Dr Kevin McCarroll
Medical Matters
September has been designated ‘Sepsis Awareness Month’ in a campaign to increase knowledge and recognition by the public of one of the most common yet poorly understand medical conditions. In fact, sepsis occurs more frequently than heart attacks affecting about 17,000 people each year in Ireland and is the leading cause of death from infection. Indeed, about one in five people who develop sepsis will die.
So what is exactly is sepsis? Sepsis is a life threatening condition that occurs when an infection provokes a severe immune response that can result in damage to multiple organs including the kidneys, lung, heart, brain and liver. Often referred to as blood poisoning or septicaemia it results not just from bacterial but also viral and fungal infections that can lead to”septic shock” and multi-organ failure.
Sepsis can spread with great rapidity and within hours can kill so early identification and treatment is crucial. Whilst any infection can progress to sepsis, it is more common in those who are very young or old or have a weakened immune system. An infection is more likely to become invasive if there are underlying problems such as deep skin breaks, lung, heart or other conditions which can also effect the pattern of presentation. However, sepsis can also take hold in otherwise healthy individuals who pick up very virulent and pathogenic infections and there are also unique genetic factors that influence it too.
Ultimately, the body produces a major inflammatory response that can have devastating ‘knock on’ systemic effects. Indeed, International Sepsis Day was marked earlier this month and provided the opportunity for Irish families and survivors of sepsis to highlight just how serious it can be, striking unexpectedly and causing death or longterm disability.
Sepsis develops with such speed that survival rates decrease by 8% for every hour treatment is delayed.”
But infections are common, so what should we look out for to alert us to sepsis? Unfortunately, it is often not possible to identify early on who might go on to develop sepsis and indeed bad flu like symptoms are often mistaken for a relatively benign illness. However, sepsis usually comes on much quicker over hours as opposed to days and there may be signs and symptoms that can indicate severe response to infection. These include altered mental state (drowsiness or confusion), rapid breathing or heart rate, very pale or mottled skin (that will not blanch), passing little or no urine, muscle pain and a high temperature.
Sepsis develops with such speed that survival rates decrease by 8% for every hour treatment is delayed. In fact, getting antibiotics within the first hour of recognition of sepsis or septic shock can improve survival rates to up to 80%. If you are very unwell and suspect sepsis, you should get to the hospital as a matter of urgency. Control of the source of infection is also crucial and may involve surgery as mortality can increase by up to 25% for each day of delay in removing the infective source.
In general, measures that reduce infection and sepsis risk include good sanitation, personal hygiene and proper management of skin cuts and wounds. If you’re diabetic you should pay careful attention to your foot care and in optimising your blood sugars. Factors such as a healthy diet, maintaining a normal weight, avoiding smoking, alcohol excess and stress and getting adequate sleep may help to keep your immune system strong. You should also make sure to get your relevant vaccinations such as the flu vaccine which becomes available next month.
If you are 65 or over, or have chronic lung, heart or kidney conditions or a weak immune system you should also the get the pneumonia vaccine. It protects against invasive pneumococcal infection and needs to be given no more frequently than every five years.
A major focus of research is in developing better ways of detecting sepsis in its earliest stages and in predicting those who will go on to develop severe illness. Early warnings clinical systems based on physical signs that prompt closer monitoring have helped. However, it can take many hours before current blood tests indicate the beginnings of a severe infection.
A recently developed blood test measuring Pancreatic Stone Protein (PSP) appears highly sensitive and specific in confirming early sepsis and predicting disease severity and may hold promise in the near future. Work is also underway in producing drugs that could bind to or block the effects of inflammatory chemicals released in the sepsis cascade that cause toxic organ damage.
Finally, resistance to antibiotics has increased in the last decade and poses a threat in the war on sepsis. It’s as ever so important to use antibiotics judiciously as repeated courses can increase the likelihood of resistant bacterial strains emerging.
To conclude, if you become very sick acutely and have ‘sepsis’ symptoms – make sure to get urgent medical attention – it could be a life saver.