Sepsis, a medical emergency
We spoke to Dr Timothy Gray, Staff Specialist Microbiology and Infectious Diseases at Concord and Canterbury Hospitals, ahead of World Sepsis Day, an initiative by the Global Sepsis Alliance. The awareness day takes place on 13 September each year, providing an opportunity for people around the world to unite in the fight against sepsis.
Dr Timothy Gray said:
“Sepsis is a medical emergency and remains one of the main causes of death worldwide. Sepsis occurs when chemicals released by the body to fight infection trigger inflammatory responses, resulting in damage to tissues and organs and causing them to fail. It is a potentially life threatening response by the body to infection and can be triggered in any part of the body. Most commonly it is caused by bacteria; however, viral and fungal infections can also cause sepsis.
“A person with sepsis will often present with a high fever, but occasionally the body will respond by dropping to a low temperature. A person with sepsis may find their heart racing or have a rapid breathing rate. A person with severe sepsis may be confused, have difficulty breathing and have pain at the site of infection. If no treatment is sought, the sepsis patient’s blood pressure will drop, which can lead to dizziness or sometimes collapse.”
Sepsis accounts for at least 8 million deaths worldwide annually. Those who are at the highest risk include the very young and the very old, as well as people with an impaired immune system, and those suffering from a chronic or serious illness such as diabetes or cancer.
“While anybody can develop sepsis it is most common in the elderly and those with weakened immune systems. It is also more dangerous in these individuals. In Australia, approximately 12% of patients admitted to the Intensive Care Unit have a diagnosis of sepsis. With early recognition, though, the clinical course can be changed and the majority of patients with sepsis do not require admission to the intensive care unit”, said Dr Gray.
Sepsis should be treated in-hospital as a medical emergency, as quickly and efficiently as possible. A 2006 study showed that the risk of death from sepsis increases by 8% with every hour that passes before treatment begins. Early recognition and treatment reduces sepsis mortality by 50%.
“The laboratory plays a central role in diagnosing sepsis and is important in guiding prompt and appropriate treatment. Many branches of pathology, including biochemistry, haematology and microbiology, all play key roles in diagnosing sepsis. In particular, the microbiology laboratory focuses on detecting the microorganism (most commonly a bacterium) that is causing the triggering infection. The microbiology results help guide the choice of an appropriate antibiotic.
“There has been a renewed focus in the healthcare system to ensure that a person with sepsis is recognised early and timely management is implemented. The use of appropriate antibiotics as soon as sepsis is recognised has been shown to be a key intervention.
“The treatment of sepsis has not changed for a long time. The mainstay of treatment involves the prompt administration of antibiotics, removal of infected devices or drainage of pus, intravenous fluid therapy, organ system support with drugs that support blood pressure, mechanical ventilation and dialysis as required, and oxygen if levels are low. It is important to perform investigations, such as culturing the blood, early, and to establish the site of infection, as this can help guide treatment.
“Most patients with sepsis respond to treatment and do well. Dying from sepsis is more common among the elderly, those with pre-existing medical problems and those who require admission to the intensive care unit. In fact, of patients admitted to the intensive care unit with sepsis, approximately one in five will succumb despite the best treatment,” said Dr Gray.
“One of the major challenges going forward is the increased number of drug resistant bacteria. Although Australia has remained a lucky country with generally lower rates of drug resistant bacteria compared to the rest of the world, the numbers are increasing. When an infection caused by a drug resistant bacterium triggers sepsis, this can be more difficult to treat and the outcome for the person with sepsis is worse. This is a major challenge for all people involved with the treatment of sepsis. The microbiology laboratory plays a key role in identifying these drug resistant bacteria and supporting doctors in the treatment of their patients with sepsis,” said Dr Gray.
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This article appeared in the August 2018 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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