Sepsis: symptoms, treatment, classification, clinical and diagnostic concept, prevention

Sepsis( decay) is a serious, life-threatening, general-organism pathology that manifests itself in a generalized( affecting all organs) inflammatory reaction that occurs when pyogenic bacterial forms or toxins( poisons) enter the systemic circulation. And this article will shed light on such issues as the classification and clinical-diagnostic concept of sepsis, its symptoms in adults, children, newborns and the treatment of such a disease.

Features of the disease

The popular name of sepsis - "blood poisoning" - determines the nature of the pathology. The development of blood infection occurs in conditions of the inability of the immune system to resist the common infection.

Blood poisoning is very difficult to respond to any treatment methods, since in this condition there is a massive multiplication in the patient's blood of pathogens and an increase in the volume of poisons released by them.

• Such a serious pathology is especially dangerous for children. And the younger the child, the greater the threat this condition. In newborns and small children diagnosed sepsis due to lack of development of immune forces often means a sentence to a small patient if the treatment is delayed.
  instagram viewer
• The same applies to people of the "winter" age of 70 years, who have weakened the defenses and the work of all organs.

There is no incubation period for blood infection. Symptoms begin to manifest in the interval from 3 to 5 hours to 3 to 7 days. It is necessary to have a source of blood infection in the form of wound injuries, skin burns and mucous membranes, and a primary focus in the form of a boil, phlegmon, abscess, panaritium, acute surgical pathology, including diffuse appendicitis, peritonitis.

Only accurately and quickly diagnosed and immediate intensive therapy reduces the death rate of patients.

The classification of sepsis in adults, children and newborns will be presented next.

The following video is available and understandable about sepsis:

Classification of sepsis

Symptomatic symptoms and possible prognosis are associated with the form of blood infection and the stage of sepsis. Regardless of the type of pathogen, the clinical signs for blood infection are typical, and the flow is extremely severe.

Pathology is classified according to the following parameters.

Pathogenesis of sepsis

At the site of penetration of the causative agent

At the site of penetration of the pathogen and the initial focus:

• surgical sepsis , which has a source of pyogenic processes in open and closed wounds, complications of external and internal ulcers. Isolate wound sepsis, which occurs when fighting injuries.
• obstetrics and gynecology .Development is due to the activity of microorganisms on the uterine mucosa due to postpartum infection, inflammation after abortion, diseases of reproductive organs.
• postoperative , which occurs after a violation of aseptic procedures during operations;
• therapeutic .Occurs in the form of complications( septicemia) with streptococcal, staphylococcal angina( tonsillar sepsis), pneumonia, cholecystitis, pancreatitis, renal pathologies, leading to hemorrhages, tissue degenerations, thrombophlebitis. Severe sepsis is accompanied by the appearance of purulent metastases( septicopyemia).Therapeutic sepsis includes:
  • abdominal( inflammation in the organs of the abdominal cavity, perforations of the stomach, intestines, esophagus, internal abscesses caused by E. coli, peritonitis);
  • urosepsis( purulent processes in the organs of the genitourinary system, infection with congestive urine);
  • otolaryngological( deep abscesses in the tonsils, paranasal sinuses, acute diseases of the oral cavity, middle ear);
  • is odontogenic( as a result of infection of the gingival and bone tissue in purulent dental infections).
• idiopathic ( essential, cryptogenic, genuine) or sepsis, the source of which is not identified.

By exciter

By exciter:

• staphylococcal sepsis,
• meningococcal,
• fungal,
• streptococcal
• and mixed.

By development time

By development time:

• early : if no more than 14 days have passed from the formation of the source to the active septic process;
• late : manifestations of blood poisoning are observed after 2 weeks from the beginning of the process.

On the course of

On the course of:

• fulminant sepsis with a characteristic rapid increase( within the first 24 hours) of symptoms and their severity, including damage to the kidneys, heart, liver. Without treatment, the patient's death is predicted in 1 to 2 days.
• acute : the development of the process goes 7 - 20 days;
• subacute form of : latent development for weeks( up to 12 - 16);
• is a chronic or recurrent form of of blood infection( rarely diagnosed) with wave-like stunning and exacerbations of manifestations for several years.

