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The word "sepsis" causes many of us fear bordering on panic. Should we really be afraid of sepsis? What is really under that name? Find out what the symptoms of sepsis are, how is it treated and who is most at risk.

-Sepsiscauses a lot of confusion, many people still wonderis sepsis contagious- emphasizes prof. dr hab. Janusz Cianciara from the Department of Hepatology and Acquired Immunological Deficiency of the Medical University of Warsaw. - Meanwhile, contrary to popular belief, sepsis, as a general reaction of the body to infection, is not contagious at all. Fortunately, it does not occur as often as it would appear from press reports.

Sepsis as old as the world

He already wrote about sepsis, or sepsis, about Hippocrates, and yet we stillnot know everything about it . Doctors admit that sepsis is a challenge for them. - Only recently, most of the mechanisms governing it have been discovered - says prof. Cianciara. - There is still no clear answer to the question why in a basically he althy person a life-threatening critical condition occurs within a few or several hours.

Curiosity

The epidemicis associated with the illnesses of thousands of people. Meanwhile, specialists also name the incidence of an infectious disease in a specific area and at a given time in a greater number than in previous years. So the epidemic can already be called3-4 casesmeningococcal sepsis in military barracks.

Sepsis: causes

Everybacterial, viral or fungal infectionmobilizes the immune system to fight. His "special forces" are trying to trap the infection and fight it as quickly as possible. Sometimes, however, it happens that the immune barrier is weakened or is broken and a generalized organism is infected, i.e. sepsis.

This is a verycomplex process . Among other things, more and morecytokines(inflammatory mediators) appear in the blood. Under their influence, the heart rate accelerates, the temperature rises (or on the contrary - drops). Cytokines also have an effect on blood vessels. Micro clots may form. At the same time, the mechanisms involved in the dissolution of clots fail, and the damaged vessels leak plasma into the surrounding tissues. Hypoxic cells are damaged and necrotic.

In addition to circulatory problems, there are disturbances in consciousness,the kidneys are also damaged. Over time, more and more organs stop working properly. Sometimes it leads to complete multi-organ failure and shock, which is usually irreversible.

Sepsis: unusual first symptoms

The first symptoms of sepsis are not very specific and can be mistaken for flu symptoms. They may occur, among others :

  • fever or, on the contrary - decreased body temperature (below 36 degrees)
  • breathing faster
  • increased heart rate or drop in blood pressure
  • general weakness of the body
  • smash.

As the infection develops, symptoms increase rapidly. Very characteristic isa slight red or bluish rashon the limbs and body that does not fade under pressure. Depending on which organ was attacked, the following may also occur:

  • blood coagulation disorders
  • urinary retention
  • nausea and vomiting

If you notice them, especially after an operation, tooth extraction or when your body is weakening, immediatelycontact your doctor .

You can at your own expense (the National He alth Fund still cannot decide to reimburse you)get vaccinated against meningococcus- infants under 1 year of age are given two doses of the vaccine after consulting a doctor , for older children and adults - one. The price of one dose of conjugate vaccine is about PLN 140-170.

Sepsis is not contagious

This is by far the biggest misconception about sepsis. - Sepsiscannot be infected , because it is a term referring to disease symptoms accompanying generalized infection - emphasizes prof. Cianciara. - However, you can get infected with bacteria, viruses or fungi, and these, under favorable circumstances, may be responsible for the development of sepsis.

Among bacteria, apart from meningococci, sepsis can also be caused by:

  • staphylococci,
  • pneumococcus,
  • streptococci,
  • E. coli bacteria.

Among fungi - Candida albicans, and among viruses - those causing hemorrhagic fever.

- There is no vaccine against sepsis - adds prof. Cianciara. - There are, however, vaccines against some bacteria that can cause sepsis, such as meningococci and pneumococci.

Sepsis - a growing problem
  • About750,000 people suffer from sepsis annually in the United States. people .
  • The U.S. he alth care system spends over $ 17 billion on it every year.
  • Experts estimate that three in ten patients dieovernightmonth . If postoperative complications are mentioned as the cause of death on the death certificate, sepsis may be suspected to be the real cause of death. 86% of the surveyed doctors from the European Union countries share the view.
  • It was the sepsis that beat Franklin Delano Roosevelt, Andy Warhol and Freddie Mercury. Vaclav Havel won with her.
  • The incidence of severe sepsis is increasing every year due to an aging population, increasing antibiotic resistance and widespread invasive treatments.

Anyone can get sepsis

The truth is sad - anyone can get sick. However, those whose immune systemis not fully functional(children, the elderly and chronically ill) oris weakened(stress, inappropriate nutrition). Those who undergo invasive procedures also belong to the increased risk group. The disease develops very quickly, hence it is so important to recognize it quickly and immediately starttreatment in the hospital.

Worth knowing

Quick sepsis diagnosis is now possible in every doctor's office

Since January 2016, a new diagnostic technology has appeared in Europe and Poland, enabling rapid testing of procalcitonin - a sensitive marker of sepsis. So far, this type of research has been performed only in well-equipped laboratories in large hospitals. The test is performed with the use of the innovative, miniaturized Labgeo IB-10 diagnostic device that enables quantitative testing of procalcitonin directly in a doctor's office, outpatient clinic, hospital emergency ward, emergency room of even the smallest hospital and an ambulance. The measurement is fully automated, and the test result is obtained within 20 minutes of blood collection. The quality and reliability of the procalcitonin test used in the Labgeo IB-10 device has been confirmed in many clinical trials.

