We tend to think of a hospital as a place to go to get better. But many patients who develop a life-threatening complication of infection—sepsis—do so after being admitted to a hospital.
Sepsis is a rapid, whole- body response to illness, usually an isolated bacterial infection such as pneumonia or appendicitis. Most hard hit are adults over age 65—they’re three times more likely than those younger to develop sepsis within three months of being discharged from the hospital, report University of Michigan researchers in a study published online in May 2015 in the American Journal of Respiratory and Critical Care Medicine.
Breaking down sepsis
“Infections involving the gastrointestinal or genitourinal (stomach or urinary) systems are more common in older adults,” says Claudene George, M.D., R.Ph., assistant professor of clinical medicine, geriatrics, at Albert Einstein College of Medicine, N.Y.
Sepsis occurs when an overwhelming immune response triggers bodywide inflammation. The source of sepsis in hospitalized patients is often an infection that originates around an intravenous line, surgical wound, surgical drain, or areas where skin breaks down (often a bedsore), letting bacteria into the bloodstream.
Some people mistakenly refer to sepsis as blood poisoning, probably because of the immune chemicals released into the blood that cause the condition, but no poisoning is involved. Here are four different levels of the condition:
1. Systemic inflammatory response syndrome (SIRS) occurs when no infection is present. Symptoms are the same as those in infection-related sepsis: fever, rapid breathing, rapid heart rate, chills, confusion, decreased urine output, and skin rashes. But, George warns, “The early signs and symptoms that lead to sepsis such as fever, chills, and sweating can be absent.”
2. Sepsis has the same symptoms as SIRS but is triggered by infection. Patients may have additional symptoms depending on the infection’s origins, such as abdominal pain, vomiting, and diarrhea if the infection starts in the abdomen or a cough and sputum production for a lung infection.
3. Severe sepsis occurs rapidly and is characterized by dangerously low blood pressure and inadequate blood flow to one or more organs.
4. Septic shock is a life-threatening condition triggered by a dramatic drop in blood pressure. Not enough blood reaches the body’s major systems, such as the central nervous system, and organs, including the kidneys and lungs. Septic shock is fatal in 28 to 50 percent of cases, says the Centers for Disease Control and Prevention.
In 2000, there were 621,000 cases of sepsis reported in the United States, nearly doubling to 1,141,000 in 2010. Rising sepsis rates are thought to be a result of increasing antibiotic resistance; an aging population; the number of more invasive procedures being performed; an uptick in the number of at-risk patients with weakened immune systems, and chronic illnesses, such as cancer, AIDS, and diabetes; and better tracking and reporting of cases by hospitals.
The University of Michigan researchers found that the risk of developing sepsis in the hospital was 30 percent higher for patients who were admitted for an infection than for patients who were admitted for other reasons. The most vulnerable patients were those with the gastrointestinal infection Clostridium difficile (C. difficile), with a 70 percent higher chance of developing sepsis. One in 10 C. difficile patients ended up with sepsis within three months.
Although they couldn’t identify a direct cause, the authors partly attribute the large incidence of sepsis in C. difficile patients to the drugs used to treat the gut infection. Antibiotics, proton pump inhibitors, H2 receptor antagonists, and other drugs disrupt the healthy bacterial balance of the digestive tract and set the stage for sepsis. The finding holds promise for future research since doctors may be able to focus on balancing the bacteria before sepsis can develop.
Speed is crucial
Delaying sepsis treatment by as little as a few hours can mean the difference between life and death. People experiencing sepsis symptoms should be taken to a hospital emergency room immediately (or call for the nurse if already in the hospital).
Patients are treated with intravenous antibiotics and large amounts of fluids to restore blood volume, and drugs to maintain blood pressure may be given.
“About half of all people who experience severe sepsis can recover with early intervention,” George says, “but their risk of recurrence rises and risk of death remained up to within one year later. Many survivors, especially patients with a prior chronic condition, may have permanent organ damage, such as kidney failure. Others may experience cognitive difficulties, such as problems with planning and organizing.”