What are the signs and treatment of sepsis?

From the Guidelines

Sepsis is a life-threatening condition that requires immediate medical attention, and its signs include fever, low body temperature, rapid heart rate, rapid breathing, confusion, extreme pain, and decreased urination, with treatment involving broad-spectrum antibiotics and fluid resuscitation. The diagnostic criteria for sepsis often follow the Sequential Organ Failure Assessment (SOFA) score or the quicker qSOFA, which looks for altered mental status, respiratory rate ≥22 breaths/minute, and systolic blood pressure ≤100 mmHg 1. Some key points to consider in the management of sepsis include:

• Early recognition and prompt administration of intravenous fluids for resuscitation, with the goal of achieving a mean arterial pressure of 65 mmHg 1
• The use of broad-spectrum antibiotics, such as piperacillin-tazobactam, meropenem, or vancomycin, plus an aminoglycoside for severe cases 1
• Fluid resuscitation with crystalloids at 30 ml/kg within the first 3 hours, and the addition of vasopressors like norepinephrine if blood pressure remains low despite fluids 1
• Source control through drainage or removal of infected material is essential when applicable 1 It is essential to note that the mortality rate increases approximately 8% for each hour that appropriate antibiotics are delayed, making rapid recognition and treatment critical [@Example@]. The most recent and highest quality study, published in 2017, provides guidelines for the management of sepsis and septic shock, emphasizing the importance of early recognition, prompt fluid resuscitation, and broad-spectrum antibiotic therapy 1. In terms of specific treatment recommendations, the use of norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg is recommended, with the addition of epinephrine or vasopressin as needed 1. Overall, the management of sepsis requires a multifaceted approach that involves early recognition, prompt treatment, and careful monitoring of the patient's response to therapy.

From the Research

Signs of Sepsis

• Sepsis is characterized by a dysregulated host response to infection, leading to life-threatening organ dysfunction 2
• Common signs and symptoms include fever or hypothermia, tachycardia, tachypnea, and either leukocytosis or leukopenia 3
• Sepsis can be subtle, particularly in older patients and those who are immunocompromised, and may not always present with typical symptoms 2
• The Sequential Organ Failure Assessment (SOFA) is a useful tool for early diagnosis of sepsis 2

Treatment of Sepsis

• Fluid resuscitation is a priority in early management, with administration of an intravenous crystalloid at 30 mL per kg within the first three hours 2
• Antimicrobial therapy should be initiated early, with most research indicating that it should be started within three hours of presentation 2
• The latest guidelines recommend starting antimicrobials within one hour, but this is controversial 2
• Vasopressor therapy is indicated if hypotension persists despite fluid administration 2
• Meropenem and piperacillin-tazobactam are commonly used antibiotics for the treatment of sepsis, with some studies suggesting that meropenem may have a lower mortality rate 4, 5