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Blood poisoning (sepsis): causes and treatment

by Josephine Andrews
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Blood poisoning (sepsis) describes the body’s immune response to an infection that spreads through the blood throughout the body. The term “poisoning” is misleading here, since it is a question of a disturbed defense reaction of the immune system. Read more about the development and treatment of blood poisoning here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

A39 B37 A41 A54 A40 R57 P36 A22 A26 R65 T88

quick overview

  • Causes and risk factors: Infection with pathogens such as bacteria, more rarely viruses or fungi, which cause an immune reaction
  • Diagnosis: Checking of various vital signs such as respiratory rate, serum lactate levels, oxygen saturation , inflammation levels through blood tests, for example, and classification of brain and consciousness function
  • Treatment: antibiotic therapy, fluid intake by infusion , vasopressor therapy with vasoconstrictive drugs, depending on the severity of the sepsis, artificial respiration and dialysis may be necessary
  • Course of the disease and prognosis: If left untreated, sepsis is always severe and often leads to death. With treatment, the course is often favorable.
  • Prevent: General hygiene measures in the private sphere, comprehensive hospital and clinic hygiene to prevent hospital infections, careful wound treatment, have infectious diseases clarified by a doctor at an early stage, receive vaccinations

What is blood poisoning or sepsis?

Doctors also speak of sepsis in blood poisoning. The term derives from the Greek word for “decay” or “decomposition” and is now defined as an acute, life-threatening organ dysfunction in which the body reacts incorrectly to an infection.

Blood poisoning is not caused by the presence of pathogens in the blood, as is often assumed, but by the body’s reaction to these pathogens.

The immune system tries to defend itself against the pathogens, but this fight not only harms the invaders, but also the body itself. Sepsis is a potentially life-threatening disease and requires treatment that is as quick and consistent as possible.

Finding bacteria in the blood (bacteremia) does not mean that you have blood poisoning. Small amounts of bacteria enter the bloodstream, for example when brushing teeth, through micro-injuries in the gums without triggering a body-wide immune reaction.

The body’s healthy immune system can easily cope with such small amounts of pathogens. Only when this is no longer the case and you become ill as a result of this fight do doctors speak of blood poisoning.

If organs are impaired in their function as a result of the defense reaction, doctors spoke of “severe sepsis” according to the definition of sepsis that was valid until 2016. The term “severe sepsis” is now obsolete and was redefined by a working group made up of members of the Society for Intensive Care and the European Society for Intensive Care Medicine and changed to “infection” . by a working group made up of members of the Society for Intensive Care Medicine and the European Society for Intensive Care Medicine.

If the blood pressure is no longer stable at a sufficient level due to the body’s own inflammatory reaction, doctors speak of “septic shock” . This end stage of blood poisoning endangers the blood supply to vital organs and often leads to multiple organ failure and even death.

SIRS (Systemic Inflammatory Response Syndrome)

The diagnosis of sepsis is difficult, especially in the early phase, since the symptoms are very varied and also depend on the infection that caused it. So far, the criteria for a so-called SIRS (Systemic Inflammatory Response Syndrome) have been considered groundbreaking for identifying early sepsis.

However, these criteria are not specific enough and include other diseases with similar symptoms. This means that it is not always sepsis if the SIRS criteria are met. In addition, they hardly give any indication of the possible probability of death from the disease, which is an important criterion in the case of sepsis.

Doctors therefore no longer only use the SIRS criteria to diagnose sepsis. Rather, they serve for in-depth analysis and support the selection of the appropriate form of therapy.

You can find out more about the triggers and what happens in a systemic inflammatory reaction in the body in the article  SIRS .

Septic shock

In the article  Septic Shock  You can find out more about the risks in the final stages of blood poisoning in the

neonatal sepsis

A special case of blood poisoning is the so-called neonatal sepsis . She describes blood poisoning in babies in the first month of life. A distinction is made here between two types, depending on how quickly the sepsis after birth.

The so-called early onset sepsis, in which the pathogen is most likely transmitted by the mother during the birth process, occurs within the first four days of life. After that it is a late sepsis (late onset sepsis). However, new research shows that this subdivision has no significant relevance for treatment.

The sepsis criteria in neonatal sepsis are more difficult to identify than in adult patients. Newborn sepsis is feared because of its brilliant course. In babies, blood poisoning leads to a life-threatening illness much more quickly.

A doctor usually examines the mother before the birth for bacteria in her vagina that could potentially endanger the child. Due to this investigation and strict hygiene regulations, neonatal sepsis has been significantly less common in industrialized nations over the past decade.

Symptoms of blood poisoning

You can read everything you need to know about the typical signs of sepsis in the article Blood poisoning – symptoms .

What are the causes and risk factors for blood poisoning?

In principle, every infection has the possibility of leading to blood poisoning. Infections of the respiratory tract, the gastrointestinal tract, the urogenital system, and the skin and soft tissues are the most common causes of sepsis. In principle, it is advisable to have every infection treated by a doctor at an early stage, even if it appears harmless at first.

