- 1 What is Sepsis?
- 2 Types and Symptoms of Sepsis
- 3 Causes of Sepse
- 4 Is sepsis transmissible?
- 5 Groups of risk
- 6 How is the diagnosis of sepsis made?
- 7 Does sepsis cure? What is the treatment?
- 8 Medications for Sepse
- 9 Complications
- 10 How to prevent Sepse?
What is Sepsis?
Also known as generalized infection, septicemia or systemic inflammatory response syndrome (SIRS), sepsis is an inadequate manifestation of the body in the face of an infection.
It starts with a local infection and causes a more serious blood infection, as the body, when trying to fight the first, ends up compromising the functioning of all organs. Thus, it becomes lethal, as the person affected by the inflammation may not be able to bear it due to dysfunction or multiple organ failure. In Brazil, the disease affects about 400 thousand people a year and is fatal for half of them.
Sepsis has stages differentiated by symptoms and their severity. Are they:
The local infection reaches the bloodstream and causes inflammation throughout the body. SIRS can remain in the body even after this initial infection no longer exists.
It has some usual symptoms of the common infection, so situations can occur in which the symptoms of the infection only appear when it has already become sepsis. They are:
- Hyperthermia (high fever);
- Nausea and vomiting;
- Prostration (physical weakness, weakness);
- Difficulty breathing.
It is characterized by abnormal tissue perfusion (introduction of liquid substances into tissues) and organ dysfunction. The inflammatory chemical mediators cause an increase in the permeability of blood vessels, facilitating the leakage of fluid to some organs, such as the skin and lungs.
Therefore, the patient may present:
- Organic hypoperfusion (low blood supply);
- Hypotension ;
- Hyperbilirubinemia (abnormal amount of bilirubin in the blood);
- Change in the level of consciousness;
- Change in coagulation;
- Oliguria (reduced urine production);
- Evidence of visceral perforation (mainly in the abdominal cavity) or peritonitis;
- Lactic acidosis;
- Swelling (edema) and water in the lungs.
Disseminated intravascular coagulation (ICD), resulting from severe sepsis, prevents oxygen and nutrients from reaching vital organs. As a result, homeostasis (balance of body functions and chemical compositions) cannot be maintained without intervention, there is no response to the administration of fluids intravenously and blood pressure drops dramatically.
As a consequence of these factors, it can happen:
- Thrombosis and hemorrhage;
- Formation of microthrombi (clots that form in the heart and small vessels);
- Hypovolemia (abnormal decrease in blood volume);
- Tissue hypoxia (low oxygen content in the tissues);
- Gangrenous necrosis (tissue death) of arms, legs, hands and feet;
- Multiple organ failure;
In some people the symptoms can be atypical, such as:
- Hypothermia ;
- Petechiae (red spots on the body caused by a small hemorrhage from blood vessels);
- Increase in the leukocyte count and decrease in the number of platelets;
- Hypermetabolism (with increased glycogenolysis, hepatic glycogenolysis, lipolysis and muscle, intestinal and connective tissue protein catabolism).
Read more: What can be low temperature (Hypothermia)?
Sepsis arises when a local infection is not controlled, favoring the invasion of infectious agents in the bloodstream. As these microorganisms arrive en masse in the blood, the defense cells need to act in several regions at the same time, then an inflammatory response appears in the whole body. Therefore, inflammation is not an influence of the bacteria, but rather a way for the body to defend itself.
The infection that results in sepsis is usually of bacterial origin, but it can also be caused by fungi, viruses and parasites. Thus, any more serious infection can lead to a generalized infection, whether hospital or not.
As many elements related to the causes of this pathology are still unknown, mainly because there is no understanding of the relationship between immunity, inflammation and coagulation, there is no specific criterion to point out precise risk factors. Even so, there are three cases of sepsticemia that are more frequent:
- Pulmonary sepsis: occurs when the primary infection is the lung (pneumonia);
- Urinary sepsis: occurs when the focus of the primary infection is any organ of the urinary tract (kidneys, ureters, bladder and urethra);
- Abdominal sepsis: occurs when the primary infection is the peritoneum (peritonitis), which is a membrane that lines the inner wall of the abdomen and most organs of the abdominal region.
However, other infections are also common to progress to generalized infection:
- Central nervous system infections;
- Erysipelas (inflammation of the skin);
- Endocarditis (infection of the endocardium);
- Arthritis (inflammation of the joint);
- Otitis (ear infection);
- Surgical wounds.
As it is the aggravation of a previously established infection, septicemia cannot be transmitted from one person to another. Contact with a septic patient only becomes a matter of concern due to the possible risk of transmission of the original infection. That is, if the microorganism that causes sepsis is not contagious, there is no danger in contact with the patient.
Although anyone can have an infection that results in SIRS, some groups are more likely to experience widespread organ infection:
- Hospitalized people;
- Malnourished people;
- People with weakened immune systems;
- Users of corticosteroids or any other immunosuppressant;
- HIV carriers;
- Patients who have had chemotherapy or who have neoplastic cells (tumor);
- People with chronic diseases (heart failure, kidney failure and diabetes);
- Children under one year old;
- Alcohol and other drug users;
- Places that present wounds or injuries, mainly caused by firearms, car accidents or burns.
