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Sepsis is something most people only hear about in medical dramas. It’s rare for a healthy individual to become septic, but it still affects 1.7 million Americans a year and it can be fatal. 1 in 3 patients who dies in a hospital has sepsis, according to the Centers for Disease Control and Prevention. Older adults, pregnant women, children, people with underlying health conditions, and those with weakened immune systems are most vulnerable to sepsis if they contract even a minor infection. Here’s what you should know about the life-threatening condition and sepsis treatment options.
What is sepsis?
Sepsis is a rapidly progressing and life-threatening condition caused by the body’s overreaction to an infection. Normally, the body fights infection with an immune response directed at the infection site. Sepsis, however, is an immune reaction to an infection throughout the body. Called systemic inflammatory response syndrome (SIRS), sepsis puts into motion a cascade of effects that eventually results in organ dysfunction and death.
Also called septicemia, or sepsis syndrome, sepsis is commonly misunderstood as an infection, which it is not. Instead, sepsis is triggered by an infection. Bacterial, viral, or fungal infections can all provoke sepsis. Even the novel coronavirus that causes COVID-19 can cause sepsis. However, bacterial infections are the most common cause.
The immune system normally responds to an infection by producing inflammatory substances that kill the microorganism as well as surrounding tissues. The immune system dials up the immune system at the site of the infection and dials back the immune system in the rest of the body. It’s like the immune system presses the accelerator in one spot and slams on the brakes everywhere else.
Sometimes that balance falls out of whack and the immune system overreacts. Inflammatory substances circulate throughout the body, and the inner lining of the blood vessels produces substances that both damage blood vessels and cause them to grow wider. Fluid in the blood leaks out, and blood pressure goes down. The body compensates by speeding up the heart and breathing. This is the clinical definition of sepsis.
As more fluid leaks out of the bloodstream, blood pressure falls and tissues throughout the body stop receiving enough oxygen to carry on their functions. The condition is now a serious medical emergency called severe sepsis. Fluid continues to leak out of the blood vessels, blood clots begin to form in the bloodstream, lactic acid builds up, and blood cells become less flexible, further reducing oxygen flow to the body.
Septic shock occurs when blood pressure is too low to adequately fill the heart with blood, and tissues throughout the body are starved of oxygen. Vital organs begin to lose function and they eventually fail for lack of oxygen. Called multi-organ dysfunction syndrome (MODS), this is the final and often fatal stage in sepsis.
Worldwide, sepsis causes more deaths than any other cause. Globally, one in five deaths each year are due to sepsis. The majority are young children and 40% are young children under 5.
In the United States, however, infection prevention and widespread use of antibiotics make sepsis less of a threat than in other parts of the world. It is still a serious threat, however. The Centers for Disease Control and Prevention (CDC) estimate that 1.7 million people in the United States are struck with sepsis each year. A quarter-million of them die, representing about 10% of all registered deaths in the U.S.
Sepsis is so deadly because it can progress rapidly. Fortunately, sepsis can be medically managed and people can recover. However, every minute counts, so it pays to know what it is and what to do when symptoms first appear.
How is sepsis diagnosed?
Sepsis is primarily diagnosed by physical symptoms, lab tests, and microbiology cultures.
Sepsis symptoms
Because sepsis can progress rapidly, it is important to know the initial symptoms and immediately seek medical attention. The symptoms of sepsis are:
- Fever or hypothermia
- Fast heartbeat
- Rapid breathing or hyperventilation
- Low blood pressure or hypotension is usually included in the symptoms of sepsis
The fourth criterion for a diagnosis of sepsis is an elevated white blood cell count, which can only be confirmed with a blood test. Any two of these four symptoms are sufficient for a sepsis diagnosis.
Risk factors
In taking a medical history, the healthcare provider will be particularly interested in risk factors that make sepsis potentially life-threatening such as:
- Active cancer
- Diabetes
- Lung disease
- Congestive heart failure
- Liver disease
- Kidney problems
- A compromised immune system
The presence of any of these increased risks for severe sepsis will indicate the need for aggressive treatment from the outset.
