Sepsis

On By Vaseline

Key facts

  • Sepsis is one of the most common causes of death worldwide, but there are challenges in collecting reliable population-level data (1).
  • Data published in 2020 shows that there are 48.9 million cases and 11 million sepsis-related deaths worldwide, accounting for 20% of all deaths worldwide (2).
  • Nearly half (20 million) of all estimated cases of sepsis worldwide occurred in children under 5 years of age.
  • For every 1,000 hospitalized patients, an estimated 15 patients will develop sepsis as a complication of receiving health care.
  • Although sepsis can affect any individual worldwide, significant regional differences in incidence and mortality exist, with the highest rates occurring in lower middle-income countries (LMICs). (2).
  • Sepsis is costly; the average hospital-wide cost of sepsis was estimated at more than $32,000 per patient in high-income countries (3).

Overview

Sepsis is a life-threatening condition that occurs when the body’s immune system overreacts to an infection, causing organ dysfunction (4). The body’s response causes damage to its own tissues and organs and can lead to shock, multiple organ failure and sometimes death, especially if not recognized early and treated promptly.

Sepsis can affect anyone, but people who are older, very young, pregnant, or have other health problems are at greater risk.

Common symptoms of sepsis include fever, rapid heart rate, rapid breathing, confusion, and body aches. It can lead to septic shock, multiple organ failure and death.

Sepsis is usually caused by bacterial infections, but can result from other infections such as viruses, parasites, or fungi. Its treatment requires medical care, including the use of antimicrobials, intravenous fluids and other measures.

Healthcare-acquired sepsis is one of the most common adverse events during healthcare delivery, affecting hundreds of millions of patients worldwide every year.

Healthcare-associated infections are caused by pathogens that are often drug resistant and can rapidly lead to worsening clinical conditions. Antimicrobial resistance is an important factor determining clinical non-response to treatment and rapid progression to sepsis and septic shock. Sepsis patients with resistant pathogens appear to have a higher risk of hospital mortality. In 2019, there were an estimated 4.95 million deaths due to antimicrobial resistance, of which 1.27 million deaths were directly attributable to it (5).

Implementing preventive measures against infections, such as good hygiene practices, ensuring access to vaccination programs, improved sanitation and water quality and availability, and other best practices in infection prevention and control, both in the community and in healthcare settings, are important steps in reducing the incidence of infections. of sepsis. Early diagnosis and timely and appropriate clinical management of sepsis, such as optimal antimicrobial use and fluid resuscitation, are crucial to increase survival. Although the onset of sepsis can be acute and carries a short-term mortality burden, it can also be the cause of significant long-term morbidity requiring treatment and support. Sepsis therefore requires a multidisciplinary approach.

Who is at risk?

Anyone affected by an infection, serious injury or serious non-communicable disease can progress to sepsis, but vulnerable populations are at greater risk (6.7) included:

  • older persons
  • pregnant or recently pregnant women
  • newborns
  • hospitalized patients
  • patients in intensive care units
  • people with a weakened immune system (e.g. HIV, cancer)
  • people with chronic medical conditions (e.g., kidney disease, cirrhosis).

Signs and symptoms

Sepsis is a medical emergency. It can cause different signs and symptoms at different times. People who think they may have sepsis should seek medical attention immediately.

Common signs and symptoms include:

  • fever or low temperature and chills
  • confusion
  • difficulty breathing
  • clammy and sweaty skin
  • extreme body pain or discomfort
  • high heart rate, weak pulse or low blood pressure
  • low urine output.

Symptoms in children include:

  • rapid breathing
  • convulsions
  • pale skin
  • lethargy
  • difficulty waking up
  • cold to the touch.

In children under 5 years of age, this can cause difficulty feeding, frequent vomiting or lack of urination.

Prevention

Sepsis can be prevented by treating infections early and through good hygiene at home and in healthcare settings.