In addition, it must be considered that some bacteria that cause infection are more harmful than others and that the organisms do not deal with the invading germs in the same way. Thus, there may be different inflammatory responses.
Cases are also more frequent in less favored countries and regions, where the diagnosis is usually late and there is a lack of intensive care beds.
As most cases of sepsis occur in ICUs, suspicions tend to come from general practitioners or the medical team responsible for the patient in question. The diagnosis of generalized infection depends on a careful clinical and laboratory evaluation by a pathologist to identify the infectious focus that started the syndrome. Tests such as:
- CBC and blood culture (blood tests);
- Urine tests;
- Culture of any biological material that can be collected;
- Measurement of serum lactate levels;
- Antimicrobial sensitivity test;
- Measurement of pressure and saturation of central venous oxygen;
- Magnetic resonance imaging;
Candidate biomarkers and mediators of sepsis have been investigated, as they are considered useful both in diagnosis and in their classification. It is bet that the use of these substances will allow the prediction of the outcome of the pathology.
As it is a difficult case to be diagnosed clinically, it is common for neonates to remain asymptomatic until a hemodynamic and respiratory collapse occurs. If there is a suspicion of sepsis, even if remote, it must be treated with antibiotics and the newborn must be kept under observation until the results of the cultures are obtained.
A quick diagnosis is crucial for the treatment to be effective.
The treatment of sepsis should be carried out as soon as possible to prevent the inflammation from becoming larger and more widespread and, thus, increasing the chances of the patient surviving. It is recommended that patients with severe sepsis or septic shock be treated in an intensive care unit (ICU), as the treatment requires full patient care and sophisticated equipment.
Immediately after the suspicion of septicemia, it is common to prescribe intravenous broad-spectrum antibiotics, as they are effective against a greater variety of bacteria. When reached, they are eliminated from the blood and the stimulus to the inflammatory process is interrupted. However, these drugs have no effect if the infection is not of bacterial origin. Therefore, when the results of the cultures are available, there may be a readjustment of the antibiotic used.
Volemic Replacement and Vasopressors
Volume replacement should be performed, as it replenishes the blood lost in the event of hypovolemia and avoids the damage caused by inadequate tissue perfusion. If it does not work, vasopressor drugs come into action, which help to constrict the vessels and stabilize blood pressure levels. If even these drugs are not enough, adrenaline ( epinephrine ) should then be added to the treatment.
Mechanical ventilation and Hemodialysis
Respiratory failure cases require mechanical ventilation or elective tracheal intubation and renal failure cases require hemodialysis.
Strict glycemic control should be carried out so that cases of hypoglycemia are identified and, therefore, treatment is immediate.
As there are numerous obstacles to oral feeding, alternative routes should be considered, as long as the patient does not have unstable blood circulation. Enteral nutrition (using a nasogastric tube) is the most frequently used, as it maintains the integrity of the digestive tract, reduces the incidence of complications and minimizes the risk of displacing the bacteria.
Parental nutrition (directly in the bloodstream) is indicated when the enteral route does not meet the estimated nutritional needs or when the gastrointestinal system is impossible.
Anticipated Directed Therapy
These are measures that must be taken early in the treatment of severe sepsis, optimizing preload, afterload and cardiac contractility.
The use of corticosteroids is recommended for patients with septic shock who, even after volume replacement and vasopressor drugs, still maintain hypotension .
Other measures that can be taken are:
- Drainage of abscesses (pus pockets that accumulate in tissues and organs);
- Removal of necrotic tissues;
- Application of a central venous catheter and an arterial catheter (with intravenous fluids);
- Removal of infected devices or prostheses;
- Actions to reduce deep vein thrombosis and ulcers;
- Measurement of hemodynamic variations.
Drotrecogin alfa activated (activated protein C), which was previously marketed for severe sepsis, has been proven to be ineffective.
The drugs usually indicated are:
- Insulin ;
- Modulators of the immune system;
- Vancomycin ;
- Ampicillin ;
- Norepinephrine or norepinephrine ;
- Dopamine ;
- Hydrocortisone ;
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Even when a patient survives a severe sepsis crisis or septic shock, he can have sequelae, mainly neuropsychological and myopathic (related to muscle fibers), which change his quality of life.
To prevent septicemia, you need to decrease your risk of getting infections. For this, individual and collective efforts are needed.
When it comes to hospital environments, there must be a strict practice of cleaning and sterilizing medical instruments and the use of gloves, aprons and lab coats by professionals.
In addition, it is also possible to prevent infections at home, through the following practices:
- Wash your hands frequently with soap and water;
- Do not smoke near children;
- Keep the vaccination of children up to date;
- Pay attention to the occurrence of fever (which is a sign to seek medical advice);
- Avoid the habit of bringing your hand to your mouth or nose.
Septicemia is the leading cause of deaths in ICUs worldwide and its treatment needs to be carried out with the utmost urgency. However, the poor knowledge of the population about the syndrome leads many cases to be diagnosed too late.
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