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Encyclopedia > Sepsis
Sepsis/Septicaemia
Classification & external resources
ICD-10 A40. - A41.0
ICD-9 038

Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition, resulting from the immune response to a severe infection. Septicaemia is sepsis of the bloodstream caused by bacteremia, which is the presence of bacteria in the bloodstream. The term septicaemia is also used to refer to sepsis in general. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Bacteremia (Bacteræmia in British English, also known as blood poisoning or toxemia) is the presence of bacteria in the blood. ...

Contents

Epidemiology

In the United States, sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common cause of death overall according to 2000 data from the Centers for Disease Control and Prevention.[1] Sepsis is common and also more dangerous in elderly, immunocompromised, and critically ill patients. It occurs in 1%-2% of all hospitalizations and accounts for as much as 25% of intensive care unit (ICU) bed utilization. It is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for septic shock. The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... “Intensive Care” redirects here. ... Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ...


Signs and symptoms

Symptoms of sepsis are often related to the underlying infectious process. When the infection crosses into sepsis, the symptoms of tachycardia, tachypnea, fever and/or decreased urination.


The immunological response that causes sepsis is a systemic inflammatory response causing widespread activation of inflammation and coagulation pathways. This may progress to dysfunction of the circulatory system and, even under optimal treatment, may result in the multiple organ dysfunction syndrome and eventually death. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... The coagulation of blood is a complex process during which blood forms solid clots. ... Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ... Multiple organ dysfunction syndrome MODS; previously known as multiple organ failure (MOF) is altered organ function in an acutely ill patient requiring medical intervention to maintain homeostasis. ... This article or section does not adequately cite its references or sources. ...


Definition of sepsis

Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met:[2] It has been suggested that this article or section be merged with Sepsis. ...

  • Heart rate > 90 beats per minute
  • Body temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
  • Hyperventilation (high respiratory rate) > 20 breaths per minute or, on blood gas, a PaCO2 less than 32 mm Hg
  • White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L), or greater than 10% band forms (immature white blood cells).

Consensus definitions however continue to evolve with the latest expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience.[3] Heart rate is a term used to describe the frequency of the cardiac cycle. ... In medicine, hyperventilation (or hyperpnea) is the state of breathing faster or deeper (hyper) than necessary, and thereby reducing the carbon dioxide concentration of the blood below normal. ... Arterial blood gas measurement is a test that can be done to determine the amount of oxygen, carbon dioxide and bicarbonate in the blood, as well as the pH of the blood. ... The torr is a unit of pressure. ... White blood cells or leukocytes are cells which form a component of the blood. ... The cubic metre (symbol m³) is the SI derived unit of volume. ... The litre or liter (U.S. spelling, see spelling differences) is a unit of volume. ...


The more critical subsets of sepsis are severe sepsis (sepsis with acute organ dysfunction) and septic shock (sepsis with refractory arterial hypotension). Alternatively, when two or more of the systemic inflammatory response syndrome criteria are met without evidence of infection, patients may be diagnosed simply with "SIRS." Patients with SIRS and acute organ dysfunction may be termed "severe SIRS." In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... In medicine, systemic inflammatory response syndrome (SIRS) is an inflammatory state of the whole body (the system). It is characterized by fast heart rate (tachycardia, heart rate >90/min), low blood pressure (systolic <90 or MAP <65), low or high body temperature (<36 or >38 C), high respiratory rate (>20...


Patients are defined as having "Severe Sepsis" if they have sepsis plus signs of systemic hypoperfusion; either end organ dysfunction or a serum lactate greater then 4 mmol/dL. Patient are defined as having Septic Shock if they have sepsis plus hypotension after an appropriate fluid bolus (typically 20 ml/kg of crystaloid). Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ...


The criteria for diagnosing an adult with sepsis do not apply to infants under one month of age. In infants, only the presence of infection plus a "constellation" of signs and symptoms consistent with the systemic response to infection are required for diagnosis (Oski's Pediatrics, 2006).


Treatment

The therapy of sepsis rests on antibiotics, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. This may include hemodialysis in kidney failure, mechanical ventilation in pulmonary dysfunction, transfusion of blood products, and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition, if necessary by parenteral nutrition, is important during prolonged illness. Staphylococcus aureus - Antibiotics test plate. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ... It has been suggested that Renal anomalies and Renal plasma threshold be merged into this article or section. ... mechanical or forced ventilation is the use of powered equipment, e. ... Respiratory system The lungs flank the heart and great vessels in the chest cavity. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... Total parenteral nutrition (TPN), also called hyperalimentation, is the practice of feeding a person without using the gut. ...


A problem in the adequate management of septic patients has been the delay in administering therapy after sepsis has been recognized. Published studies have demonstrated that for every hour delay in the administration of appropriate antibiotic therapy there is an associated 7% rise in mortality. A large international collaboration was established to educate people about sepsis and to improve patient outcomes with sepsis, entitled the "Surviving Sepsis Campaign." The Campaign has published an evidence-based review of management strategies for severe sepsis,[4] with the aim to publish a complete set of guidelines in subsequent years.


Early Goal Directed Therapy (EGDT), developed at Henry Ford Hospital by E. Rivers, MD, is a systematic approach to resuscitation that has been validated in the treatment of severe sepsis and septic shock. It is meant to be started in the Emergency Department. The theory is that one should use a step-wise approach, having the patient meet physiologic goals, to optimze cardiac preload, afterload, and contractility, thus optimizing oxygen delivery to the tissues.[5] Henry Ford Health System is one of the nations leading health care providers, offering a seamless array of acute, primary, tertiary, quaternary and preventive care backed by excellence in research and education. ... Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ...