At the beginning of a sepsis there is usually a localized infection, the causes of which are often bacteria, sometimes also viruses, fungi (Candida sepsis) or so-called protozoa (single-cell organisms). The immune system starts defense reactions against the invaders in the form of inflammation: the blood flow to the affected tissue increases, as does the permeability of the blood vessels.

This causes large amounts of white blood cells ( leukocytes) reach the site of infection and enter the tissue, where they eliminate the pathogens and destroyed cells.

However, the concentrated defenses of the immune system are sometimes not sufficient to limit and eliminate the infection at its point of origin. The pathogens then gain the upper hand: the pathogens and their toxins enter the bloodstream. According to the definition of sepsis, doctors do not speak of blood poisoning in this case, but of bacteremia (bacteria in the blood).

If these substances trigger a body-wide inflammatory reaction, this corresponds to a typical course of sepsis. The corresponding symptoms of sepsis are related to this body-wide fight between the immune system and pathogens.

The vessels throughout the body expand and lead to a drop in blood pressure. At the same time, signs of inflammation in the blood increase dramatically, while the heart and lungs try to compensate for the lack of return flow of the blood and its enrichment with oxygen through increased work. This increases breathing and heart rate.

The blood clots faster due to the changed blood flow and damage to vessels and tissue caused by pathogens and the immune system.

Risk groups for sepsis

In principle, the causes of blood poisoning include all localized infections such as pneumonia or urinary tract infections. Hospital infections (nosocomial infections) are often the trigger for sepsis. The risk of blood poisoning is particularly high in the case of:

  • Very young people (newborns) as well as very old people and pregnant women
  • A weakened immune system, for example due to chemotherapy for cancer or high-dose cortisone therapy for rheumatism or respiratory diseases
  • Wounds or injuries, such as extensive burns
  • Certain treatments and examinations such as catheters in blood vessels, bladder catheters, wound drainage
  • Addiction disorders, eg alcoholism, drug addiction
  • Genetic predisposition to sepsis

investigations and diagnosis

The SIRS criteria provide indications of possible sepsis, but are not sufficient to confirm actual sepsis. They are not sensitive enough to identify patients who have acute sepsis.

Therefore, additional criteria are used: The so-called sequential assessment of organ failure ( SOFA, Sequential Organ Failure Assessment) is a very complex screening instrument that is well known from intensive care medicine.

A somewhat simplified model is called ” quick SOFA” (qSOFA) and includes three important clinical parameters:

  • Respiratory rate ≥ 20 breaths/min
  • Glasgow Coma Scale (GCS) < 15 (used to assess impaired consciousness and brain function)
  • Systolic blood pressure ≤ 100mmHg

Blood poisoning is suspected if two or more of these points apply to those affected.

Physicians review other clinical signs according to the SIRS criteria, such as:

  • Presence of an infection , eg through microbiological detection of pathogens in a patient sample (blood sample, urine sample, wound swab) or pneumonia based on an X-ray image
  • Fever (at least 38 degrees Celsius) or hypothermia (36 degrees Celsius or less) measured with a thermometer in the anus (rectal), in a blood vessel (intravasal), or in the urinary bladder (intravesical)
  • Heart rate of at least 90 beats per minute (tachycardia)
  • Certain changes in complete blood count: WBC (white blood cell) count either increased (≥12,000/µL) or decreased (≤4,000/µL) or ≥ 10 percent immature neutrophils (a subset of white blood cells)
  • Increase in the inflammatory parameters CRP (C-reactive protein) or pro-calcitonin
  • Defective organ function, for example in the brain (impaired alertness, disorientation, agitation, confusion, delirium , coma, loss of feeling in a part of the body, restricted movement), liver (hepatic enzymes and bilirubin increased, skin color changed), kidney (urinary output decreased, blood pH decreases, creatinine increases), lungs (decreased levels of oxygen and increased levels of carbon dioxide in the blood)
  • Coagulation disorders, falling number of blood platelets (thrombocytes)
  • Surgical or covert causes of sepsis using ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI)

If organs only function to a limited extent, doctors speak of an infection in the sense of severe sepsis. This also applies if the causes of sepsis have not yet been clarified. If there is a critical drop in blood pressure, this is called septic shock.

Treatment of blood poisoning

A prerequisite for successful treatment of sepsis is the treatment of the underlying disease – ie the infection that led to blood poisoning. It is done either surgically or through medication.

The treatment of blood poisoning always begins with the search for the source of the infection, such as an inflamed appendix, an infected joint prosthesis or seemingly banal things such as a vascular access in the arm or a urinary catheter.

The focus is most often in the lungs, abdomen, urinary tract, skin, bones and joints, teeth or in the central nervous system (e.g. meningitis, encephalitis).

Foreign material in the body is also sometimes the seat of the source of infection, for example screws and plates used in bone surgery or the ” IUD ” (IUD) for contraception.

In the so-called cause check, the doctor eliminates this starting point of the sepsis as quickly as possible. In some sepsis patients, however, the source of the infection cannot be identified.