Lab tests
Blood tests may confirm an infection and can show signs of organ failure. Blood cultures (and sometimes urine, joint fluid, or spinal fluid cultures) are used to identify the infecting organism.
Imaging
While imaging is not used to diagnose sepsis, it can help identify the site and extent of the infection. Chest X-rays, computerized tomography (CT scan), magnetic resonance imaging, or ultrasound are used to locate and define the infection.
Severe sepsis: hypotension
Severe sepsis is a life-threatening emergency. In addition to the symptoms of sepsis, its cardinal symptom is low blood pressure (hypotension). If at any time during an infection blood pressure falls, emergency medical treatment is usually required.
Other symptoms of severe sepsis may include altered mental state, disorientation, unconsciousness, blue skin, overly warm skin or cold skin, and either a decrease or increase in urine output.
Blood tests, cultures, and imaging will be used to diagnose and treat severe sepsis, but hospitalization is required. As a result, vital signs will be monitored continually and blood tests will be performed regularly to monitor the progress of the condition.
Sepsis treatment options
Sepsis treatment follows a protocol based on the progress or severity of the condition. Survival depends on keeping blood pressure normal. Antibiotics are used from the beginning to manage the infection. Intravenous fluid replacement is used to replace lost blood volume. If blood pressure drops and cannot be improved with intravenous fluids, medications will be used to increase blood pressure.
Most people will initially be treated in an emergency room and then be hospitalized, most often in an intensive care unit (ICU). About one in seven people, however, will have a mild enough case of sepsis that they will be released from the emergency department for outpatient treatment.
Infection control
The first line of therapy against sepsis is to bring the infection under control with antibiotics. Patients are immediately given broad-spectrum antibiotics at the outset, but when the infecting organism is identified, an antimicrobial medication appropriate for that organism will be used. Surgery may be used to remove infected or dead tissue such as an abscess.
Shock management
The goal of shock management is to prevent or reverse low blood pressure. Time is of the essence, so patients will be put on IV fluids to restore blood volume. If that does not work, medications that rapidly increase blood pressure will be administered. Most patients will be put on supplemental oxygen or mechanical ventilation to increase oxygen levels in the body.
When these measures fail, the patient may be put on medications that increase the force of the heart’s contractions or be given a packed red blood cell (pRBC) transfusion to increase blood flow if their blood count is low; this would not be done if they have a normal hemoglobin or blood count. In the most life-threatening cases, the patient may be put into an induced coma for several days using sedatives.
Sepsis medications
Sepsis medications focus on one of two goals: controlling the infection or restoring blood pressure. Any delay in treating the infection increases the chance of death, and controlling blood pressure is critical to survival.
Antibiotics
When all the signs point to sepsis, a physician will typically start the patient on a combination of broad-spectrum antibiotics that may include vancomycin, ceftriaxone, piperacillin-tazobactam, cefepime, tobramycin, imipenem-cilastatin, gentamicin, and others. Physicians will follow a protocol based on the location and source of the infection as well as the patient’s history with antibiotics. In addition, most hospitals currently employ an anti-microbial steward committee, which is usually headed by an infectious disease doctor. This is a group of healthcare providers tasked with ensuring the appropriate and judicious use of antibiotics in the hospital.
The goal of broad-spectrum antibiotic therapy is to kill as many types of bacteria as possible. Once the cultures have identified the microorganisms responsible for the infection, antibiotics that work the best against those organisms will be used. For out-patients with sepsis, oral antibiotics may sometimes be used, but hospitalized patients will be treated with intravenous antibiotics.
Other antimicrobial medications
For sepsis caused by viruses, an appropriate antiviral medication will be used. Some viruses, however, cannot be controlled by medications. Sepsis can also be caused by fungal infections, so amphotericin B or echinocandins such as Cancidas (caspofungin) or Mycamine (micafungin) will be used.
