Typically an infection (mostly gram positives) that causes a dysregulated inflammatory response leading to other systemic abnormalities. Sepsis can be a life-threatening condition that can cause multiple organ dysfunction syndrome. It can lead to severe sepsis and even septic shock.
What if they don't necessarily have an infection?
SIRS: Systemic Inflammatory Response Syndrome
A form of dysregulated inflammation typically abnormalities in 2 or more of:
Temperature (>100), Heart Rate (>90), Respirations (>20), or WBC (<4,000 or >12,000)
Other symptoms include: any symptoms specific to a source of infection, altered mental status, ileus, decreased capillary refill or mottling of the skin
Conditions other than infections that can now be considered for sepsis under SIRS criteria:
Pancreatitis, vasculitis, thromboembolism, burns, surgery, other autoimmune disorders
Who is at risk?
Typically patients over 65
Patients with Multi-Drug resistant infections
African American males
Higher incidence in winter months (more respiratory illnesses)
All patients with infection and bacteremia are at a risk of developing sepsis
ICU patients: ~50% have a nosocomial infection therefore putting them at risk
Community Acquired Pneumonia
What is the prognosis
Sepsis can lead to septic shock which has circulatory, cellular, and metabolic abnormalities that together has a greater mortality than sepsis alone. Septic shock is identified by a lactate >2 or a mean arterial pressure >65. Mortality rates can range from 10-52%. Antibiotics need to be started within 6 hours otherwise mortality increases significantly.
First, try to find the source and see what it is susceptible to, early (within first 6 hours) treatment leads to decrease in mortality. Broad spectrum antibiotics such as Vancomycin to cover MRSA, other antibiotics can be added based on probability for pseudomonal infection.
If the probability is low then add one of the following:
Beta-lactam/beta-lactamase inhibitor (piperacillin-tazobactam,
Carbapenem (imipenem, meropenem)
3rd generation Cephalosporin (ceftriaxone, cefotaxime)
4th generation Cephalosporin (cefepime)
If the probability of a pseudomonal infection is high then add two of the following:
Antipseudomonal cephalosporin (ceftazidime, cefepime)
Antipseudomonal carbapenem (as above)
Antipseudomonal beta-lactam/beta-lactamase inhibitor (as above)
Fluoroquinolone with good anti-pseudomonal activity (ciprofloxacin)
Aminoglycoside (gentamicin, amikacin)
For septic shock fluids should be administered for fluid replacement.
If hypotensive, then levophed is recommended as first line.
All of this is just the overly simplified basics of sepsis and management. Each patient is different and therefore requires specific management tailored to him/her. This is partially why I love this field of medicine, because there is no textbook right answer to every case. Critical thinking is crucial for patient well-being and treatment.
*information from Washington Critical Care Manual and UpToDate