Wednesday 13 September 2017

World Sepsis Day

Today is World Sepsis Day.

Here are some key points from World Sepsis Day 2017

What is sepsis?
Sepsis is a life-threatening condition that occurs when the body's response to an infection damages its own tissues and organs. Instead of local inflammation resulting from a local infection, which would be the appropriate response, the body’s entire system goes into inflammation. That’s sepsis. It is the leading cause of death from infection around the world, despite advances in modern medicine like vaccines, antibiotics, and acute care. Millions of people around the world die of sepsis every year.

How can this “inflammation” result in death?
This inflammatory response can lead to dehydration and changes in circulation, for instance a drop in blood pressure. This can compromise the ability of the circulatory system to provide adequately oxygen etc. to the tissues. That leads to dysfunction in various organs, such as the lung, heart, kidney, and brain. It can also lead to shock, multiple organ failure, and death, especially if it is not recognized early and treated promptly. Sepsis is an emergency.

How do I know it is sepsis?
Usually the first symptoms are those associated with the source of infection, such as a cough due to pneumonia or abdominal pain from appendicitis. Fever, a high pulse rate, and accelerated breathing are also signs. Everyone should be aware of the main clinical symptoms that indicate the worsening of an infection. Shortness of breath, reduction in urine output, dizziness, or altered mental status with confusion, agitation, or drowsiness can be signs of organ dysfunctions. In laboratory tests, sepsis often coincides with high white blood cell counts. But in the highly acute phase, and especially in immunocompromised patients, there may also be a decrease in white blood cell counts. In most cases, indicators of inflammation are increased.

Can sepsis be treated successfully?
Yes. The first hours of treatment are the most important. Patients must receive appropriate antibiotic therapy as soon as possible. Blood cultures and cultures from the site of infection under suspicion should be taken to detect the cause. Patients should also have their blood lactate levels measured, as this is a sign of dysfunction in the circulatory system. Patients with severe signs, such as hypotension and elevated lactate levels, should also receive fluids. Depending on the severity of organ dysfunction, they may require treatment in an intensive care unit.
If the sepsis has been caused by an infected foreign object in the body, a stone in the renal pelvis, or a ruptured intestine, then antibiotics alone are not enough. In these cases the focus of the sepsis or the foreign object needs to be removed surgically.

Is it normal to feel continually exhausted after having sepsis? Will I recover the energy I had before?
Fatigue after any serious illness, including sepsis, is very common. Your body has gone through a tremendous ordeal; it not only battled an infection, but it also dealt with sepsis, which could have resulted in death. Now that your body has successfully recovered from the immediate danger of sepsis, you need to rest, begin to regain your strength, and rebuild your body’s reserves.
If you continue to be exhausted, there may be other issues going on. You may want to consider a check-up with your doctor or nurse to be sure that other parts of your body, such as your thyroid, are functioning properly. You can also help rebuild your energy and strength by eating a healthy, balanced diet and getting enough physical exercise. Exercising when you are already tired may not seem easy, but if you start slowly, such as with regular walks around the neighborhood, you should be able to build up your energy. Also, check if there are any health rehabilitation programs available to you. In these programs, qualified personnel help you with simple exercise programs and monitor your progress over time.
Many people have cognitive problems like memory loss, inability to concentrate, and difficulty performing mental tasks that used to be easy before sepsis. It seems that the older you are when you get sepsis, the higher the risk of memory problems afterwards.

Can I prevent sepsis?
Preventing infections is the best way to prevent sepsis. Although there are no specific vaccines to prevent sepsis, vaccines are available for certain sepsis pathogens, such as pneumococci. Especially small children, people over 65, and patients who have no spleen should get vaccinated – they are particularly susceptible to pneumococci. This includes people who were born without a spleen as well as people who lost theirs due to an injury, surgery, or aggressive chemotherapy. You can also help prevent infection by maintain a healthy lifestyle with nutritious food, exercise, and rest. Wash your hands frequently. Seek medical help if an illness does not seem to be improving or is getting worse. Do what you can to prevent hospital-acquired infections. If you do get an infection, you can prevent sepsis by treating it seriously.
This means:
• Taking antibiotics as prescribed
• Finishing the entire course of antibiotics
• Don’t take antibiotics needlessly; this helps reduce the chances of developing antibiotic-resistant infections
• Don’t take someone else’s antibiotics
As healthcare professional you can help to reduce hospital acquired infections by following the patient safety program of the WHO.

Are there any specific risk factors that increase a person's likelihood of developing sepsis?
Anyone can get sepsis, even someone who was previously healthy. However, people with diabetes, cancer, HIV infection, previous chemotherapy, as well as corticosteroids users or those with any form of immunosuppression are more susceptible to severe forms of infection. Especially premature infants, small children, people 65 and older, and people with no spleen are more at risk. That risk can be reduced with a vaccination against pneumococci.

Can small wounds lead to sepsis?
If they develop from a local infection to a systematic inflammation, they are a source of sepsis.
We have seen sepsis cases triggered by small cracks at the corner of the mouth, which enable bacteria from the skin to spread into the circulatory system in children and adults.

Why have I never heard of sepsis before?
Sepsis isn’t talked about very often. We hear of people dying of infections. Often it was sepsis. Even today, if someone dies of sepsis due to pneumonia, (infection of the lungs) the cause of death is listed as pneumonia. If someone dies of sepsis after being severely burned, the cause of death is complications due to burns. Because sepsis is seldom listed as the cause of death, many people think it isn’t a problem. That is one of our biggest concerns. Increasing awareness of sepsis is one of our major goals.

Posted by Dr. Tim Sandle

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