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Sepsis, what is it? Symptoms, diagnosis, treatment and complications of sepis

What it is? Sepsis is a purulent infection that has spread throughout the body, developing from the primary focus against the background of weakening of the defense mechanisms and proceeding with a sharp inhibition of the functions of a number of vital organs and systems. The problem of sepsis is relevant in connection with the increase in morbidity, difficulties in diagnosis and high mortality - then we take a closer look at what the disease is.

The word "sepsis" of Greek origin means rotting or decay. The term is used in various areas of clinical medicine, has a broad terminological interpretation, due to the variety of clinical manifestations of the disease. This condition is caused by penetration into the bloodstream and tissues of pathogens and their metabolic products, characterized by inflammation throughout the body.

For centuries, sepsis took the lives of the wounded and sick, he was considered the most severe, terrible complication of wound infection. Before the discovery of antibiotics, the mortality rate as a result of the disease reached 100%.

But even now mortality is also kept at a high level. In the United States, about 700 thousand cases of sepsis are registered annually, and 200-215 thousand patients die. This is not only a medical, but a demographic and economic problem.

Content

Causes of sepsis

sepsis

Sepsis is triggered by various types of bacteria, viruses or fungi. Most often it is caused by streptococci and staphylococci, less often it can be provoked by pneumococci and E. coli. In its development, a significant role is assigned to the protective forces of the body, which can be reduced as a result of a serious illness, loss of a large amount of blood, and surgical intervention.

The root causes of common infection include:

  • suppuration of the wound;
  • aggravated course of local purulent diseases (furuncle);
  • complications after childbirth and abortion;
  • purulent inflammation of the urogenital system;
  • acute or chronic purulent processes of the organs of the oral cavity.

Septic reaction develops with peritonitis, pneumonia, infection of intravascular devices and catheters. Sepsis does not occur as a result of the direct influence of microbes and toxins on the body, but is the result of large disorders in the immune system, complete or partial loss of ability to suppress the pathogen beyond the boundaries of the infectious focus, due to which recovery of the patient becomes almost impossible without intensive treatment.

Classification

According to domestic and foreign publications, there are many views on the definition and pathogenesis of sepsis. Nowadays, the disease is usually divided according to the clinical course, depending on the entrance gate of the infection, the type of pathogen and the localization of the primary focus.

According to the clinical course of sepsis is:

  • lightning fast or acute;
  • acute;
  • subacute;
  • chronic.

Lightning sepsis is characterized by a rapid onset and rapid progression, often fatal in 1-2 days. The acute form of the disease lasts from 6 to 14 days without remission. Subacute - from 2 to 12 weeks, the signs are less pronounced. Chronic sepsis with relapses and periods of remission may occur for several years.

Depending on the entrance gate delimit:

  • wound sepsis (accidental or postoperative wound);
  • burn;
  • postnatal;
  • sepsis in the pathologies of internal organs (pericarditis, pneumonia).

Regarding the localization of the primary septic source of sepsis is:

  • stomatologic;
  • tonsilogenic (primary focus in the tonsils);
  • otogenic (otitis complication);
  • rhinogenic (primary focus is localized in the paranasal sinuses and the oral cavity);
  • gynecological;
  • umbilical (entrance gate has an umbilical wound);
  • cardiogenic (septic focus in the endocardium).

This also includes urosepsis with the location of the infection in the kidneys and urinary tract.

Infection is distinguished by the type of pathogen. According to this classification feature, it is:

  • staphylococcal;
  • streptococcal;
  • colibacillary;
  • pseudomonosis;
  • anaerobic;
  • fungal.

Sepsis can be secondary, developing with purulent infection and primary, when the focus can not be determined. The admissibility of the latter form is debatable, since an infectious source at the time of sepsis may lose its clinical significance and may not be detected during the examination of the patient.

Symptoms of sepsis

Symptoms of sepsis

Almost all organs and systems of the body are affected by pathological processes that are observed in sepsis. Symptoms of sepsis are diverse and depend on its clinical form, the location of the primary focus.

As a rule, the disease begins acutely, with a rise in temperature to 39-40 ° C. Fever can be permanent, remitting or wavy. It is accompanied by a shaking chill, torrential sweats and painful rapid heartbeat, which continues after the normalization of body temperature.

Changes in the central nervous system include drowsiness, confusion, agitation or lethargy, disorientation.

Among organ lesions, the most common manifestations are arthritis and polyarthritis, endocarditis with valve involvement, polysegmental pneumonia.

