In Germany, between 75.000 and 95.000 people from sepsis. Superinfection of the entire organism is the third most frequent cause of death – after cardiovascular diseases and cancer. Experts assume that up to approx. 20.000 sepsis cases could be prevented by early detection, preventive measures (vaccinations and prophylaxis of hospital-acquired infections) and better treatment.
Status: September 2021
If the disease, commonly known as blood poisoning, is not correctly diagnosed and treated with intensive care within a very short time, it can be fatal. And: Those who survive the difficult-to-detect infection of the whole body often suffer from burdensome late effects.
In sepsis, an inflammation gets out of control: it takes hold of the entire body, damages the organs and, if left untreated, leads to death in the shortest possible time. Problematic: The signs of sepsis often resemble the symptoms of harmless infections. Together with Prof. Dr. med. Frank M. Brunkhorst, one of the leading sepsis researchers in Germany, the IPF informs about the disease.
The expert : Prof. Dr. med. Frank M. Brunkhorst
Prof. Dr. med. Frank M. Brunkhorst heads the Center for Clinical Studies (ZKS) at Jena University Hospital and the Paul Martini Research Group Clinical Septomics/Clinic for Anesthesiology and Intensive Care Therapy. He is also a board member of the Integrated Research and Treatment Center (IFB) Sepsis and Sepsis Consequences (Center for Sepsis Control and Care, abbreviated: CSCC) of the University Hospital Jena, co-founder and vice chairman of the self-help organization Deutsche Sepsis-Hilfe e.V. and board member of the German Sepsis Society e.V. In December 2005, he was awarded the Order of Merit of the Federal Republic of Germany for his commitment to the cause.
Catastrophe in the body
Experts have noted a worrying trend: the number of sepsis cases in industrialized countries is increasing by around seven to eight percent a year. Any initially localized infection can develop into life-threatening sepsis. This is especially true when the immune system is weakened, for example in old age, after serious operations or due to chemotherapy for cancer. Existing more severe infections also increase the risk of sepsis. For example, 44 percent of those affected have pneumonia beforehand. Nine percent of sepsis cases also arise from infections of the urinary tract and reproductive organs.
Attention, suspicion of sepsis!
In the early stages, sepsis is difficult to recognize. Symptoms include fever, increased pulse and low blood pressure – symptoms that also apply to many other diseases. Nevertheless, there are signs that in combination indicate sepsis. Relatives should not hesitate to alert the emergency physician in case of doubt, and always point out to emergency physicians any existing pre-existing conditions with an increased risk of infection. For first responders and emergency physicians, the following applies: Thoroughly query signs and interpret them correctly.
Prof. Dr. med. Brunkhorst:
"If the patient has a fever, chills, is confused, and there is a suspicion of any infection, emergency physicians and physicians in the outpatient setting should be on alert. Low blood pressure in combination with increased heart and respiratory rate also indicates the onset of sepsis. When physicians admit patients with a suspected diagnosis of sepsis to the hospital as soon as possible, they must immediately perform the diagnostics specified in the guidelines there."
Sepsis at a glance
Immune system out of control
As a rule, the immune system is able to fight infection foci in the body on the spot. In some cases, however, bacteria enter the bloodstream and gradually infect the organs. In this case, the immune system overshoots the mark in its efforts to contain the infection. The white blood cells release toxins to destroy the bacteria. The amounts are so large that they damage the walls of the blood vessels. The fluid can thus pass unhindered from the vessels into the tissue. The consequences: Blood pressure drops rapidly, oxygen becomes scarce, the heart pumps in vain against the undersupply. Gradually, the organs fail.
Surgery and intensive care
If the focus of infection can be identified, physicians will surgically remove it (focal decontamination). However, this is not always possible: In one in ten patients, doctors are unable to find the site of origin of the infection – and in some cases, the disease originates from a source that they simply cannot remove (such as lungs, peritoneum, heart valves).
Regardless of this, patients with sepsis must receive intensive medical care as quickly as possible. They receive fluids through a venous catheter to maintain blood pressure (volume therapy) and antibiotics to fight the infectious agents. Doctors combat the extremely high blood sugar levels in sepsis with intensive insulin therapy, and dialysis and artificial respiration replace the function of damaged organs such as the kidneys and the liver
Hygiene and vaccination
The risk of sepsis increases, especially for people who are hospitalized with pre-existing conditions and are dependent on catheters or ventilators for prolonged periods of time. Through meticulous hygiene, both when laying and changing the tools, every tenth to seventh sepsis could be prevented.
People without a spleen represent a special risk group. The organ performs numerous tasks for the immune system. If it is lacking, those affected should definitely strengthen their body’s defenses through vaccinations. Physicians from the German Society of Internal Medicine advise those affected to get vaccinated against pneumococcus, meningococcus and Hib. They should also take advantage of the annual flu vaccination, as viral flu often sets the stage for bacterial pneumonia.
Stages of sepsis
Doctors distinguish between three stages of sepsis, depending on how much the infection has already taken hold of the body. This also affects the chances of overcoming the disease.
In simple sepsis, the pathogens leave or. the poisons they produce the focus of inflammation and spread throughout the body (called whole body infection). 90 percent of those affected recover from this form of sepsis.
In severe sepsis, individual organs also fail. 60 percent of patients survive the disease.
In septic shock, the blood pressure drops massively and several organs fail at the same time (so-called multi-organ failure). In this form of sepsis, only 40 percent of sufferers escape with their lives.
Vigilance and precisionDiagnosis of sepsis
Every minute counts in sepsis. If patients are treated in the first hour of illness, 90 percent survive. After five hours, only about 60 percent survive, and after 36 hours, barely one in five make it.
There is room for improvement in these statistics: Experts estimate that the number of sepsis fatalities will fall by about 15 per year.000 to 20.000 would be lower if physicians could consistently follow the appropriate treatment guidelines.
Prof. Dr. med. Brunkhorst:
"In patients with severe sepsis or septic shock, we still have to face a maximum mortality rate. This trend has changed little despite modern intensive care therapies such as organ replacement, circulatory therapy, respiratory therapy and anti-infective therapy."
Above all, the quantity and quality of laboratory tests, especially blood cultures, plays a key role in the fight for early detection and higher survival rates. Also important: to interrogate specific symptoms and interpret them coherently.
Gold standard of diagnostics
Sepsis diseases can arise from hospital infections. These can be detected at an early stage by blood cultures. That is why current guidelines state that hospitals should provide between 100 and 200 blood culture sets for every 1.000 patient days are created. Statistics from the European Center for Disease Prevention and Control suggest, however, that German hospitals are looking much less intensively for infections: The rate of blood culture sets was only about 16 per 1.000 patient days. Doctors can only tell from a blood culture which pathogen caused the infection and which antibiotics work against it.
Certain markers in the blood help to detect inflammatory processes at an early stage. Currently, the best studied sepsis marker is procalcitonin (PCT). Elevated levels act as a "red flag. However, the value may be elevated even without infection. Even though physicians worldwide are researching more precise markers – even the best one could not replace in-depth microbiological diagnostics using blood culture. Because only by means of blood culture can treating physicians determine what the pathogen is and how strong it already is.
Sepsis as a tracer diagnosis
About 80 percent of all sepsis cases in Germany develop outside of the hospital. Prof. As a result, Brunkhorst and other experts are working to add sepsis to the list of diagnoses that first responders and emergency medical technicians routinely screen for during missions. These so-called tracer diagnoses include, for example, heart attack and stroke. Advantage: all first responders and emergency physicians would ask about suspicions according to a set pattern and admit patients to the hospital already diagnosed with sepsis.