Tuesday, May 20, 2014

Health Care and Sepsis

Bloodstream infections -- also known as sepsis -- occur in about 10 percent of hospital patients in the United States but contribute to as many as half of all hospital deaths, a new study says by the American Thoracic Society (ATS). Sepsis is common, affecting as many as 750,000 hospitalized patients in the United States each year, according to the U.S. Centers for Disease Control and Prevention.

As reported in HealthDay.com, even though hospitalization rates fell between 2000 and 2010, the number of sepsis-related deaths among hospital patients rose 17 percent during that time, from 45,000 to 135,000. Sepsis is the most expensive cause of hospitalization in the United States, with an annual cost of more than $24 billion, according to the U.S. Agency for Healthcare Research and Quality.  More info on this topic can also be found at this site: http://consumer.healthday.com/infectious-disease-information-21/misc-infections-news-411/blood-infections-play-role-in-up-to-half-of-hospital-deaths-687819.html .

Medical professionals have been debating the exact definition of sepsis for decades, according to the Sepsis Alliance. However, one thing they can agree upon is the origin of the disease. The word sepsis comes from the Greek meaning “decay” or “to putrefy.” In medical terms, sepsis is defined as either “the presence of pathogenic organisms or their toxins in the blood and tissues” or “the poisoned condition resulting from the presence of pathogens or their toxins as in septicemia.”

Patients are given a diagnosis of sepsis when they develop clinical signs of infections or systemic inflammation; sepsis is not diagnosed based on the location of the infection or by the name of the causative microbe. Physicians draw from a list of signs and symptoms in order to make a diagnosis of sepsis, including abnormalities of body temperature, heart rate, respiratory rate, and white blood cell count. Sepsis may be diagnosed in a 72-year-old man with pneumonia, fever, and a high white blood cell count, and in a 3-month-old with appendicitis, low body temperature, and a low white blood cell count.

Sepsis is defined as severe when these findings occur in association with signs of organ dysfunction, such as hypoxemia, oliguria, lactic acidosis, elevated liver enzymes, and altered cerebral function. Nearly all victims of severe sepsis require treatment in an intensive care unit for several days or weeks. While most cases of sepsis are associated with disease or injury, many events follow routine, even elective surgery.

Sepsis can rage in response to incidents as seemingly benign as a playground scrape or a nicked cuticle from the beauty parlor. Sepsis has been named as the expensive in-patient cost in American hospitals. Forty percent of patients diagnosed with severe sepsis do not survive. Until a cure for sepsis is found, early detection is the surest hope for survival. Up to 50% of survivors suffer from post-sepsis syndrome. More information can be found at this website: http://www.sepsisalliance.org/ .

According to the National Institutes for Health (NIH), sepsis is an illness in which the body has a severe response to bacteria or other germs. This response may be called systemic inflammatory response syndrome (SIRS). A bacterial infection anywhere in the body may set off the response that leads to sepsis. Common places where an infection might start include:

·         The bloodstream
·         The bones (common in children)
·         The bowel (usually seen with peritonitis)
·         The kidneys (upper urinary tract infection or pyelonephritis)
·         The lining of the brain (meningitis)
·         The liver or gallbladder
·         The lungs (bacterial pneumonia)
·         The skin (cellulitis)

For patients in the hospital, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as bedsores (decubitus ulcers). In sepsis, blood pressure drops, resulting in shock. Major organs and body systems including the kidneys, liver, lungs, and central nervous system stop working properly because of poor blood flow. A change in mental status and very fast breathing may be the earliest signs of sepsis. In general, symptoms of sepsis can include:

·         Chills
·         Confusion or delirium
·         Fever or low body temperature (hypothermia)
·         Light-headedness due to low blood pressure
·         Rapid heartbeat
·         Shaking
·         Skin rash
·         Warm skin
·         Bruising or bleeding may also occur.

A person with sepsis will look very sick, according to the NIH. If you have sepsis, you will be admitted to a hospital, usually in the intensive care unit (ICU). Antibiotics are usually given through a vein (intravenously). Oxygen and large amounts of fluids are given through a vein. Other medical treatments include:

·         Medications that increase blood pressure
·         Dialysis if there is kidney failure
·         A breathing machine (mechanical ventilation) if there is lung failure 

In the hospital, careful hand washing and proper care of urinary catheters and IV lines can help prevent infections that lead to sepsis. Much more material on the subject of sepsis can be found at this website: http://www.nlm.nih.gov/medlineplus/ency/article/000666.htm .

Sepsis can affect people of any age according to KidsHealth.org, but is more common in
infants under 3 months, whose immune systems haven't developed enough to fight off overwhelming infections, including the following:

·         The elderly
·         People with chronic medical conditions
·         Those whose immune systems are compromised from conditions such as HIV or cancer.

If your infant is less than 3 months old, has a rectal temperature of 100.4°F (38°C), seems lethargic, irritable, uninterested in eating, having difficulty breathing or appears ill, take your baby to see a doctor immediately. More info can be found at this site: http://kidshealth.org/parent/pregnancy_center/newborn_health_conditions/sepsis.html .

According to the New England Journal of Medicine (NEJM), severe sepsis and septic shock represent one of the oldest and most pressing problems in medicine. With advances in intensive care, increased awareness, and dissemination of evidence-based guidelines, clinicians have taken large strides in reducing the risk of imminent death associated with sepsis. However, as more patients survive sepsis, concern mounts over the lingering sequelae of what was previously a lethal event.

Strategies are also needed to reach the many millions of patients with sepsis who are far from modern intensive care. At the same time, advances in molecular biology have provided keen insight into the complexity of pathogen and alarm recognition by the human host and important clues to a host response that has gone awry, according to the NEJM. However, harnessing that information to provide effective new therapies has proved to be difficult. To further improve the outcome of patients with sepsis through the development of new therapeutic agents, newer, smarter approaches to clinical-trial design and execution are essential. Much more clinical material can be found at this website: http://www.nejm.org/doi/full/10.1056/NEJMra1208623 .

Sepsis can be deadly. Do all you can to avoid it if possible, but if diagnosed get immediacte and aggressive medical treatment. If you may be in a high risk category, please avoid any issues or situations that can lead to a possible infection. Know your body, and recognize possible symptoms.

Until next time.

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