Sepsis is a generalized infection caused by a bacterium. It causes significant inflammation. The disease has been known for a long time, since the term sepsis was created in 1837 by a French doctor, Pierre Piorry. Currently infectiologists tend to replace the term sepsis with that of “bacteremia associated with sepsis” (bacteremia means “circulation of bacteria in the blood” and sepsis “generalized inflammatory response, following a serious infection.” The word sepsis still remains widely used by the general public and doctors.
- Bacteremia is defined as the presence of bacteria in the bloodstream. When their numbers are low, they are eliminated by the defenses of the body, which is the most common situation. In this case, the person has no symptoms, but can sometimes feel a slight fever (fever) or a slight transient fatigue. When there are too many bacteria or when the person’s immune defenses are diminished (by a treatment, a disease, an HIV infection for example or a congenital immunodeficiency), or overwhelmed by their number, the body can is more able to eliminate them which can lead to sepsis.
- Sepsis is the excessive generalized inflammatory reaction in response to a serious infection.
- Septic shock (which can also occur in cases of sepsis) is related to the release into the blood of toxins secreted by certain bacteria.
Causes of sepsis
The release of bacteria into the blood can be linked to sometimes trivial situations, such as brushing teeth, dental care or rare situations such as cleaning a wound, changing a probe, surgery or even pulmonary, urinary, osteoarticular, digestive (especially biliary tract), cutaneous (infected wounds, abscess or eschar) infection or endocarditis (pathological heart valve infection) … etc.
The risk of sepsis is increased by the presence of a “foreign body” in the body, such as a bone or joint prosthesis, a cardiac valve prosthesis, a vascular catheter, a urinary or digestive probe, a tracheal intubation tube ( probe allowing the arrival of air in the bronchi).
Bacteria that accumulate at the level of this foreign material or an infectious center are released episodically into the bloodstream.
All bacteria can be involved, including those that are not pathogenic (that is, usually do not cause infection) and that the body is usually a carrier in the skin. Respiratory tract or digestive tract for example.
Fungi, such as candida, can rarely cause sepsis, so-called fungi, mainly in people with weak immune systems.
The risks of sepsis
People at risk for Septicemia
People with weakened immune defense systems are particularly at risk:
- Women who have just given birth (sepsis is called puerperal fever) and newborns. Sepsis is a major cause of death at birth in emerging countries.
- Old people.
- People with diseases that reduce immunity such as diabetes, cirrhosis, certain cancers or blood disorders, HIV-AIDS, congenital immunodeficiencies.
- Drugs or treatments that may weaken immunity, such as corticosteroids, certain chemotherapies or biotherapies.
- hospitalized patients are at risk of septicemia with nosocomial germs, often resistant to antibiotics
- drug injections with contaminated equipment or without disinfection of the skin
- The wearing of osteo-articular prostheses, urinary catheters, digestive tubes, intubation, drains, catheters.
- Valvulopathies (heart valve diseases) or prosthetic valves (cardiac valve prostheses).
- Cutaneous infections boils, bedsores, burns, wounds.
- the dental, sinus, biliary, etc. infectious foci
- Surgical procedures.
Symptoms of sepsis
Septicemia results in a generalized infection, responsible for a high fever but sometimes contrary to a drop in body temperature (hypothermia), major fatigue, often associated with an acceleration of heart and respiratory rates. It is accompanied by chills, sweating, abdominal pain, vomiting, diarrhea, and even mental confusion in older and younger people. Fever, chills and sweating often occur in flares.
Other signs vary depending on the seat of the initial infection and complications. Septicemia can be complicated by a “septic shock”, with drop in blood pressure and impaired function of various organs due to lack of blood supply. When the oxygen supply is insufficient, the skin becomes cold, marbled, cyanotic (bluish tone) especially at the ends.
Diagnostic of Septicemia
During a blood test:
- On the blood count, the white blood cell count is usually very high or, on the contrary, significantly lowers.
- The CRP (C Reagent Protein) and the blood procalcitonin testify to the existence of an inflammation, but their elevation is not specific of an infection. However, low levels make it unlikely that sepsis
- The bacteremia is found on a blood sample showing the presence of a bacterium in the blood, bacteria sometimes visible on direct examination under the microscope. The blood sample is cultured (hence the term blood culture , “blood culture”) to identify the bacteria or bacteria responsible and determine their sensitivity to various antibiotics. The blood culture should ideally be done as soon as one suspects a bacteremia, before taking any antibiotics that could skew the results. This is not always done and it complicates the interpretation of the results. Other samples are taken from the potential entrance gates of the infection (sputum, urine, catheter, catheter, and wound) to identify the bacterium and put it in culture.
Other radiological, biological or cardiological examinations are required to search for the site of initial infection, the secondary infectious locations and to assess the severity of the infection and shock and their impact on the cardiovascular and respiratory systems in particular.
Prevention and treatments of Septicemia
Septicemia is a particularly serious disease, with a risk of death, especially in cases of septic shock, complications of initial or secondary infections and damage to the “noble” organs that can leave sequelae after healing of the infection.
The risk of complications depends on the fragility of the person, the speed of the start of treatment, the existence of antimicrobial resistance.
It is necessary to consult in urgency when the signs of infection persist despite the antibiotic treatment, especially as it is a vulnerable person, suffering from valvulopathy or carrier of foreign material.
Prevention of sepsis
Persons at risk due to poor immunity or wearing a prosthetic joint or valvular must receive preventive antibiotic treatment before certain dental or medical / surgical.
To ensure complete cure of an infectious focus and avoid the development of antibiotic-resistant bacteria, it is essential to respect the doses and duration of treatment and to take antibiotics only if they are absolutely necessary and then take them really on the duration advocated by the doctor.
Treatments for sepsis
Treatment is done in the hospital, usually in intensive care or intensive care units.
The treatment of the infection is based on intravenous antibiotics, initiated as soon as possible after the blood cultures but without waiting for their result. Two or three antibiotics are generally associated, the choice being based on the supposed origin of the initial infection, the state of the subject and the existence of other pathologies. The results of blood cultures are obtained in 1 to 3 days depending on the germ and allow adapting the antibiotics. The duration of antibiotic therapy is 7 to 14 days or more, depending on the negativation of blood cultures, clinical condition, and fever, and germ, initial and secondary locations.
The material on which bacteria could have been deposited such as a catheter should be removed, open wounds thoroughly cleaned, abscesses drained.
Treatment of vital functions
The management and monitoring of the cardiovascular, respiratory and renal systems generally leads to infusion of intravenous fluids to fight shock and restore normal blood pressure and provide oxygen. In severe cases, it is necessary to ensure good ventilation by intubation or even by a machine assisting breathing.
Injectable corticosteroids are prescribed in some cases when blood pressure remains low despite treatment.