Clinical Notes : Infections and Sepsis

7. Sepsis

Definition

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.

It is characterised by derangements in multiple pathobiological processes, which may lead to widespread tissue injury.

It encompasses a clinical spectrum of severity, including severe sepsis, septic shock, and multi-organ failure.

Sepsis is a leading cause of morbidity and mortality worldwide.

Traditionally, sepsis has been defined based on the presence or absence of the systemic inflammatory response syndrome (SIRS). In adults, the definitions of sepsis were updated in 2016, moving away from the SIRS definition and removing the term ‘severe sepsis’

Etiology

Causative agents vary significantly depending on the region, hospital size, season, and type of unit (neonatal, transplantation, obstetric, oncology, or haemodialysis units)

Pathogenic organisms are identified in only around half of cases of sepsis.

Where organisms are identified, bacteria (gram-positive and gram-negative) are identified as the causative organism in approximately 90% of cases, with gram-positive bacteria and fungal infections increasing in frequency.

The host response to some viral infections so closely mimics sepsis that it should be considered as such.

 
 
 
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Early Warning Score
Assessment
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NEWS 2 

National Early Warning Score 2 is an early warning score produced by the Royal College of Physicians in the UK.

The higher the score, the higher the risk of clinical deterioration

 
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In Primary Care
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Refer to A+E urgently if any one or more red flag criteria are present :

  • 999 ambulance

  • and pre-alert A+E

Refer to A+E urgently if any one or more amber flag criteria are present and :

  • patient apperear critically ill 

  • definitive diagnosis unclear

  • unsafe to treat in the communi

In Hospital
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Prognosis

The prognosis in patients with sepsis and septic shock is guarded at best.

 

The mortality rate from sepsis has been estimated in a number of studies to be between 28% and 50%.

More recently, In Europe overall hospital mortality is 36%, 

Intensive care setting (ICU)-specific mortality has been shown to be 27% to 32% in patients with sepsis, and 50% to 70% in patients with septic shock, compared with 14% in ICU patients without sepsis.

 
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In the OOH setting

the absence of sepsis

should be annotated every time

an antibiotic is prescribed

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Sepsis Toolkit

Royal College of General Practitioners, 2016. Online.

Access

Sepsis: recognition, diagnosis and early management

NICE guideline NG51. July 2016

Access

Suspected sepsis: summary of NICE guidance

Andreas Freitag, Margaret Constanti, Norma O’Flynn. Saul N Faust

BMJ 2016;354:i4030. August 2016.

Access

The UK Sepsis Trust

Online.

Access

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Mervyn Singer et al. JAMA.2016;315(8):801-810. February 2016

Access

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