Septicaemia and sepsis

Definition Terminology here can be confusing. Sepsis and septicaemia are often used interchangeably. Technically, septicaemia means bacteria entering the bloodstream while sepsis is a potentially life-threatening condition resulting from the body’s response to an infection leading to organ dysfunction.

Epidemiology In the UK, the incidence of sepsis is estimated to be around 123,000 cases annually, with a mortality rate of approximately 30%. The prevalence is higher in the elderly, neonates, and individuals with compromised immune systems. Seasonal variation is observed, with higher incidence during winter, partly due to increased prevalence of respiratory infections.

Diagnosis

Clinical features: Early recognition of sepsis is critical. Key symptoms include fever or hypothermia, tachypnoea, tachycardia, altered mental state, hypotension, and signs of organ dysfunction. Skin may show signs of infection or petechiae. High suspicion is crucial in patients with predisposing factors such as recent surgery, invasive procedures, or indwelling devices. Organisations such as NICE have produced risk stratification charts for sepsis which include parameters such as respiratory rate, BP, hydration, temperature and skin changes.

Investigations: From the GP perspective, the key action is immediate admission to hospital, so investigations are clearly the remit of secondary care. Diagnosis involves laboratory tests and imaging. Typical abnormalities include leucocytosis or leucopenia, increased C-reactive protein (CRP), and increased lactate levels. Blood cultures are essential to identify the causative organism. Other investigations depend on the suspected source of infection and may include urine cultures, chest X-ray, CT scans, and lumbar puncture.

Treatment Early and aggressive management is crucial. The ‘Sepsis Six’, as recommended by the UK Sepsis Trust, includes diagnostic and therapeutic steps to be initiated within one hour of recognizing sepsis. Therapeutic steps include administering high-flow oxygen and giving broad-spectrum antibiotics. Empirical antibiotic therapy should be guided by the likely source of infection, patient allergies, and local antimicrobial resistance patterns. Fluid resuscitation and vasopressors may be necessary for managing septic shock.

Prognosis Prognosis varies depending on the patient’s age, comorbidities, the severity of sepsis, and the time to initiation of treatment. Early recognition and treatment improve outcomes significantly. Despite advances in care, the mortality rate remains high, particularly in septic shock. Long-term consequences can include physical, psychological, and cognitive impairments.