The best way to reduce the risk of sepsis is to prevent infections. Steps include:

  • good personal hygiene, such as washing hands and preparing safe food
  • avoiding unclean water or unsanitary toilets
  • receive vaccines recommended by local health officials
  • eating a healthy diet
  • breastfeeding for newborns.

Hospitals and clinics must follow effective rules for infection prevention and control. Antibiotics should be used appropriately to treat infections.

Sepsis is always a serious condition, but people with HIV, tuberculosis, malaria and other infectious diseases are at greater risk.

Therapy

Treatment for sepsis is most effective when started early.

Health professionals watch for troubling signs and use tests to diagnose sepsis. They will then try to find the source of the infection. Early use of antimicrobials to treat bacteria, parasites, fungi, or viruses is essential to improve sepsis outcomes.

Low blood pressure is treated with intravenous fluids and sometimes with drugs called vasopressors, which can increase blood pressure.

Antibiotic resistance can complicate treatment.

Sustainable Development Goals

Sepsis is a leading cause of maternal, neonatal and infant mortality. Consequently, combating sepsis will contribute to achieving the Sustainable Development Goals (SDGs) targets 3.8 on the quality of care, and 3.1 and 3.2 by improving mortality rates in these vulnerable populations. Sepsis can also ultimately lead to death in patients affected by HIV, tuberculosis, malaria and other infectious diseases included in objective 3.3. The prevention and/or appropriate diagnosis and treatment of sepsis is also linked to adequate vaccination coverage, quality universal health care coverage, the ability to comply with the International Health Regulations, preparedness and water and sanitation. However, the challenge remains how to achieve universal prevention, diagnosis and treatment of sepsis.

WHO response

To combat this major global health threat, WHO responded with a WHO Secretariat Report and in May 2017, the Seventieth World Health Assembly adopted Resolution WHA70.7 on improving the prevention, diagnosis and clinical management of sepsis. The main pillars of Resolution WHA70.7 are:

  • Develop WHO guidelines on the clinical management of sepsis and on the prevention of bloodstream infections;
  • raise awareness of the public health impact of sepsis and assess the global burden of sepsis;
  • support Member States in defining and implementing standards and establishing guidelines, infrastructure, laboratory capacity, strategies and tools to identify, reduce the incidence of, morbidity and mortality from sepsis; And
  • work with UN agencies, partners, international organizations and stakeholders to improve the treatment of sepsis and the prevention and control of infections, including vaccinations.

In collaboration and coordination with WHO Regional Offices, Member States and other stakeholders, several WHO Headquarters programs are currently working on the public health impact of sepsis and providing guidance and country support on sepsis prevention, early and appropriate diagnosis and timely and appropriate clinical treatment. .

References

  1. Fleischmann-Struzek C, Rudd K. Challenges in assessing the burden of sepsis. Med Klin Intensivmed Notfmed. December 2023; 118 (Supplement 2): 68-74. doi:10.1007/s00063-023-01088-7.
  2. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S, Fleischmann-Struzek C, Machado FR, Reinhart KK, Rowan K, Seymour CW, Watson RS, West TE, Marinho F, Hay SI, Lozano R, Lopez AD, Angus DC, Murray CJL, Naghavi M. Global, regional, and national incidence and mortality of sepsis, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. Jan 18, 2020;395(10219):200-211. doi: 10.1016/S0140-6736(19)32989-7.
  3. Arefian H, Heublein S, Scherag A, Brunkhorst FM, Younis MZ, Moerer O, Fischer D, Hartmann M. Hospital-related costs of sepsis: a systematic review. J Infect. 2017 Feb;74(2):107-117. doi: 10.1016/j.jinf.2016.11.006.
  4. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. February 23, 2016; 315(8):801-10. doi: 10.1001/jama.2016.0287.
  5. Collaborators of antimicrobial resistance. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0.
  6. Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018 Jul 7;392(10141):75-87. doi: 10.1016/S0140-6736(18)30696-2.
  7. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. British medical journal 2016.