Scheme of sepsis classification

Steps of progression

1. Toxic resorptive fever , manifested in the general inflammatory response of all body structures to the introduction and multiplication of pathogens. Characteristic of the general poisoning by bacterial poisons. Body temperature can vary from febrile( 39 - 40 C) to low( less than 36C).There is a tachycardia, rapid breathing( more than 20 breaths per minute in adults).Blood in the analysis shows only the presence of toxins, that is, bacteremia( pathogenic bacteria in the blood) is not detected.
2. Septicemia or sepsis .In manifestations similar to the toxic-resorptive fever, the multiplying microbial flora, signs of progressive inflammatory processes( meningitis, pneumonia, purpura, peritonitis) are revealed in blood, urine or cerebrospinal fluid.
3. Septicopyemia or severe sepsis .In all tissues metastases or purulent foci are rapidly forming. In liquids, a large number of microbes are detected. Of the additional signs - a drop in pressure, a violation of the internal organs.
4. Septic shock .A threatening state with a high risk of death of the patient to 70 - 90% due to a violation of the supply of organs with blood. Active resuscitation actions have low effectiveness and are rarely able to stop the pressure drop and normalize the tissue blood supply.

The causes of sepsis are listed below.

Causes of

Mechanism of

Pyogenic( or pyogenic) bacteria - cocci, Pseudomonas aeruginosa, Klebsiella, Proteus, enterococci, enter the body, form the primary focus. Further progression of sepsis is highly dependent on the resistance of the immune forces, early diagnosis and intensive treatment.

Factors provocateurs

The leading factor provoking the development of blood contamination is the inadequacy of the immune system function. A patient with a reduced immune defense, unable to withstand bacterial aggression, can become infected and get contaminated with blood when germs are introduced into the blood through the gum tissue during a banal brushing of the teeth.

Risk factors that reduce immune defense and increase the risk of sepsis include:

• chronic, severe pathologies, including bacterial pneumonia, diseases of the blood, heart, kidneys, liver;
• malignant tumors, HIV, autoimmune diseases;
• diabetes mellitus,
• deep skin burns and frostbite;
• abscesses of any nature, injuries, soft tissue injuries, pressure sores;
• gastric ulceration, esophagus, intestines;
• uncontrolled use of psychoactive substances, intravenous infusion of narcotic drugs;
• use of immunosuppressants( medicines that suppress the immune system), cytostatics( antitumor drugs) in radiation therapy, prolonged unreasonable treatment with antimicrobial and antibacterial drugs, suppressing useful flora;
• depletion, weakening the immune system;
• nosocomial infections, in which conditions microorganisms get on the mucous through the instrumentation, dressings.

Special care requires the following medical manipulations:

• dental treatment of infectious foci( drainage of abscess);
• long-term use of intravascular medical needles;
• surgical interventions using infected donor tissues;
• prolonged wearing of prosthetic joints;
• installation of catheters in the bladder against the background of infection of the genitourinary organs, colostomy tubes when creating a tap in the intestine.

The first( early) symptoms-signs of sepsis in newborns and adults will be discussed below.

Symptoms of

Symptomatic of sepsis at different stages is similar in many respects, but its severity increases with the progression of pathology.

Dissemination of sepsis

Baseline symptoms of

Common and persistent signs of severe intoxication( toxemia) and active inflammatory process refer to the basic symptoms of sepsis in the stages of toxic resorptive fever and septicemia:

• severe general condition, refusal to eat, intense headache;
• nausea, sometimes vomiting, often diarrhea difficult to respond to therapy;
• temperature "jumps" from 35 - 36C( usually in the morning) to 39 - 41C, and the more active the septic process, the more pronounced they are;
• if the patient is elderly, emaciated, weakened, the temperature increase may be insignificant, and often its indices fall below the norm, indicating a very low level of immune forces;
• strong chills with trembling of the body, as from the cold, heavy( pouring) sweat;
• tachycardia( over 90 beats / min, up to 150 with severe form), heart murmurs;
• shortness of breath without other signs of bronchopulmonary pathology;
• Oppression, general depression, followed by overexcitation, delirium;
• in the blood, urine or cerebrospinal fluid reveals pathogens in the stage of reproduction( bacteremia);
• joint pain;
• increase and soreness of the spleen, liver;
• jaundice of the skin, whites of the eyes, mucous membranes;
• increase or decrease in the number of leukocytes in the blood( less than 4 units or more than 15 and up to 25 - 30) in units of "109 / l"( thousands of cells in 1 microliter - μl).
• Reduction of erythrocytes, a drop in hemoglobin level( up to 20-30%);
• increased ESR( 30 - 50 mm and more) per hour.
• rashes in the form of pinpoint skin lesions on the chest, hands, belly( petechia), vesicles with blood on the oral mucosa, bleeding sclera with redness of the eye protein, indicating the development of hemorrhagic syndrome( due to damage to the vessels by toxins).Later the rashes merge with the formation of spots and blisters.

Chronic course of

In chronic course of pathology, all manifestations are poorly expressed. The main symptom is poor health, shortness of breath.

Often, signs of chronic sepsis are disguised as signs of other internal diseases. Therefore, diagnosing a chronic form is a rather complex process, in which many factors should be analyzed.

Next, the diagnosis and treatment of sepsis, as well as clinical recommendations in this case.

The treatment of sepsis is the subject of the following video:

Diagnosis of

Blood poisoning is diagnosed based on symptoms and blood test data on the presence of bacteria, given that at the stage of toxic resorptive fever and in chronic course of remission, bacteremia( presence of germs in the blood)is not detected.

Laboratory methods

Laboratory methods include:

• a bacteriological blood test for the detection of an active microbe and its reaction to the action of various antibacterial drugs( antibioticogram) for the development of an optimal treatment regimen. The fence is made from two different subcutaneous veins in a volume of 5 to 10 ml, by sowing in a nutrient medium.
• isolates the genetic material of the pathogen that caused sepsis by polymerase chain reaction( PCR) by express methods. Within 2 hours identification of up to 25 species of microorganisms and pathogenic fungi is possible.
• determination of the amount of procalcitonin in the blood: its elevated content is considered as a characteristic sign of infection of the blood;

The test for procalcitonin has a high degree of diagnostic value, allowing to confirm the diagnosis of bacterial sepsis, septic shock, differentiate the disease from other pathologies with similar clinical signs.

Changes in blood counts

When diagnosed necessarily take into account changes in blood parameters, which are characterized by:

• progressive anemia;
• high leukocytosis( abnormally high white blood cell count) or, in case of debilitated patients, leukopenia( decrease in the number of white blood cells);
• thrombocytopenia - reduced platelet count;
• high levels of bilirubin and residual nitrogen;
• reduced calcium and chloride content.

In the urine, protein, white blood cells, erythrocytes, an increased amount of urea and uric acid are detected.

Treatment

Therapy of sepsis at any stage is complex and is carried out using intensive methods exclusively in the hospital for prompt correction of treatment and constant monitoring of vital signs.

For the modern treatment of sepsis with antibiotics and other drugs we will talk further.

Therapeutic and medical

Blood, urine, liquor( if necessary), separation of wounds and abscesses should be analyzed immediately upon admission, prior to the initiation of antimicrobial therapy.

Priorities of

Priorities( within the first 6 hours):

1. artificial ventilation in case of respiratory failure;
2. increase and stabilization of blood pressure( up to 65 mm Hg arterial, up to 12 - central venous) in order to prevent shock and coma. To maintain systolic pressure at 90 mm Hg. Stimulation of cardiac output and kidney function is used: Dopamine - in doses not exceeding 20 mcg per kilogram of weight per minute. If there is no curative effect, use Dobutamine and Noradrenaline( 2-8 μg / kg / minute).
3. oxygen saturation( minimum 70%) to prevent cardiac arrest and destruction of the brain tissue;
4. activation of urine output for the excretion of poisons( minimum - 0.5 ml per kilogram of patient weight per hour);
5. prevention of thrombohemorrhagic syndrome: Heparin( 20 - 80 thousand units per day) under the control of blood coagulability( coagulogram).

