“A life-threatening organ dysfunction due to a dysregulated host response”
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“Think Sepsis” (click here) in any person with suspected infection
- Sepsis may present with non-specific symptoms and signs and without fever
- Have a high index of suspicion of Sepsis in those who are aged <1 year or >65 years, pregnant (or post-partum), or immunocompromised, and those who have a device or line in situ or have had recent surgery
- Use risk factors and any indicators of clinical concern to decide if a full assessment is required
- Most patients with Sepsis /query Sepsis broad-spectrum antibiotics and intravenous fluids if in hospital
- If in doubt, refer and treat
Syndromes that mimic Sepsis include hypovolaemia (including covert acute blood loss), pulmonary embolus, myocardial infarction, acute pancreatitis, transfusion reaction, diabetic ketoacidosis, and adrenal insufficiency.
The systems most commonly infected are the respiratory, genitourinary, and gastrointestinal systems, as well as the skin and soft tissue. These sites comprise more than 80% of all cases of sepsis. Bacterial microbes are the most common causative organisms (gram-positive bacteria account for 30% to 50% ). However, a small number of patients may manifest with fungal, viral, or parasitic infections.
People at the extremes of age are at higher risk of developing sepsis. Patients older than 65 years are 10-15 times more likely to develop sepsis and have a two-fold higher risk of death from sepsis independent of race, sex, comorbid conditions, and severity of illness.
Additional risk factors include malnutrition, chronic illness, immunosuppression (either secondary to treatment eg immunosuppression or biological agents), recent surgery or hospitalisation, pregnancy or post-partum; and indwelling catheters or other devices.
The signs and symptoms of sepsis are highly variable, and a clinical diagnosis is often made before culture results are available. Although localised signs and symptoms may be present, organ hypoperfusion or shock can manifest without an obvious cause. This is especially true of neutropenic sepsis. Overall, the respiratory system is the most common site of sepsis, although, in patients older than 65 years, the most common site is the genitourinary tract.
Signs of severe sepsis include
- Hypotension (especially relative to normal BP)
- Cool and mottled skin
- Reduced conscious level
As a GP you have to answer four questions.
- Does the patient have suspected Sepsis?
- Can I treat at home (oral antibiotics)?
- Does the patient need 999 admission for hospital-based treatment (ie IV antibiotics/IV fluids, and possibly more intensive treatment in ITU or surgery?
- Are they so ill, that I should give IV antibiotics in the GP surgery or at home, and 999 to a hospital?
If in doubt, treat as Sepsis :
RING 999 – TELL THE AMBULANCE SERVICE THE PATIENT HAS SEPSIS