What are the symptoms and treatment of sepsis?

Sepsis Symptoms and Treatment

Sepsis is characterized by a dysregulated inflammatory response to infection with symptoms including fever or hypothermia, altered mental status, rapid breathing, elevated heart rate, skin changes (mottling/rash), decreased urine output, and severe pain or shivering, requiring immediate broad-spectrum antibiotics within one hour of recognition and aggressive fluid resuscitation. 1, 2

Symptoms of Sepsis

Sepsis presents with a constellation of symptoms across multiple body systems:

Temperature and General Symptoms

• Fever (≥38°C/100.4°F) or hypothermia 1
• Feeling very unwell or sense of impending doom 1
• Rigors/severe shivering 1

Neurological Symptoms

• Altered mental status/confusion 1, 2
• Dizziness 1
• Slurred speech 1

Cardiovascular Symptoms

• Elevated heart rate (tachycardia) 1
• Hypotension (systolic BP ≤100 mmHg) 2
• Clammy/sweaty skin 1

Respiratory Symptoms

• Rapid breathing (respiratory rate ≥22/min) 1, 2
• Difficulty breathing/breathlessness 1

Skin Manifestations

• Mottled or discolored skin (blue/pale/patchy) 1
• Nonblanching rash 1

Other Systems

• Decreased urine output (less than once per day) 1
• Severe muscle pain 1
• Gastrointestinal symptoms (nausea, vomiting, diarrhea) 1

Diagnosis

Early recognition is critical for improved outcomes. Assessment should include:

• Evaluation using qSOFA score (respiratory rate ≥22/min, altered mental status, systolic BP ≤100 mmHg) 2
• Blood cultures (at least two sets) before starting antibiotics 2
• Urine cultures if urinary source suspected 2
• Laboratory tests for organ dysfunction (lactate levels, complete blood count, renal and liver function) 1
• Imaging studies to identify source of infection (ultrasound, CT) 2

Treatment

Immediate Interventions (First Hour)

• Administer broad-spectrum antibiotics within one hour of sepsis recognition 1, 2
• Obtain cultures before starting antibiotics (if this won't delay therapy by >45 minutes) 2
• Begin aggressive fluid resuscitation with crystalloids (at least 30 mL/kg) 2

Source Control

• Identify and control the source of infection rapidly 2
• Drain abscesses or collections if present 2
• Remove potentially infected devices or foreign bodies 2
• Relieve any obstruction (particularly important in urosepsis) 2

Antimicrobial Therapy

• Initial empiric therapy should cover all likely pathogens 2, 3
• For most infections, consider:
  • Meropenem or imipenem/cilastin or piperacillin/tazobactam 1
  • Ceftriaxone for susceptible organisms 3
  • For Pseudomonas risk: extended-spectrum beta-lactam plus aminoglycoside or fluoroquinolone 2
• Review antimicrobial therapy daily 2
• De-escalate to targeted therapy once culture results are available (typically within 48-72 hours) 2

Hemodynamic Support

• Target mean arterial pressure ≥65 mmHg 1, 2
• Continue fluid resuscitation as needed 1
• Add vasopressors if fluid resuscitation inadequate to maintain blood pressure 1
• Monitor central venous pressure (target 8-12 mmHg) 1

Ongoing Care

• Monitor for signs of organ dysfunction 2
• Provide adequate nutritional support (20-30 kcal/kg/day) 2
• Typical duration of antibiotic therapy is 7-10 days 2

Common Pitfalls to Avoid

• Delayed antibiotic administration: Each hour of delay in antimicrobial administration is associated with an average decrease in survival of 7.6% 1
• Inadequate source control: Failure to identify and address the source of infection (e.g., urinary obstruction) is a common cause of treatment failure 2
• Inappropriate de-escalation: Narrowing therapy too early before having reliable culture data 2
• Insufficient fluid resuscitation: Inadequate volume replacement can worsen organ perfusion 1
• Overlooking sepsis in patients without fever: Some patients with sepsis may present with hypothermia rather than fever 1

Early recognition and aggressive management of sepsis are essential to improve patient outcomes and reduce mortality.