Sepsis in adults: symptoms and treatment

Blood poisoning (sepsis) is an acute or chronic disease that occurs due to the penetration into the body of a bacterial, viral or fungal flora. Many people believe that the blood of sepsis develops after severe festering wounds, but in reality, there are many other “gates” through which infection can enter the bloodstream, and very often it turns out that the true causes of disease and find out you can not.

What it is?

Sepsis is a serious infectious process that is formed as a result of the constant presence or periodic entry of various pathogens into the human blood circulation system. The clinical picture is dominated by symptoms of a disruption of the whole body, rather than local reactions.

Classification

Depending on the rate of development of the infectious process, the following types of septic states are distinguished:

  1. Lightning sepsis, which develops within three days after infection with pathogenic pathogens;
  2. Acute, in which clinical symptoms develop no earlier than a week after the primary focus of infection;
  3. The subacute septic state is formed from a week to four months;
  4. Chronic sepsis in adults will be considered at the appearance of the first symptomatology not earlier than in six months; it, as a rule, develops in patients with immunodeficiencies of different etiology.

In the epidemiological plan, when characterizing this pathology, the following types are distinguished:

  1. Intrahospital infection. It develops as a result of surgical, gynecological, diagnostic or other medical manipulations arising after the provision of medical care.
  2. Community-acquired infection. The cause is an infectious disease, for example, intestinal infection, meningitis, ENT pathology, etc.

According to the peculiarities of the manifestation of clinical symptoms of sepsis, there are:

  1. Toxemia, which develops a systemic inflammatory process, caused by the spread of infection from the primary focus;
  2. Septicemia, which is characterized by the absence of formation of secondary purulent foci;
  3. Septicopia, with such foci present.

Causes of blood poisoning

As sepsis pathogens appear very different microorganisms: Staphylococcus, meningococcus, pneumococcus, Escherichia coli, Mycobacterium tuberculosis, Klebsiella, Candida type fungi, viruses gerpetimorfnoy group.

It should be noted that the development of sepsis is associated not so much with the properties of the pathogens themselves, but with the state of the human body and its immunity. The decrease in the effectiveness of protective barriers leads to the fact that our security systems can no longer localize harmful pathogens in time and, the more so, prevent their penetration into various organs.

If we talk about the most common methods of infection with sepsis, it is worth noting that they depend on the type of specific pathogen. Each of them has its own characteristics and epidemiological prerequisites. Only isolated cases are when patients develop nosocomial sepsis, the symptoms of which sometimes make themselves felt even after inhaling poorly purified air in the wards (60% of the samples reveal potentially dangerous microorganisms).

There are also other ways of infection that determine the main symptoms of sepsis:

  • obstetric-gynecological;
  • otogenic;
  • cryptogenic;
  • through cutaneous sepsis;
  • oral;
  • infection of the blood, resulting from surgical and diagnostic manipulation.

The identification of the “gateway” through which sepsis has penetrated is of great importance for the successful treatment of patients. Early diagnosis of sepsis allows time to identify the infection, separate it from cases of short-term presence of microbes in the blood and activate the body’s defense systems.

As we said above, for the development of sepsis, certain conditions must be observed, in particular:

  • the formation of secondary foci, which in the future also supply pathogens;
  • presence of the primary focus (it should be associated with the circulatory system or lymphatic vessels);
  • multiple penetrations of pathogens into the blood;
  • the inability of the body to organize the necessary immune defense and provoke reactions against harmful microbes.

Only if all these conditions are met and the patient has relevant clinical signs of infection, doctors diagnose sepsis of blood. The development of sepsis triggered by severe diseases (diabetes, cancers, rickets, HIV, congenital defects of the immune system), therapeutic interventions, trauma, prolonged use of immunosuppressive drugs, radiotherapy, and some other factors.

The first symptoms of sepsis

The clinical course of sepsis in adults may be fulminant (rapid development of displays for 1-2 days), acute (5-7 days), subacute or chronic. Often there are atypical, or “effacement” symptoms thereof (so in the midst of the disease cannot be high temperature), which is associated with a significant change in the properties of pathogenic agents by the massive use of antibiotics.

In the diagnosis of blood poisoning, the following are distinguished:

  1. Syndrome of systemic inflammatory reaction. It is characterized by a change in body temperature (both upward, more than 38 ° C, and downwards – below 36 ° C), palpitations (more than 90 beats per minute) and breathing (more than 20 breaths per minute), a change in the number of leukocytes in blood (less than 4 × 109 or more than 12 × 109 cells per liter of blood).
  2. Sepsis. With the same symptoms as in the case of the systemic inflammatory syndrome, one of the known pathogens, revealing signs of peritonitis, pneumonia, purpura and other local inflammatory processes, is found in one of the sterile normal tissues (blood, cerebrospinal fluid, urine …).
  3. Severe Sepsis. It is characterized in the same way as usual sepsis, but with hypotension, hypoperfusion, or dysfunction of individual organs.
  4. Septic shock . The most serious condition, after which every second patient has a death due to a violation of the blood supply of organs and tissues. It is defined by the same symptoms as sepsis when intensive resuscitation measures do not lead to normalization of blood flow and blood pressure level. Other signs of septic shock include slow urine formation and confusion.

In February 2016, the concepts and diagnostic criteria for sepsis were revised. The concept of the syndrome of systemic inflammatory reaction and severe sepsis is recognized as irrelevant, the concepts of sepsis and septic shock are given new definitions.

To identify and diagnose sepsis, it is recommended to use the SOFA and sofa scales.

