Saturday, December 03, 2005
Alternative names Return to top
Systemic inflammatory response syndrome (SIRS)
Definition Return to top
Sepsis is a severe illness caused by overwheming infection of the bloodstream by toxin-producing bacteria.
Causes, incidence, and risk factors Return to top
Sepsis is caused by bacterial infection that can originate anywhere in the body. Common sites include the following:
The kidneys (upper urinary tract infection)
The liver or the gall bladder
The bowel (usually seen with peritonitis)
The skin (cellulitis)
The lungs (bacterial pneumonia)
Meningitis may also be accompanied by sepsis. In children, sepsis may accompany infection of the bone (osteomyelitis). In hospitalized patients, common sites of infection include intravenous lines, surgical wounds, surgical drains, and sites of skin breakdown known as decubitus ulcers or bedsores.
The infection is often confirmed by a positive blood culture, though blood cultures may be negative in individuals who have been receiving antibiotics. In sepsis, blood pressure drops, resulting in shock. Major organs and systems, including the kidneys, liver, lungs, and central nervous system, stop functioning normally.
A change in mental status and hyperventilation may be the earliest signs of impending sepsis.
Sepsis is often life-threatening, especially in people with a weakened immune system or other medical illnesses.
Symptoms Return to top
Fever or hypothermia (low body temperature)
Rapid heart beat
Confusion or delirium
Decreased urine output
Signs and tests Return to top
White blood cell count that is low or high
Platelet count that is low
Blood culture that is positive for bacteria
Blood gases that reveal acidosis
Kidney function tests that are abnormal (early in the course of disease)
This disease may also alter the results of the following tests:
Peripheral smear may demonstrate a low platelet count and destruction of red blood cells.
Fibrin degradation products are often elevated, a condition that may be associated with a tendency to bleed.
Blood differential -- with immature white blood cells seen
Treatment Return to top
Septic patients usually require monitoring in an intensive care unit (ICU). "Broad spectrum" intravenous antibiotic therapy should be initiated as soon as sepsis is suspected.
The number of antibiotics administered may be decreased when the results of blood cultures become available and the causative organism is identified. The source of the infection should be discovered, if possible, which may mean further diagnostic testing. Sources such as infected intravenous lines or surgical drains should be removed, and sources such as abscesses should be surgically drained.
Supportive therapy with oxygen, intravenous fluids, and medications that increase blood pressure may be required for a good outcome. Dialysis may be necessary in the event of kidney failure, and mechanical ventilation is often required if respiratory failure occurs.
Expectations (prognosis) Return to top
The death rate can be as high as 60% for people with underlying medical problems. Mortality is less (but still significant) in individuals without other medical problems.
Complications Return to top
Impaired blood flow to vital organs (brain, heart, kidneys)
Disseminated intravascular coagulation
Update Date: 8/25/2004
Updated by: Updates to specific sections made by Jacqueline A. Hart, M.D., Senior Medical Editor, A.D.A.M., Inc. Previously reviewed by Daniel Levy, M.D., Ph.D., Infectious Diseases, Greater Baltimore Medical Center, Baltimore, MD. Review provided by VeriMed Healthcare Network (7/14/2004).
Sepsis is a serious but rare infection that is usually caused by bacteria. It occurs when bacteria, which can originate in a child's lungs, intestines, urinary tract, or gallbladder, make toxins that cause the body's immune system to attack the body's own organs and tissues.
Sepsis can be frightening because if it is untreated, it can lead to serious complications that affect a child's kidneys, lungs, brain, and hearing. But by learning to recognize the symptoms, you can help your child get treatment and fully recover.
Sepsis can affect a person of any age, but it is more prevalent in young infants whose immune systems have not developed enough to fight off overwhelming infections and people whose immune systems are compromised from conditions such as HIV.
If your infant has a rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius)seems lethargic, uninterested in eating, or seems to be having difficulty breathing, it's a good idea to call your child's doctor. In an older child, the symptoms of sepsis may include a fever (an oral temperature at or above 99.5 degrees Fahrenheit [37.5 degrees Celsius]); your child may also seem lethargic, irritable, and may complain that his or her heart feels like it's racing.
If your child's temperature is normal, but you're still concerned, it's a good idea to call the doctor.
What Is Sepsis?
Sepsis occurs when the body's normal reaction to inflammation or a bacterial infection goes into overdrive. With sepsis, the bacteria create a toxin that causes a widespread inflammation of the body's organs and causes rapid changes in a person's body temperature, blood pressure, and dysfunction in the lung and other organs.
Babies under the age of 2 months are more susceptible to sepsis because their immune systems have not yet developed enough to fight off some serious infections. It is also more prevalent in people of all ages whose immune systems are compromised by chronic illnesses and conditions like HIV.
Signs and Symptoms of Sepsis
Sepsis in newborns produces few concrete symptoms, though symptoms can vary widely between from child to child. Frequently, these babies suddenly aren't feeling well or "just don't look right" to their caretakers.
