Canadian Sepsis Foundation - Understanding Sepsis

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Understanding Sepsis

Overview

Internationally, sepsis has been reported in 15% of all Intensive Care Unit (ICU) patients. Even with improvements in health care, the frequency of sepsis continues to increase. It is estimated that 1 in 18 deaths in Canada are related to sepsis, making it the 12th leading cause of death nationally. Although sepsis is not commonly cited as the primary cause of death, it is often a significant contributing factor. Between 2009 and 2011, sepsis was implicated in 53.4% of deaths from infectious diseases, which includes conditions ranging from bacterial intestinal infections to pneumonia.

Many patients diagnosed with sepsis require care in the ICU, placing a considerable burden on the health care system. The total cost of treating sepsis in Canada amounts to $325 million annually. These numbers are equally reflective of the broader problem. A global assessment of the burden of sepsis found that 29.5% of hospital patients had sepsis and a third of this group died from the condition during their stay. Sepsis also remains to be the leading cause of death in Third World countries. It is thought that 3 in 1000 people are affected by sepsis which equates to 18 million people per year. At both the national and international levels, sepsis is undoubtedly a significant strain.

Definition of Sepsis-3

The definition of sepsis was re-written in 2016 by an international task force consisting of 19 experts on sepsis in response to an outdated former definition developed in 2001. This updated definition now known as Sepsis 3 states that “sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.” Sepsis-3 now gives us a new definition of sepsis, and the sub-category of septic shock.
Further research is needed to determine how the Sepsis-3 definitions will help healthcare professionals recognize sepsis.
The previous definition of sepsis included an intermediate stage between sepsis and septic shock titled “severe sepsis.” Severe sepsis had a vague description which made it confusing to classify the severity of someone suffering from an infection. The imprecise description of severe sepsis also led to a lack of standardization in treatment.
By taking out the intermediate classification of sepsis, it is hoped that it will improve the accuracy and quality of diagnosis and treatment of affected patients.
The Sepsis-3 definitions are based on the qSOFA score (quick Sequential Organ Failure Assessment) which has been proven to better diagnose sepsis than the previous SIRS (Systemic Inflammatory Response Syndrome) criteria.

Sepsis vs Septic Shock
Sepsis
Sepsis is a result of cardiovascular dysfunction which can progress to septic shock. The major difference is that individuals with septic shock experience a drastic decrease in blood pressure leading to a much higher likelihood of death. The criteria for the diagnoses of sepsis are as follows:

Sepsis for adults (>12 years)

Altered mental state

Systolic blood pressure ≤ 100 mmHg
Breathing rate > 22 beats/min
Acute change in total SOFA score ≥ 2 points

Septic Shock
The definition of septic shock includes the aforementioned definition of sepsis with the addition of the following criteria:

patient's need for medication to maintain an adequate blood pressure level (M622 ean Arterial Pressure > 65 mmHg)
Inadequate levels of oxygen present in the bloodstream despite adequate liquid provided (serum lactate level > 2 mmol/L)

Pediatric Sepsis
Is your child at risk?
The following conditions mean that your child is at higher risk:

Babies less than one month old are at the highest risk
Premature babies Low birth weight
Pediatric patient with an injury
Post-surgical patients
Mothers with symptoms of an infection
Genetic factors
Presence of an underlying illness (e.g. HIV, cancer, diabetes)
Males have a higher chance of being septic

Stages of neonatal sepsis:
Early onset (up until 72 hours after birth)

85% of newborns that develop early onset sepsis present symptoms within the first 24 hours

Early onset sepsis is usually caused by pathogens from the mother’s body

Late onset (from 4 to 90 days after birth)

Caused by pathogens from the home environment

How can you reduce the chance of your child getting neonatal sepsis?
Ensuring that your child has the proper vaccines is the first step towards reducing the likelihood of developing sepsis. The most common childhood diseases are rubella and varicella. Furthermore, close attention to wounds and common infections is critical as they can escalate if left untreated. Finally, paying close attention to general hygiene will diminish the likelihood of developing sepsis.
Why should I be worried about neonatal sepsis?
Sepsis and meningitis are responsible for the most neonatal deaths in developing countries. Around one million neonatal deaths are caused by sepsis/pneumonia annually. Between 1990 and 2015 the global newborn mortality has fallen from 5.1 million to 2.7 million deaths. However, without treatment septic shock in children still has a mortality rate of over 80%. The survival rate is dramatically increased when appropriately diagnosed and treated.
Aboriginals and Effects of Canadian Racial Diversity
There is currently no evidence that sepsis itself has a higher or lower prevalence in Aboriginal populations or any racial population in Canada. However, there is evidence that suggests that Aboriginal populations are more likely to contract certain infections that can lead to sepsis.
For instance, the H1N1 viral infection pandemic of 2009 had a high occurrence in the Canadian Aboriginal population. One study found that a quarter of the study population that contracted H1N1 were Aboriginal.
Aboriginal populations in the Canada prairies and rural Australia are more susceptible to developing a certain infection called MRSA (Methicillin-resistant Staphylococcus aureus) that can lead to sepsis. The Australian study suggests that higher standards of housing and hygiene along with appropriate use of antibiotics would be beneficial to the health of this population.
Neonatal early-onset group B streptococcal (GBS) infections can lead to sepsis in babies. It has been shown that Aboriginal babies born in hospitals in Australia were three times more likely to develop sepsis from GBS than non-Aboriginal babies.