Sepsis accompanies the defeat of the kidneys of a different nature. Changes are manifested in the form of damage to the renal tubules, oliguria. The spread of infectious sepsis in the kidneys can be expressed by cystitis, paranephritis, pyelitis.

On the part of the digestive system is often debilitating diarrhea, nausea, vomiting, soothing abdominal pain. Pathological processes in the liver and spleen manifest as jaundice, increased bilirubin.

Practically obligatory in patients with sepsis is a lesion of the respiratory system. The severity of the condition can vary from shortness of breath to the development of severe lung function disorders in the form of respiratory distress syndrome. Pathology is characterized by a hemorrhagic or pustular rash on the trunk and extremities, which appears at the end of the 1st week of the disease and lasts a long time, extinguished and flared up again.

Sepsis is a dynamic process that often develops according to an unpredictable scenario, so there is no main and only diagnostic criterion for it.

Diagnosis of sepsis

The diagnosis of sepsis is based on an exhaustive analysis, evaluation and comparison of clinical and laboratory data. Anamnesis, the presence of the primary focus, the entrance gate and the comparison of septic syndrome (fever, chills, severe intoxication, inadequate tachycardia) with multiple organ lesions are important.

Laboratory diagnosis is based on the definition of a marker of systemic inflammation - procalcitonin, which is considered the most effective indicator of sepsis. Usually in humans, this figure does not exceed 0.5 ng / ml. If the number is more than 2 ng / ml, sepsis is diagnosed with a high probability.

Also carried out microbiological research. Not only blood is taken for diagnosis, but also material from wounds, tracheotomy tubes, drainages.

To the diagnostic minimum, which the doctor must prescribe to clarify the diagnosis include:

  • detailed blood test with the formula;
  • general urine analysis;
  • X-ray of the organs of the chest cavity.

Additional research methods: ultrasound, computed tomography, puncture.

Sepsis treatment

In the treatment of sepsis, an important role will be assigned to timely phased antimicrobial therapy. The choice of an antibacterial drug depends on the severity of the patient's condition and the pharmacological characteristics of the drug, on whether the community-acquired or nosocomial infection provoked the infection, on the presence of a lesion.

When treating blood sepsis with antibiotics, carbapenems (imipenem), cephalosporins (ceftriaxone) in combination with aminoglycosides (gentamicin), glycopeptides (vancomycin) are of the greatest importance.

A delay in initiating the necessary antibiotic therapy increases the risk of complications and mortality. Drugs prescribed courses for 2-3 weeks, while using several funds.

The treatment also includes detoxification therapy, nutritional support (enteral nutrition), immunotherapy, correction of tissue hypoxia, intensive therapy and resuscitation, according to indications - surgical intervention. Almost all patients with sepsis have a need for respiratory therapy.

To prevent damage to the lungs with symptoms of acute distress syndrome, a special mode of artificial ventilation is needed.

The organization of treatment is always difficult. Therapy is carried out in a close union of a surgeon, therapist and resuscitator. One of the important tasks of treatment is the search and rehabilitation of primary and secondary purulent foci - without their elimination, even with the highest level therapy, one cannot count on the patient's recovery.

Sepsis in newborns

Sepsis in newborns

In the structure of mortality factors in full-term newborns, an increase in the proportion of infectious diseases is observed. Among the causes of sepsis in newborns, the last role in the violation of an adequate immune response belongs to fetal intrauterine infection.

The focus of infection in such cases is:

  • microflora of the birth canal of the mother;
  • infectious inflammatory diseases in pregnant women;
  • anhydrous period in labor for more than 6 hours;
  • community hospital labor.

High risk of developing sepsis in children is diagnosed if the body weight at birth is less than 1500 g.

Complications

Various complications arising during the course of the disease often significantly change the clinical picture and predetermine its outcome. Complications of sepsis include:

  • septic shock;
  • acute renal and hepatic failure;
  • bleeding;
  • thromboembolism;
  • pneumonia;
  • pyelonephritis;
  • endocarditis.

Some of these complications are the result of a weakening of the body’s compensating abilities during the course of sepsis, others arise due to intoxication and the spread of infection as a result of metabolic disorders. Septic shock is considered the most common cause of death.

Prognosis and prevention

The prognosis for sepsis is extremely serious. It is especially disappointing in young children, during pregnancy, in people of mature age, with aggravating comorbidities.

Prevention consists in the timely treatment of wounds and purulent foci, the implementation of the rules of asepsis and antisepsis during surgical operations.

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