Source: PAP Press Center

Sepsis: treatment

Treatment consists in administering as soon as possible:

  • antibiotics (during the first hours when symptoms appeared),
  • liquids,
  • cardiac drugs,
  • anticoagulant drugs.

The most important thing, however, is to determinewhich microorganism caused the sepsis , and therefore to perform blood cultures. The primary source of infection in the body is also looked for: abscesses or inflammations. Most often, the organism responsible for sepsis is detected in the blood, which facilitates therapeutic management. However, at around30percentcases could not be confirmed (identified) by bacteriological examination of the type of infection. In such situations, therapy with broad-spectrum antibiotics is started just as quickly.

Expert comment on the diagnosis and treatment of sepsis in PolandProf. dr hab. Krzysztof Kusza, MD, PhDSpec. anaesthesiology and intensive care, president of the Polish Society of Anaesthesiology and Intensive Therapy.

Sepsis and septic shock are life-threatening and require immediate treatment in the Anesthesiology and Intensive Care Units. Mortality in the course of sepsis and septic shock is very high, reaching 50%.

This means it is higher than the mortality from myocardial infarction and the mortality from sepsis is higher than the combined mortality from lung cancer and breast cancer.

The report of the Supreme Audit Office of 2022 emphasized the lack of reliable national data on the incidence of sepsis and septic shock.

According to the Supreme Audit Office, keeping a registry of sepsis would allow obtaining reliable data on diagnosed cases, necessary for the analysis of its symptoms, treatment methods and mortality rate. In Poland, we do not have data on the etiology of these cases and the type with a distinction between outpatient and inpatient.

For several years, there has been a strong tendency to simplify the classification of sepsis and to standardize the definition of these syndromes of symptoms and diseases. Based on the "Surviving Sepsis Campaign" guidelines implemented by an international team of experts, the following definition of sepsis currently applies:

"Sepsis is a life-threatening multi-organ failure caused by dysregulation of the patient's response to infection, and septic shock is sepsis with circulatory disturbances and associated tissue hypoperfusion, which is the cause of high mortality."

They were the basis for modifying the coding of diagnoses in the ICD10 system published by WHO (modification 10).

The Polish version of the "International Statistical Classification of Diseases and He alth Problems" still uses the concept of sepsis, which is not scientifically related and contradicts current medical knowledge of sepsis and septic shock.

Sepsis and septic shock are characterized by multi-organ failure, which is at risk of very high mortality in the course of an atypical system response to infection.

I presented this issue during the meeting of the Parliamentary Committee for He althcare Organization at its invitation on 10/09/2019. Conclusions made during thisUnfortunately, the meetings were not brought to Parliament.

The definition of sepsis emphasizes the essential importance of organ dysfunction in the course of the infection. Potential life threat and the need for prompt diagnosis and immediate treatment. WHO also presents a simplified definition of sepsis:

"Sepsis is a life-threatening condition that occurs when the body's response to infection damages its own tissues and organs."

Patients with an "SOFA" organ failure score of 2 and above have an overall risk of mortality of approximately 10% in the general hospital population when sepsis is suspected. This risk is greater than the 8.1% mortality from ST segment elevation myocardial infarction.

Despite this, a heart attack is commonly considered a life-threatening condition requiring immediate intervention, and sepsis does not …?

OAiiT is usually the last step in treating septic shock patients with high mortality due to multi-organ failure, which could have been prevented earlier. Hence, representatives of the anaesthesiology and intensive care discipline are interested in rapid intervention and diagnostics at the basic stages of sepsis diagnosis and treatment. Thus, the suspicion of sepsis is quickly raised.

The reasons for this are not complex and include:

  • Lack of education among medical personnel, and thus social awareness and awareness of the phenomenon in the medical staff itself.
  • Inability to diagnose sepsis in the category of the International Classification of Diseases and He alth Problems ICD-10 in Poland.
  • Lack of quick diagnostics on critical parameters and microbiological diagnostics

The consequences of these deficiencies are as follows:

  • High mortality in excess of that from acute coronary syndromes and certain neoplastic diseases.
  • Surviving a septic shock usually makes it impossible to return to an active working life.
  • Patients become participants in a dialysis program or apply for a kidney transplant
  • Sepsis generates significant costs (the average cost of treating septic shock in the range of 30 person-days in the ICU is 200-400 thousand zlotys)

Can it be avoided? or reduce sepsis mortality?

Yes. Through the appropriate organization of the he alth care system and universal education.

This means you should:

  • Establish intermediate structures with the hallmarks of Intensive Surveillance or Intensive Care Units. In Poland nowthere is no intermediate level between the primary department and ICU.
  • Introduce quick diagnostics and quick referral of patients in the initial stage of sepsis to adequately prepared human resources and technology departments of an intermediate hospital, such as (Step-down Unit, Intermediate Unit, HDU, etc.) (monitoring, supervision and care) .
  • Include sepsis in the International Classification of Diseases and He alth Problems ICD-10
  • Finance modern, effective medical technologies
  • Increase the quality of the treatment process at every stage (monitoring the quality of the treatment process)
  • Introduce CMJ initiatives at the Jagiellonian University - establish Rapid Response Teams as one of the solutions leading to rapid clinical evaluation of patients with suspected sepsis!

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Category:

Infectious diseases