If the sepsis is less severe, a stay in the intensive care unit is usually not necessary. It is often sufficient to eliminate the source of the infection and start therapy with antibiotics (eg broad-spectrum penicillin), since bacteria are usually responsible for blood poisoning.

If it is a fungal (Candida sepsis), viral or parasitic infection, it is treated accordingly. Immunocompromised people therefore usually receive an antimycotic against possible fungal pathogens in addition to a broad-spectrum antibiotic.

Treatment in severe cases

With severe blood poisoning, in addition to eliminating the source of infection and antibiotic therapy, it is necessary to stabilize the impaired organ functions. In this more dangerous course of sepsis, treatment almost always takes place in an intensive care unit.

For the best possible therapy, it is necessary to identify the pathogen. Depending on the pathogen, a targeted therapy with an antibiotic or an antimycotic is then carried out.

Additional measures of sepsis treatment in the intensive care unit are:

  • Infusion of fluids (saline or crystalloid solution) to stabilize blood pressure and cardiovascular system and maintain tissue supply
  • Nutrient solutions when the patient is no longer able to eat independently, for example with a tube through the nose into the stomach ( gastric tube )
  • If necessary, the replacement of blood cells and plasma by transfusion
  • Supporting the function of affected organs, for example through artificial respiration in the event of (threatening) lung failure or dialysis, which relieves the kidneys of the task of filtering blood
  • The administration of pain killers and sedatives
  • If needed, blood-sugar-lowering insulin therapy, since blood-sugar levels rise in some patients with sepsis
  • Prevention of a so-called stress ulcer – an ulcer in the stomach or duodenum caused by body stress that causes bleeding. So-called proton pump inhibitors or histamine-2 receptor blockers (H2 blockers) are used in particular, which prevent the stomach from releasing gastric acid.
  • The administration of anticoagulant medication to prevent blood clots (thrombosis), which sometimes form anywhere in the body in severe sepsis

Newer therapies with artificial antibodies (immunoglobulins) are still under discussion for severe cases. There is still a lack of knowledge as to which antibodies are most effective in which form of sepsis. Therefore, this treatment is not yet recommended as a standard for blood poisoning.

Course of the disease and prognosis

The course of blood poisoning is usually always the same: Bacteria enter the bloodstream from somewhere in the body and spread through the bloodstream (bacteremia). If the body is unable to contain the infection, sepsis occurs.

Without treatment, the fight against the causative agents of blood poisoning becomes more and more widespread until the vessels and organs are finally damaged (severe sepsis).

How quickly the sepsis progresses depends on the causative pathogen, the age of the patient and the effectiveness of their immune system.

In the further course of sepsis, cardiovascular failure sometimes occurs. Then the blood flow to vital organs is endangered, and doctors speak of septic shock. The earlier you start treatment, the better your chances of being completely cured.

In the case of organ damage, lifelong damage often remains – for example a restricted or failed kidney function, which requires lifelong dialysis (blood purification).

In some patients, the blood poisoning cannot be successfully treated and the sepsis leads to death.

Roughly speaking, without adequate treatment, the risk of death from sepsis increases by about one percent every hour. After one day without treatment, the risk is already 24 percent.

In the case of severe sepsis with organ damage, an average of 20 percent of patients in Germany do not survive the disease. Across Europe, the mortality rate is around 26 percent.

In Germany, 26.5 percent of those affected die of circulatory failure due to blood poisoning after 30 days of septic shock.

risk of consequential damage

After being discharged from the hospital, many patients report long-term effects of blood poisoning such as nerve damage (polyneuropathy), muscle weakness or post-traumatic stress and depression (microscopic nerve damage).

The best way to avert the consequences of blood poisoning is to inform the doctor at an early stage if you have symptoms.

This applies in particular to people who are accommodated in hospitals or care facilities, for immunocompromised patients and patients who have just had surgery. These patient groups should inform their doctor immediately if they experience fever, chills, shortness of breath and/or dizziness.

Prevention is an important issue, especially in hospitals. Hygiene measures, good wound care and consistent protection of immunocompromised patients can prevent blood poisoning in many cases.

How to prevent sepsis

The options available to prevent sepsis depend on the specific cause of the blood poisoning.

Prevention of hospital infections

Often the cause of sepsis is an infection that occurs during a hospital stay (nosocomial infection).

In order to prevent such hospital infections, the Commission for Hospital Hygiene and Infection Prevention (KRINKO) for Germany has drawn up a recommendation for the prevention of nosocomial infections as well as for operational-organizational and structural-functional hygiene measures in hospitals and other medical facilities.

prevention at home

In the private environment, blood poisoning is sometimes difficult to prevent. Nevertheless, there are measures to reduce the risk of sepsis:

  • Observe general hygiene measures such as washing hands and food
  • Always clean open wounds thoroughly with clean water and protect them from renewed contamination with a bandage or plaster
  • Do not scratch insect bites as this will result in open wounds
  • Have infectious diseases examined by a doctor at an early stage, go to the doctor if there are signs of sepsis
  • Have vaccinations in accordance with the recommendations of the Standing Vaccination Committee at the Robert Koch Institute (STIKO).

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