Sepsis

What is sepsis?

Sepsis happens when the body response to an infection begins damaging its own tissues and organs. It can follow any infection, including a chest infection, urine infection or an infected wound. It is a medical emergency where every hour of delay in giving antibiotics increases the risk of death, so it is treated on suspicion rather than waiting for confirmation.

Causes

• Bacterial infection, the most common origin
• Chest infection or pneumonia
• Urinary tract and kidney infection
• Abdominal infection such as appendicitis or a perforated bowel
• Skin and wound infection including cellulitis
• Viral or fungal infection in some cases

Symptoms

• Feeling confused, slurred speech or unusual drowsiness
• Extreme shivering or muscle pain
• Passing no urine in a day
• Severe breathlessness
• A feeling of impending doom or that you are dying
• Skin that is mottled, blue or very pale
• A rash that does not fade under pressure
• Very high or very low temperature

Risk factors

• Age over 75 or very young infants
• Weakened immune system or chemotherapy
• Diabetes
• Recent surgery or invasive procedure
• Indwelling catheters or lines
• Pregnancy and the period just after birth
• Absent or non functioning spleen

Diagnosis

• Clinical recognition using a screening tool such as NEWS2
• Blood cultures taken before antibiotics where possible
• Blood lactate measurement
• Full blood count, kidney and liver function
• Imaging to locate the source of infection
• Urine output monitoring

Treatment

• Intravenous antibiotics within one hour of recognition
• Intravenous fluids for circulation
• Oxygen to maintain saturation
• Blood cultures, lactate and urine output monitoring
• Source control such as draining an abscess
• Intensive care with organ support in severe cases

Self care

• Sepsis cannot be self treated, it needs emergency assessment
• Complete prescribed antibiotic courses for infections
• Keep wounds clean and watch for spreading redness
• Keep vaccinations up to date, including flu and pneumococcal
• Ask directly "could this be sepsis" if you are worried about someone
• Seek review again if an infection is not improving

When to see a doctor

Book an appointment if:

• An infection that is getting worse rather than better
• A wound with spreading redness or discharge
• Fever that persists beyond a few days
• Feeling much worse than a usual infection
• Any infection while on chemotherapy or immunosuppression
• Recurrent infections needing repeated antibiotics

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Vaccination against flu, pneumococcus, COVID-19 and meningococcus
• Prompt treatment of infections
• Good wound care and hand hygiene
• Careful catheter and line care
• Extra vigilance if immunosuppressed or without a spleen

Outlook

Outcome depends almost entirely on how quickly treatment starts. Recognised early and treated with antibiotics and fluids within the first hour, most people recover fully. Delay allows progression to septic shock and organ failure, where mortality rises steeply. Survivors of severe sepsis may have prolonged fatigue, weakness and cognitive difficulty for months, sometimes called post sepsis syndrome.

Related conditions

Common questions