Vasopressors
Vasopressors are drugs that cause veins and arteries to contract and thus rapidly increase blood pressure. The first-line vasopressors for septic shock are the vasopressors epinephrine (adrenaline) and norepinephrine, but vasopressin is used if these drugs are not effective. To a lesser extent, these drugs also cause the heart to beat more forcefully, which also increases blood pressure and blood flow.
Corticosteroids
If vasopressors fail to increase blood pressure, corticosteroid injections can help the body compensate. Corticosteroids increase the kidney’s retention of sodium, which then increases the amount of water in the bloodstream, increasing both blood volume and pressure. However, corticosteroids should be used with caution in sepsis, as they have the potential to suppress the immune system and make the infection worse if not used in the right scenario.
Inotropes
When fluid replacement, vasopressors, and corticosteroid injections are unable to reverse shock, doctors will turn to inotropes or a red blood cell transfusion. Positive inotropes, dobutamine or milrinone, to increase the force of the heart’s contractions and increase the amount of blood pushed out with each heartbeat.
What is the best medication for sepsis?
Doctors prescribe medications for sepsis following well-known protocols based on the type of infection, lab results, and physical symptoms. There is, then, no “best” medication for sepsis, just the most appropriate set of medications for the medical situation.
| Best medications for sepsis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Vancomycin | Antibiotic | Intravenous injection | 10 ml of 250 mg / 5 ml every six hours or 20 ml of 250 mg / 5 ml every 12 hours | Decreased blood pressure, kidney injury, hearing loss |
| Rocephin (ceftriaxone) | Antibiotic | Intravenous injection | 1000-2000 mg once per day | Rash, nausea, diarrhea |
| Zosyn (piperacillin-tazobactam) | Antibiotic | Intravenous injection | 50 ml of 3-0.375 grams every six hours | Diarrhea, headache, constipation |
| Cefepime | Antibiotic | Intravenous injection | 100 ml of 2 gm/100 ml every 12 hours | Injection site reactions, rash, diarrhea |
| Primaxin IV (imipenem-cilastatin) | Antibiotic | Intravenous injection | 500 mg every six hours | Blood clots, nausea, diarrhea |
| Gentamicin | Antibiotic | Intravenous injection | Dosage depends on weight | Nausea, vomiting, stomach upset |
| Solu-Cortef (hydrocortisone sodium succinate) | Corticosteroid | Intravenous infusion | 50 mg every six hours (this regimen can vary) | Increased appetite, insomnia, mood changes |
| Epinephrine | Vasopressor | Intramuscular or subcutaneous injection | 0.3 to 0.5 mg every 10 minutes | Anxiety, restlessness, heart palpitations |
| Vasopressin | Vasopressor | Intravenous infusion | 0.01 to 0.07 units per minute | Decreased heart output, slow heartbeat, irregular heartbeats |
| Dobutamine | Inotrope | Continuous intravenous infusion | Infusion rate will depend on weight | Increased heart rate, high blood pressure, premature heartbeat |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of sepsis medications?
Sepsis is a potentially fatal medical emergency. Survival depends on medications, so side effects are not always an immediate concern. To minimize side effects, all treatment protocols involve the de-escalation of antibiotics and other medications when certain conditions are met.
Antibiotic injections commonly cause injection site reactions such as pain, redness, and swelling. In general, antibiotics cause digestive system problems such as an upset stomach, intestinal problems, nausea, and loss of appetite. Allergic reactions are the major concern with antibiotics, so the patient’s history with antibiotics will determine which drugs can be used.
Corticosteroid injections have a number of unpleasant and commonly-experienced side effects including mood and behavior changes, aggressiveness (these are not common but can occur), increased appetite, weight gain, and high blood pressure.
Vasopressors rapidly constrict blood vessels, but they are also mild positive inotropes, that is, they cause the heart to beat harder. Most people will experience significant and even serious side effects such as anxiety, nervousness, fast heartbeats, breathing problems, headache, weakness, and dizziness. The most serious but rare side effects include heart attack or stroke.