In EGDT, fluids are administered until the central venous pressure (CVP), as measured by a central venous catheter reachs 8-12 cm of water (or 10-15 cm of water in mechanically ventilated patients). If the mean arterial pressure is less than 65 mmHg or greater than 90 mmHg, vasopressors or vasodilators are given as needed to reach the goal. Once these goals are met the central venous saturation (ScvO2), i.e. the oxgyen saturation of venous blood as it returns to the heart as measured at the superior vena cava, is optimized. If the ScvO2 is less than 70%, blood is given to reach a hemoglobin of 10 g/dl and then inotropes are added until the ScvO2 is optimized. Elective intubation may be performed to reduce oxygen demand if the ScVO2 remains low despite optimization of hemodynamics. Urine output is also monitored, with a goal of 0.5 ml/kg/h. In the original trial, mortality was cut from 46.5% in the control group to 30.5% in the intervention group. [5] The Surviving Sepsis Campaign guidelines recommends EGDT for the initial resuscitation of the septic patient with a level B strength of evidence (single randomized control trial). [4] Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. ... In medicine, a central venous catheter (CVC or central (venous) line) is a catheter placed into a large vein in the chest or groin. ... The mean arterial pressure (MAP) is a term used in medicine to describe a notional average blood pressure in an individual. ... A randomized controlled trial (RCT) is a form of clinical trial, or scientific procedure used in the testing of the efficacy of medicines or medical procedures. ...


Most therapies aimed at the inflammatory process itself have failed to improve outcome, however drotrecogin alfa (activated protein C, one of the coagulation factors) has been shown to decrease mortality from about 31% to about 25% in severe sepsis. To qualify for drotrecogin alfa, a patient must have severe sepsis or septic shock with an APACHE II score of 25 or greater and a low risk of bleeding.[6] Low dose hydrocortisone treatment has shown promise for septic shock patients with relative adrenal insufficiency as defined by ACTH stimulation testing.[7] Drotrecogin alpha (activated) (Xigris®, marketed by Eli Lilly) is a recombinant form of human activated protein C that has anti-thrombotic, anti-inflammatory, and profibrinolytic properties. ... Protein C is a major physiological anticoagulant. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... APACHE II is a well validated system for rating the severity of medical illness. ... Cortisol is a corticosteroid hormone produced by the adrenal cortex that is involved in the response to stress; it increases blood pressure, blood sugar levels, may cause infertility in women, and suppresses the immune system. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Adrenocorticotropic hormone (ACTH or corticotropin) is a polypeptide hormone synthesised (from POMC, pre-opiomelanocortin) and secreted from corticotropes in the anterior lobe of the pituitary gland in response to the hormone corticotropin-releasing hormone (CRH) released by the hypothalamus. ...


Standard treatment of infants with suspected sepsis consists of supportive care, maintaining fluid status with intravenous fluids, and the combination of a beta-lactam antibiotic (such as ampicillin) with an aminoglycoside such as gentamicin.


Related conditions/complications

An infection is the detrimental colonization of a host organism by a foreign species. ... A pathogen or infectious agent is a biological agent that causes disease or illness to its host. ... Bacteremia is the presence of bacteria in the blood, and is the means by which local infections spread hematogenously to distant organs. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... A joint is the location at which two or more bones make contact. ... Disseminated intravascular coagulation (DIC) is a pathological process in the body where the blood starts to coagulate throughout the whole body. ... Acute tubular necrosis may be toxic or ischemic. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Ileus refers to limited or absent intestinal passage. ... Ischemic colitis is inflammation of the intestine (colitis) caused by inadequate blood supply (ischemia) to meet the metabolic demands. ... Multiple organ dysfunction syndrome MODS; previously known as multiple organ failure (MOF) is altered organ function in an acutely ill patient requiring medical intervention to maintain homeostasis. ... Meningitis is the inflammation (infection) of the meninges which are the membranes that cover the brain and spine. ... In animals the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ... The Spinal cord nested in the vertebral column. ... Osteomyelitis is an infection of bone, usually caused by pyogenic bacteria or mycobacteria. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... Pyaemia is a type of septicaemia that to widespread abscesses and is usually caused by the staphylococcus bacteria. ...

References

  1. ^ Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003 Apr 17;348(16):1546-54. PMID 12700374 Full Text.
  2. ^ Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55. PMID 1303622.
  3. ^ Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr;31(4):1250-6.
  4. ^ a b Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM; Surviving Sepsis Campaign Management Guidelines Committee. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004 Mar;32(3):858-73. Erratum in: Crit Care Med. 2004 Jun;32(6):1448. Correction of dosage error in text. Crit Care Med. 2004 Oct;32(10):2169-70. PMID 15090974.
  5. ^ a b Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-77.
  6. ^ Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr; Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001 Mar 8;344(10):699-709. PMID 11236773 Full Text.
  7. ^ Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA. 2002 Aug 21;288(7):862-71. PMID 12186604.

See also

Meningococcemia is the presence of Neisseria meningitidis (also known as meningococcus) in the blood stream. ... Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ... It has been suggested that this article or section be merged with Sepsis. ...

External links


  Results from FactBites:
 
sepsis - definition of sepsis in Encyclopedia (448 words)
Sepsis is a serious medical condition caused by a severe systemic infection leading to a systemic inflammatory response.
It is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for septic shock.
In the United States, sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common cause of death overall according to 2000 data from the Centers for Disease Control (Martin et al 2003).
MedlinePlus Medical Encyclopedia: Sepsis (564 words)
Sepsis is a severe illness caused by overwhelming infection of the bloodstream by toxin-producing bacteria.
In children, sepsis may accompany infection of the bone (osteomyelitis).
Sepsis is often life-threatening, especially in people with a weakened immune system or other medical illnesses.
  More results at FactBites »

 
 

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