These primary medical measures, conducted correctly and in a timely manner, reduce the number of deaths by 16-18%.

Parallel therapy

In parallel:

• infusion of glucose and water-salt solutions into the central vein( or in several peripheral ones) for active detoxification( excretion of bacterial poisons from the body) via droppers. Use solutions of NaCl, Ringer's lactate, 5% glucose, colloidal solutions, platelet mass, blood, plasma substitutes, including hydroxyethyl starch, dextrans, gelatin, albumin.
• antibacterial therapy( two, three drugs), including Polimexin B, which is carried out immediately - within one hour from the patient's admission to resuscitation( even before the diagnosis is confirmed).

• anti-inflammatory therapy with glucocorticosteroids( Prednisolone, Dexamethasone) to accelerate the suppression of inflammation;
• measures to prevent deep vein thrombosis - use of antiaggregants and blood thinning medications: intravenously in a daily dose of Pentoxifylline( Trental, Agapurin) to 400 mg, Gordox up to 100,000 units;
• prophylaxis of ulceration and bleeding in the stomach, esophagus, intestine, using 2 - 3 times a day Famotidine 20 mg( intravenously);
• immunotherapy with immunostimulants, specific antibacterial sera.

Surgical intervention

If necessary, performed concomitantly with medication and therapy. A patient with signs of sepsis is examined to identify a foci of suppuration, which infects blood and tissues.

To this end, if an abscess is found:

• perform an autopsy;
• removes foreign bodies, including implanted cardiac pacemakers, implants to prevent secondary infection and inflammation in this area. This takes into account the risk to life from the extraction of the medical device( for example, removal of the artificial valve of the myocardium is guaranteed to lead to death).
• excise dead tissue in the area of ​​the abscess, as poisons and decay products poison the body;
• is cleaned, the wound is treated with antimicrobial aseptic agents, drainage is introduced for the purpose of a continuous outflow of pus.

Do not start treating sepsis with folk remedies!

Complications, prevention of sepsis and a prognosis of recovery in newborns, adults and children with it are given below.

Prevention

Preventative measures for the development of blood poisoning include:

• mandatory and timely suppression of local suppuration and bacterial infections;
• observance of absolute asepsis in operations and medical manipulations with tissue damage;
• the maximum possible reduction in the time required to locate the needles in the veins and catheters in the bladder;
• competent use of antimicrobial agents, taking into account the rapid adaptation of pathogens to antibiotics and the development of resistance to their action;
• careful monitoring of the treatment of medical instruments, facilities, timely isolation of infected patients;
• immunization from pneumococcal infection of people with immunodeficiencies, chronic pathologies of the heart, spleen, lungs, kidneys.

Complications of

Possible consequences for sepsis:

• infarcts, purulent abscesses of the lung, gangrene( destruction and death of cells);
• paranephritis( inflammation of the kidney);
• brain abscesses, including meningitis( purulent meningitis);
• weakening of the heart and respiratory organs until the stop;
• septic shock, accompanied by failure of the lungs, liver and kidneys;
• thromboembolism, heart attack, stroke( blockage of the vessels of the lungs, heart and brain with thrombi);
• thrombohemorrhagic syndrome( DVS) with massive bleeding and organ failure;
• death.

Forecast

Prognosis for blood poisoning is always serious. With fulminant sepsis, mortality is unavoidable in 85 to 99% of patients who have undergone bacterial aggression. But in this case, active and operative therapy, carried out with suspicion of the development of pathology even before the diagnosis is confirmed, significantly reduces mortality from sepsis.

A lot of useful information about sepsis is contained in this video: