Sepsis: When infection overwhelms

Monique Tello, MD, MPH
Monique Tello, MD, MPH, Contributing Editor

When I was a doctor in training I was involved in a very sad case, the unexpected death of a patient, a woman in her fifties who had diabetes.* She had been seen in the clinic and diagnosed with pneumonia only two days before her passing. The diagnosis was correct, as well as the prescribed antibiotics. But she had been sent home, and her condition deteriorated quickly. By the time her family brought her into the emergency room, she was in septic shock.

What is sepsis?

What does it mean to be in septic shock? Sepsis is when the body’s response to a serious infection gets out of control. As the illness progresses, the cells of the immune system release a cascade of chemicals that eventually cause massive inflammation and can lead to organ malfunction, shock (“septic shock”), and death. The death rate from sepsis can range from 25%50%.

Generally, infections of the lungs (like pneumonia), urinary tract, abdomen, and skin are more likely to cause sepsis, and certain bacteria are the most common culprits.

Who is most likely to develop sepsis?

Some people are more likely to develop sepsis: those older than 65, infants younger than one year, and anyone with a weakened immune system are all particularly susceptible. The immune system can be weakened by certain medications, such as steroids, chemotherapy, or drugs to prevent transplant organ rejection; many chronic diseases such as diabetes, heart failure, and kidney failure hinder the immune system as well. This makes it easier for germs to multiply, and infections can quickly become overwhelming,

In the case of our patient above, she had a lung infection with a strain of bacteria called pneumococcus, which commonly causes pneumonia. She also had a weakened immune system due to diabetes, and she had declined the pneumonia vaccine. These factors made her very vulnerable to sepsis, and she should have been admitted to the hospital from the clinic for more aggressive treatment and closer monitoring, rather than sent home.

Since this case almost two decades ago, I have seen multiple patients who developed sepsis. Each case is very different, but they are all pretty much seared into my memory. (And, for the record, no one under my immediate care has died.) Sepsis is an emergency. People with infections or even early sepsis often first seek the help of their primary care doctors, so I am very interested in preventing it when possible, and recognizing it quickly when it does happen.

Early recognition and treatment of sepsis are critical

The Centers for Disease Control and Prevention recently published an analysis of several hundred cases of septic shock, from 2012 to 2015. The CDC partnered with the New York State Department of Health and Emerging Infections Program to examine the records of 246 adults and 79 children diagnosed with sepsis to see what factors contributed, and how it could have been prevented.

One huge factor is whether people had been properly vaccinated, and specifically whether they had gotten a pneumonia vaccine. The CDC authors state: “pneumonia is the most common infection causing sepsis, and vaccination is an important and highly effective prevention strategy.” Appropriate vaccination can prevent the worst infections from starting in the first place.

Another key finding in the CDC study was that approximately 72% of these patients had had contact with the healthcare system in the days prior to their illness. Many of these patients had chronic health problems, and so would be in medical offices or hospitals more often than healthy people. But, the report suggests that contact with the medical system itself could pose a risk for infections (and therefore sepsis), for example from hospital-acquired infections of intravenous lines and urinary catheters. Another important finding was that there may have been opportunities for providers to intervene earlier in the infections. With sepsis, early recognition and treatment is essential; once septic shock sets in, the risk of dying from sepsis increases greatly. Prevention efforts such as appropriate vaccination and minimizing hospital-acquired infection are important, and early and urgent recognition of sepsis is critical.

The CDC authors recommend that family members of susceptible patients should know the common symptoms of sepsis. These can include fevers, shaking chills, flushed skin, racing heartbeat, and confusion, among other things. As the illness progresses, the blood pressure drops dangerously low, and organs can stop functioning correctly. This can take hours or days, depending on the individual. If sepsis is at all suspected, the patient should be brought to medical attention as quickly as possible. Remember, sepsis is a medical emergency and rapid treatment can make all the difference in whether or not a person recovers.

*Yes, this example is based on a real case. But: All patient and clinical details have been altered to protect privacy. In addition, I trained over a decade ago, and my training spanned eleven years, four states, and six hospitals.

Related Information: Harvard Health Letter

Comments:

  1. Marijke

    On behalf of Sepsis Alliance, I’d like to thank you for writing about such an important topic. Awareness is vital if we are to save lives.

    This year’s Sepsis Awareness Month has provided many stories of sepsis in the media – all which has only helped. The more we say the word, the more we talk about it, the better. Thank you.

  2. Kathryn

    Hi Monique,

    I am writing my dissertation on the effect early detection of sepsis has on mortality rates, I was wondering if you still have the references for this brilliant article? especially CDC analysis?

    Thanks!

  3. Karl Bunkelman

    Are you aware of any studies that have shown the value of pH water
    to eliminate staph or specifically MRSA. The water could be 2.5 pH for external elimination or 7-9pH taken internally to enhance anti-oxidation. Thank you.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      I am not aware of this. Interesting hypothesis; sounds like pretty acidic and then basic fluid and probably would need to be tested in animals first for safety reasons.

  4. Toni Kofi

    I came by chance to this article. (I subscribe to health Havard Education newsletter) Thank you Dr. Tello. I would not know exactly the cause of death but many of my country folks but they were alive and kicking and within days, they died of Septic issues.

    I just posted your article to all my contacts on my Face Book and asked them to do the right thing.. Share it with their love ones.

  5. Liz Mathewson

    My Mother died of sepsis. She had no spleen. A silent ovarian tumor burst her intestine. She went in about 30 hours. It was a horrific experience for her, her body and us to witness.

    I implore all caregivers to understand the early symptoms of this.
    Thank you.

  6. Norman

    I think the correct way to begin the second sentence of the second paragraph is “Sepsis occurs when….” not “Sepsis is when….”

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Absolutely agree, Norman. Admittedly, when I write here, I write with a more accessible style, with the idea of engaging more readers.

  7. Donald Weber

    I lost my brother to Sepsis earlier this year. He had had a simple TURP operation and was having difficulty urinating and then was getting the symptoms. His fiancé, who had been in the health field for some time, kept urging him to go the hospital, but, partially based on what the clinic told him, he thought it would go away on its own. Finally, she forced him into the car and brought him to the hospital, but it was too late. He was in ICU for three months when he finally gave in. He probably would have still been here if he’d obeyed the early signs.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      I am so sorry Donald, that you lost your brother, that is very sad. Yes, a urinary infection can progress to sepsis and it can be very serious. Thank you for sharing your brother’s story.

  8. Diane alari

    You may be able to obtain your moms medical records through the public records act. The CDC is a public agency. Good cause would have to be shown by the agency to withhold this information.from you. I would advise you to contact an attorney with experience in this area of the law. Good luck.

  9. Amarie

    I had this from an infection in the port I used for chemotherapy. The chemo weakened my immune system, and the port had staph bacteria on it. I had high fever for five days-was in the hospital the whole time-then was sent to ICU when my blood pressure dropped and sepsis was setting in. I recall calling my husband and telling him to come, that I felt like I was dying. It can turn that quickly! If you have something that weakens your immune system and contract a high fever (mine was 103-104) go to the hospital! I’m grateful to still be here for my husband, three children and friends and family. (And my Stage 3 Lymphoma is in remission!)

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Amarie, Thanks for sharing your story, so glad that you made it through, and congratulations on being in remission! Yes, definitely good advice for people with weakened immune systems: a high fever needs to be investigated and treated quickly. Thank you.

  10. Sue

    I acquired sepsis from a facial lasering procedure (MixTo Microfractional CO2 laser) done by a board-certified plastic surgeon when I was 55 yrs old. I’d had the procedure done on a Friday and was sent to a local hotel to recover. By Monday, I felt ill; Tuesday my skin was flushed lavender; Wed I had uncontrollable diarrhea and a fever of 104F. My husband rushed me to the surgeon’s, and his nurse understood I needed help asap. I had an IV of antibiotics that likely saved my life, but the illness spawned a host of other issues for the next 4 months, including lymphatic issues, peeling hands, feet, full-body rash (yes, even down there!), and finally massive hair loss. I am lucky to be alive today.

  11. Maureen

    I was hospitalized a few years ago for sepsis. I was in my 50s and am diabetic. The surprising thing was how fast it came on. I started the day feeling fine. Mid-afternoon I was out shopping and started feeling a little unwell. I went home and lay down for a nap. I was shivering and couldn’t get warm. An hour or 2 later I woke up and wanted to get up. As soon as I started to stand I knew I was in trouble. I fell – passed out cold. My family rushed to me and I came too although groggy and a bit out of it. I went to the emergency room in an ambulance. Turned out I had an infection in my foot from a crack in my heel that put me in septic shock. This all happened in a matter of a couple of hours. I was in intensive care for 3 days and the hospital for a week. The infectious disease doctor said if I ever had uncontrollable chills like that again to get right to the emergency room.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Hi Maureen, Yes, your case is definitely an example of how fast sepsis can set in. A cut can become infected with a very strong bacteria- sounds like yours was a particularly virulent strain of staph or strep bacteria- and it can happen over a matter of hours. I am so glad that you sought care and made it through to share your story!

  12. Wendy

    My mother acquired sepsis in the hospital. After spending hours in the ICU, multiple mixtures of antibiotics, she developed the symptoms you described low blood pressure, organ failure and died. I received a letter from the hospital stating the CDC was investigating . I would not be told of the results of the investigation. I really miss my mom.

    • Margaret Staneff

      I am soooo sorry for your loss…..my heart goes out to you. I lost my mom too. After reading this article, I plan to get a pneumonia vaccine as I am diabetic and I do control it very well just with diet. I miss my mom, just like you. The CDC never lets you know anything. Wish they did.

      • Monique Tello, MD, MPH
        Monique Tello, MD, MPH

        Hi Margaret, thanks for sharing here, and I am sorry for the loss of your mother. Yes, the pneumonia vaccine is a good idea for you. FYI it is now a two-step vaccine, with the first being the Prevnar 13, followed by the Pneumovax 23 six months to a year later. These can be administered at a local pharmacy that gives vaccines.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Hi Wendy, I am sorry for your loss, that is very difficult.