Sepsis of newborns

In children due to sepsis, many processes in the body (blood movement, perfusion) are disturbed. Statistics show that the incidence of cases in newborns remains high, but this problem is being actively studied.

Sepsis in children is able to develop as a symptom associated with other diseases and may not have its own symptoms. This disease is a reaction of the body to getting into it a pathogenic micro flora. In the inflammatory process, there is an uncontrolled formation of pus. In newborns, sepsis may occur when exposed to Klebsiella and Pseudomonas aeruginosa, as well as streptococci, enterobacteria, or candida. Sometimes the disease occurs when exposed to several microorganisms. Most often, sepsis affects children under one year of low birth weight.

With the development of the fulminant form of sepsis, a septic shock occurs, which in most cases terminates lethally. The disease leads to a sharp decrease in body temperature, accompanied by severe weakness, lethargy, increased bleeding, pulmonary edema, cardiovascular disorders, of acute renal failure.

Diagnostics

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 (the presence of microbes in the blood) is not detected.

When diagnosing necessarily take into account changes in blood indicators, which are characterized by:

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

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

The laboratory methods include:

  1. Determination of the amount of procalcitonin in the blood: its elevated content is considered as a characteristic sign of blood infection
  2. Isolation of 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.
  3. Bacteriological analysis of blood 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.

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.

What consequences?

Complications of sepsis are extremely dangerous, difficult to treat even under intensive therapy. Let us consider in more detail the most common of them.

  1. Severe bleeding – can frolic as a result of a shortage of special substances (clotting factors and platelets) produced by the liver.
  2. Acute renal and hepatic insufficiency develops under the direct action of toxins on the kidney, or as a result of blockage of the filtering apparatus of the kidneys by microbial fragments and pus. Violated and completely stops the excretion of metabolic products from the body, which further exacerbates the condition.
  3. Infectious-toxic shock (ITSH) – a sharp drop in blood pressure, under the influence of a large number of microbial toxins. Without emergency medical care, you can die for an hour or even a few minutes. Treat ITH in the intensive care unit.
  4. Bacterial endocarditis – develops when germs enter the heart cavity. Causing inflammation, they contribute to the formation of blood clots in his cavity. Subsequently, these blood clots, coming off and falling with a current of blood into the vessels of the brain, can lead to a stroke.

In general, sepsis leads to impaired functions and damage to all internal organs.

What is needed to treat sepsis?

It is common knowledge that sepsis is extremely difficult to treat. Mortality with it is extremely high and in some situations reaches 50%. However, timely assistance rendered this indicator at times.

According to clinical recommendations in 2018 patients with sepsis are treated in intensive care or intensive care units. This is due to the need for constant monitoring of vital signs. During the first 6 hours of the efforts of doctors are aimed at bringing these figures to a certain value and stabilizing them:

  • the amount of urine output is 0.5 ml / (kg * h) or more;
  • saturation of mixed venous blood with oxygen – 70% or more;
  • central venous pressure – up to 8-12 mm. Hg;
  • arterial pressure – up to 65 mm Hg and higher.

Usually this is achieved by the use of various infusion solutions that are poured through the “dropper”, often directly into several peripheral veins or into one central. Sometimes it is necessary to transfuse blood products and add to the solutions drugs that increase blood pressure. Only these measures already reduce the death rate of patients by 17% (from 50 to 33).

Treatment consists in elimination of the arising complications, which in the majority are resuscitative.

For example, when acute renal failure occurs, hemofiltration, hepatoprotectors and hemodialysis are used, in case of hemodynamic disorders, vascular permeability and circulating blood volume are restored, cardiostimulating and vasotropic drugs are cardiovascular, pulmonary insufficiency is used, ventricular H2 blockers / blockers are used for stress bleeding pumps / sucralfate. As for antibiotic therapy, antibiotics should be prescribed according to the results of bacterial studies or against the most likely pathogens.

For the latter case, a table has also been created:

Localization of the primary focusThe most likely pathogens
Lung (nosocomial pneumonia developed outside the ICU)Streptococcus pneumonia, Enterobacteriaceae (E. coli), Staphylococcus aureus
Lung (nosocomial pneumonia developed in the ICU)Pseudomonias aeruginosa, Acinetobacter spp, as well as the above-listed pathogens
AbdomenBacteroides spp, Enterococcus spp, Streptococcus spp, Pseudomonas aeruginosa, Staphylococcus aureus
Skin and soft tissueStreptococcus spp, Staphylococcus aureus,
Enterobacteriaceae
KidneysEnterobacteriaceae, Enterococcus spp
The oropharynxStaphylococcus spp, Streptococcus spp, anaerobes
After splenectomyStreptococcus pneumonia, Haemophilus influenzae
Intravenous catheterStaphylococcus epidermididis, Staphylococcus aureus, enterococci and candida

In the formation of secondary purulent foci, their surgical treatment is necessary – opening abscesses, removing pus and washing the wounds, excising the affected areas.

Prevention

Preventing blood poisoning will help the following:

  • competent use of antibiotics;
  • adherence to basic hygiene rules;
  • timely treatment of purulent processes;
  • observance of aseptic conditions during medical manipulations;
  • immunization of people belonging to risk groups.

Purulent-septic diseases are much easier to prevent than cure, so patients need not only to perform individual preventive measures, but also to monitor how the procedure is performed in the medical office. Observance of these simple measures will help to prevent the development of the disease.

Prognosis for sepsis

The outcome of sepsis is determined by the virulence of the microflora, the general condition of the body, the timeliness and adequacy of the therapy. To the development of complications and unfavorable prognosis are predisposed to elderly patients, with concomitant common diseases, immunodeficiencies. With different types of sepsis, lethality is 15-50%.

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