is not always possible to prevent sepsis; however, there may be things you can do to prevent the infections that can lead to sepsis.

This includes:

• Keeping any wounds clean and well cared for.
• Taking antibiotics correctly – follow the instructions and take all your prescribed antibiotics, even if you feel better.
• Keeping up to date with vaccinations – this is particularly important for babies, children, older people and pregnant women.
• Washing your hands regularly and practising good hygiene.

Effects of sepsis

Post-sepsis syndrome (PSS) is a condition that affects up to 50% of survivors of sepsis.

It includes physical and sometimes psychological long-term effects, which can include:

• Fatigue or lethargy.
• Difficulty sleeping – this can include either difficulty getting to sleep or difficulty staying asleep.
• Shortness of breath or difficulty breathing.
• Repeat infections, particularly in the first few weeks and months after having sepsis.
• Low immune system.
• Muscle or joint pain which can be debilitating.
• Swelling in the limbs.
• Reduced organ function – this could be in one organ or multiple.
• Reduced appetite.
• Hair loss.
• Skin rash.
• Hallucinations.
• Flashbacks.
• Panic attacks.
• Nightmares.
• Decreased cognitive functioning.
• Decreased self-esteem.
• Memory loss.
• Difficulty concentrating.
• Post-traumatic stress disorder (PTSD).

The risk of having PSS is higher among people admitted to an intensive care unit (ICU) and for those who have been in the hospital for extended periods of time. There are things you can do to help if you have PSS.

 This can include:

• Doing gentle exercise to build your strength.
• Changes to your working hours or conditions while you are recovering.
• Try to prevent repeat infections, for example by practising good hygiene.
• Try to get as much regular sleep as you can.
• Try to eat and drink enough healthy foods, even if you only have a small appetite.

Complications of sepsis

Sepsis can cause various complications including:

• Blood clots can form in the blood vessels. This can lead to deep vein thrombosis, pulmonary embolism and stroke.
• Septic shock which is a severe form of sepsis. This causes dangerously low blood pressure and reduced blood flow to vital organs, including the brain, heart and kidneys.
• Multiple organ failure. Sepsis can lead to the failure of multiple organs. This can include the lungs, liver, kidneys and heart. Organ failure can be life-threatening.
• Acute respiratory distress syndrome (ARDS). This is a condition where the lungs become inflamed and filled with fluid. This makes it difficult to breathe and can result in needing assistance with breathing via a ventilator.
• Cognitive impairment. Sepsis can lead to confusion, memory loss, and other cognitive impairments. This is especially common in older adults.
• Post-sepsis syndrome. Some people can experience long-term physical and psychological effects after having sepsis. This can include chronic pain, fatigue, depression and PTSD, among other things.

How is sepsis diagnosed?

Medical professionals will want to find out where the underlying infection is coming from so that it can be treated. A sample of the infection will also be useful as this will help with the treatment plan including which medication is the most suitable.

Blood tests will help to determine:

• If there is evidence of infection.
• If there is evidence of blood clotting.
• If there is any abnormal liver or kidney function.
• If there are lower levels of oxygen in the blood than the body needs.
• If there are any electrolyte imbalances.

In order to find the source of the infection, samples may be taken from:

• Urine.
• Mucus or saliva from the respiratory tract.
• Liquid from the wound.

If the source of the infection cannot be found, other tests may be carried out.

This may include:

• X-rays – This is a quick and painless procedure commonly used to produce images of the inside of the body. An X-ray may be used to show any infection in the lungs.
• Ultrasound – This is a procedure that uses high-frequency sound waves to create an image of part of the inside of the body. Ultrasounds can show infections in the kidney or gallbladder.
• Magnetic resonance imaging (MRI) scan – This is a type of scan which uses strong magnetic fields and radio waves in order to produce detailed images of the inside of the body. An MRI scanner is a large tube which contains powerful magnets and the person being scanned will lie inside the machine. This type of scan may be useful to see soft tissue or bone infections.
• Computerised tomography (CT) scan – This type of scan uses X-rays and a computer to create detailed images of the inside of the body. They are carried out in hospital by radiographers. Infections in the liver, pancreas or other abdominal organs are easier to see on CT scans.

How is sepsis treated?

Sepsis needs treatment in hospital straight away as the condition can deteriorate quickly. Early treatment increases the likelihood of the person making a full recovery.

Someone who has sepsis will usually need to be cared for in an intensive care unit (ICU). These are specialist hospital wards that provide treatment and monitoring for people who are very poorly. They are staffed with specially trained healthcare professionals and contain sophisticated monitoring equipment. Intensive care is usually needed if someone is seriously ill and requires intensive treatment and close monitoring. Most people in an ICU have problems with one or more organs, which is usually the case with someone who has sepsis, especially when the condition is more severe.

Antibiotics should be given within one hour of arriving at the hospital.

Someone who develops sepsis may need:

• Treatment in the intensive care unit.
• Surgery to remove areas of infection.
• A ventilator machine to help with breathing.
• A lengthy hospital stay may be required in some cases.

Different medications are used to treat people with sepsis and septic shock.

These include:

• Antibiotics – Treatment from antibiotics should begin as soon as possible. Broad-spectrum antibiotics, which are used against a variety of bacteria, are often used initially until blood tests show which germ is causing the infection. Once this has been identified, the antibiotics may be changed to treat that specific infection. For further reading about antibiotics, please see our knowledge base.
• Intravenous fluids – These are specially formulated liquids that are injected into a vein to prevent or treat dehydration. They are usually given through a drip. They are commonly used for people who are unwell in hospital. It is a simple, safe and common procedure with a low risk of complications.
• Vasopressors – This is a drug that healthcare providers use to make blood vessels constrict or become narrow. They are usually used in people with low blood pressure and they will help to get enough blood to their vital organs.
• Insulin – Insulin therapy may be used in order to maintain blood glucose levels in people with severe sepsis.
• Painkillers – These are used to help manage pain and make the patient as comfortable as possible. Sometimes stronger painkillers are required, for example morphine.
• Oxygen – Oxygen therapy may be given if your lungs aren’t able to provide enough oxygen on their own. Oxygen therapy helps your organs and tissues get the oxygen they need to work properly and be healthy.
• Ventilator – This is a machine that helps with breathing. A tube is placed in the mouth, nose or through a small cut in the throat.

During treatment for sepsis, a catheter or drain may be used. Drains are tubes used to remove any build-up of blood or fluid from the body, and catheters are thin tubes inserted into the bladder to drain urine.

Doctors and other healthcare professionals should be aware of post-sepsis syndrome among sepsis survivors. This way, patients can receive the proper support.

This can include:

• Emotional and psychological support which can include counselling, cognitive behavioural therapy (CBT), or psychiatric assessment.
• Physical support such as physical therapy.

If you are a sepsis survivor and have ongoing symptoms, you should make an appointment with your GP to get some advice and support.

If you have been affected by sepsis in any way, Sepsis Trust UK offer monthly support groups, information and resources for you to access.