Some of the more common signs or symptoms of sepsis in newborns and young infants include:
disinterest or difficulty in feeding
fever (above 100.4 degrees Fahrenheit [38 degrees Celsius] rectally) or sometimes low, unstable temperatures
irritability or increased crankiness
lethargy (not interacting and listless)
decreased tone (floppiness)
changes in heart rate - either faster than normal (early sepsis) or significantly slower than usual (late sepsis, usually associated with shock)
breathing very quickly or difficulty breathing
periods where the baby seems to stop breathing for more than 10 seconds (apnea)
Older children who have sepsis might have a fever (an oral temperature above 99.5 degrees Fahrenheit [37.5 degrees Celsius]), vomit, and complain of feeling like their hearts are racing. A child with sepsis may have started with an infection such as cellulitis that seems to be spreading and getting worse, not better.
What Causes Sepsis?
Bacteria are almost always the cause of sepsis in newborns and infants.
Bacteria such as E. coli, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Salmonella, and Group B streptococcus (GBS) are the more common culprits in sepsis in newborns and infants younger than 3 months.
Premature babies receiving neonatal intensive care are particularly susceptible to sepsis because their immune systems are even more underdeveloped than other babies, and they typically undergo invasive procedures involving long-term intravenous (IV) lines, multiple catheters, and need to breathe through a tube attached to a ventilator. The incisions a young infant gets for catheters or other tubes can provide a path for bacteria, which normally live on the skin's surface, to get inside the baby's body and cause the infection.
In many cases of sepsis in new babies, bacteria enter the baby's body from the mother during pregnancy, labor, or delivery.
Some pregnancy complications that can increase the risk of sepsis for a newborn include:
an infection in the uterus or placenta
premature rupture of the amniotic sac (before 37 weeks of gestation)
rupture of the amniotic sac very early in labor (18 hours or more before delivery)
a long, difficult delivery
Some bacteria - GBS in particular - can be acquired by the newborn as the child is being delivered. At least one out of every five pregnant women carries the bacterium for Group B streptococcus in her vagina or rectum, where it can be passed from mother to child during delivery.
Diagnosing and Treating Sepsis
Because symptoms of sepsis can be vague in infants, laboratory tests play a crucial role in confirming or ruling out sepsis.
These lab tests may include:
Blood tests (including red and white blood cell counts) and blood cultures may be taken to determine whether bacteria are present in the blood.
Urine is usually collected by inserting a sterile catheter into the baby's bladder through the urethra for a few seconds to remove urine; this will be examined under a microscope and cultured to check for the presence of bacteria.
A lumbar puncture (spinal tap) may be performed, depending on the baby's age and overall appearance. A sample of cerebrospinal fluid will be tested and cultured to determine if the baby has possible meningitis.
X-rays, especially of the chest (to make sure there isn't pneumonia), are sometimes taken.
If the baby has any kind of medical tubes running into his or her body (such as IV tubes, catheters, or shunts), the fluids inside those tubes may be tested for signs of infection as well.
Sepsis, or even suspected cases of sepsis in infants, is treated in the hospital, where doctors can closely watch the infection and administer strong antibiotics intravenously to fight the infection.
Typically, doctors start infants with sepsis on antibiotics right away - even before the diagnosis is confirmed. If more symptoms of sepsis begin to appear, they usually start them on IV fluids to keep them hydrated, blood pressure medication to keep their hearts working properly, and respirators to help them breathe.
Can Sepsis Be Prevented?
Although there's no way to prevent all types of sepsis, some cases can be avoided, namely the transmission of Group B streptococcus bacteria from mother to child during childbirth. Pregnant women can have a simple swab test during the 35th and 37th weeks of pregnancy and again just before the birth to determine if they carry the GBS bacteria.
If a woman tests positive for GBS, she can receive intravenous antibiotics during labor.
Women are at higher risk of carrying GBS if they have a fever during labor, if the amniotic sac ruptures prematurely, if they have prolonged labor, or if they had other children with sepsis or other diseases triggered by GBS, such as pneumonia or meningitis. A woman with one of these risk factors can receive intravenous antibiotics to lower her risk of transmitting the bacteria to her child.
Immunizations routinely given to infants today include vaccinations against certain strains of pneumococcus and Haemophilus influenzae type b that can cause sepsis or occult bacteremia, an infection of the blood.
When to Call Your Child's Doctor
Because the symptoms of sepsis can be very difficult to identify in newborns and young infants, it's a good idea to call your child's doctor or seek emergency medical care if your baby shows any of the following symptoms:
difficulty or continued disinterest in feeding
fever (100.4 degrees Fahrenheit [38 degrees Celsius] and above rectal temperature) in newborns and young infants
labored or unusual breathing
change in skin color (paler than usual or mildly bluish)
listlessness or lethargy
change in the sound of the baby's cry or excessive crying
change in baby's muscle tone - either seeming too stiff or especially floppy
a slower or faster heart rate than usual
bulging or fullness of the "soft spot" on the baby's head
any type of behavior or appearance that concerns you
These signs and symptoms don't necessarily mean your baby has sepsis, but infants who are younger than 3 months should be checked out immediately to ensure that nothing else is wrong. Reviewed by: Barbara P. Homeier, MDDate reviewed: June 2005