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May 11, 2018

Sepsis Deadly if Not Caught on Time

I recently read an interesting account of the assassination attempt and eventual death of James Garfield, our 20th president.

Without Treatment, Infection can Overwhelm Patient’s Body

I recently read an interesting account of the assassination attempt and eventual death of James Garfield, our 20th president. He was shot at close range by an assassin, but he didn’t die from the gun shot. The book explains that because of the lack of knowledge of infections in the late 1800s, he died of overwhelming sepsis almost 2 1/2 months after he was shot.

Despite the advances in knowledge and medical practice up to this time, there are still deaths due to sepsis. It is reported that about 250,000 people in the U.S. die of sepsis every year. Of people who die in the hospital, 1 out of 3 dies of sepsis.

Sepsis is a medical syndrome that results from overwhelming infection. It is most commonly the result of a bacterial infection that gets into the bloodstream, but can be a viral or fungal infection.  The most common sites of infection from most frequent to least are lung (pneumonia), kidney (urinary tract), abdomen and skin. There are chemicals released into the bloodstream in response to infection that trigger inflammatory responses throughout the body causing damage to multiple organ systems. This can lead to organ system failure.

Most infections are localized and the immune system is able to prevent spread. However, if the infection does spread and overwhelms the immune system, patients develop fever, rapid heart rate, difficulty breathing and confusion. As the syndrome progresses from early stages to later severe stages of sepsis, the blood pressure drops and organ systems begin to fail. This is referred to as septic shock. Without intravenous fluid and antibiotics, patients usually will die.

The elderly and the very young seem to be the most susceptible to sepsis. People with immune system disease like AIDS or people taking medications that inhibit the immune system are also at a higher risk of sepsis. Sepsis is prevalent because people are living longer so there are more elderly and there are more people taking immune suppressive medication. People who take immune suppressive medication include transplant patients, people on chemotherapy for cancer and people with inflammatory diseases like rheumatoid arthritis or psoriasis.

It is a challenge in healthcare to use antibiotics appropriately to treat localized bacterial infections so they do not progress to sepsis. The inappropriate use of antibiotics has led to drug resistant bacteria, referred to as “super bugs” that can be very difficult to treat. As with most medical conditions, treatment of sepsis is generally more effective if started in the early stages especially before it reaches the stage of septic shock. 

Not all infections progress to sepsis. In addition to fever, early signs of sepsis include trouble breathing, confusion, rapid heart rate and weakness. In the later stages, blood pressure and tissue perfusion decrease leading to organ failure. Often, there is a clue as to where the infection may be originating, but not always. Patients suspected of having sepsis are assessed by drawing blood for cultures, checking markers in the blood stream for sepsis and doing tests that can identify the source of infection. Treatment consists of intravenous fluid and antibiotics. Often surgery is required if there is a pocket of pus, an obstructed kidney, an obstructed gallbladder or a bowel infection or perforation.  

If James Garfield had lived today, it is very probable that he would have survived the assassination attempt. Sepsis is treatable if it is recognized and treatment is started in the early stages. Stay healthy my friends.

Michael Shattuck, MD, is an emergency department physician at ThedaCare Medical Center-Berlin.