Inotropes are the drug of last resort for septic shock. They have serious side effects such as increased heart rate, high blood pressure, palpitations, premature heartbeats, and chest pain.
What is the best home remedy for sepsis?
Sepsis is a serious and potentially life-threatening medical emergency. If you notice at least two symptoms of sepsis–high fever or hypothermia, fast heartbeat, rapid breathing or hyperventilation, or low blood pressure–immediately go to the emergency room.
According to one study, about 16% of patients will have a mild enough case of sepsis to be treated in the emergency room and released for outpatient treatment. The rest will be hospitalized.
For outpatient treatment, or in the days and weeks following release from the hospital, patients should:
- Take all prescribed medications faithfully
- Get plenty of rest
- Drink enough fluids
- Eat a healthy and nutritious diet
- Exercise according to the doctor’s instructions
- Keep all follow-up appointments
- If surgery is performed, keep the wound clean and change the dressing as instructed
- If sent home with an IV, keep the IV site clean
- Immediately seek medical help if symptoms such as fever, heart rate, breathing rate, or blood pressure worsen
Frequently asked questions about sepsis
What is the medical treatment for sepsis?
Sepsis treatment follows guidelines based on the severity of the condition. Initial treatment starts with broad-spectrum antibiotics to control the infection and intravenous fluids to restore blood volume. In severe sepsis, the goal is to elevate blood pressure and increase oxygen to the body’s tissues, so treatment will consist of some combination of fluid replacement, vasopressors, corticosteroids, supplemental oxygen, and, as a last resort, blood transfusions or drugs that strengthen the force of the heart.
What are the chances of surviving sepsis?
Survival depends on how far sepsis advances. One out of four patients with severe sepsis and half of all patients who enter septic shock will not survive the condition.
What are the long term side effects of sepsis?
Long-term effects of sepsis depend on the severity of the condition, the age of the patient, and previous health problems. Otherwise healthy patients who are treated for mild sepsis usually suffer no or only minimal organ damage, so they usually recover fully. Patients with severe sepsis or septic shock can have long-term effects that include cognitive and psychological problems, delirium, fatigue, weakness, disability, lung injury, amputations, and organ failure. For severe sepsis and septic shock, the mortality rate is high for the two years following release from the hospital, particularly for elderly or sick people. Some patients may require hospice or residential care for the remainder of their lives.
What should I eat if I have sepsis?
If you are treated on an outpatient basis, eat healthy, nutritious meals and drink plenty of fluids to help your body heal.
Can sepsis be cured?
Sepsis and septic shock can be cured by managing the infection and maintaining blood pressure. Tissues and organs, however, damaged by lack of oxygen may not return to normal function.
Can you have sepsis and not know it?
It is possible to have an infection and not know it, especially when someone has long standing diabetes. However, when the infection triggers sepsis, the entire body is affected. Fever, pain, confusion, disorientation, difficulty breathing, or unusual sleepiness can all herald the onset of sepsis. Fever, hypothermia, fast heartbeat, fast breathing, and low blood pressure are the classic signs of sepsis. Sepsis is not only noticeable, it’s hard to ignore.
How long does it take to get better from sepsis?
Most healthy patients with mild sepsis will recover in three to ten days after leaving the hospital. Severe sepsis and septic shock may entail long-term effects that can last for months, years, or a lifetime.
How long can you live with sepsis untreated?
Sepsis is a rapidly advancing condition that can lead to death in as little as 12 hours depending on the health of the patient. The risk for death increases anywhere from 4% to 8% each hour sepsis goes untreated.
Does sepsis shorten life?
31% of patients hospitalized with severe sepsis or septic shock will not survive the first year after being released from the hospital. 41% do not survive longer than two years. It is generally believed that survival after severe sepsis depends on how healthy and how old the patient was before becoming septic.
Is sepsis death painful?
Sepsis can be and often is extremely painful (this really depends on what type of infection is causing it). At its later stages, patients often slip into confusion, unconsciousness, or coma, so it is uncertain what they experience when they pass away.