AT A GLANCE: Sepsis happens when the body’s response to an infection spirals out of control and begins damaging tissues and organs. Here are key things you will learn about sepsis from Nicholas M. Mohr, MD, MS, an emergency and critical care physician at University of Iowa Health Care, in this article:
- Any infection can cause sepsis, but pneumonia, urinary tract infections and skin infections are among the most common causes.
- Early symptoms can include fever, trouble breathing, body aches or feeling very ill, while more severe sepsis can cause confusion or sleepiness.
- Older adults, people with suppressed immune systems and those with certain chronic conditions face a higher risk of sepsis.
- It is critical to have early treatment for sepsis, which may include antibiotics, intravenous fluids and other therapies depending on how severe the infection is.
- Visit your doctor or an emergency department for severe symptoms of infection or confusion because recognizing and treating sepsis early is key.
Sepsis can begin with something as familiar as a urinary tract infection, pneumonia or a wound that is infected. But when the body’s response to that infection becomes overwhelming, the result can quickly become life-threatening.
Early symptoms may look like other common illnesses, which can make sepsis difficult to recognize. Yet identifying it quickly and starting treatment early can make a critical difference. That is why it is important to understand what sepsis can look like, who faces greater risk and when symptoms warrant immediate medical attention.
The AMA’s What Doctors Want Patients to Know™ series gives physicians a platform to share what they want patients to understand about today’s healthcare headlines.
In this installment, Nicholas M. Mohr, MD, MS, an emergency and critical care physician with University of Iowa (UI) Health Care, took the time to discuss sepsis and what patients should know. Dr. Mohr was part of a research team that studied sepsis to improve outcomes.
University of Iowa Health Care is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Sepsis is a severe infection
“Sepsis is what happens when people have severe infections that cause their organs to fail, and in some cases, sepsis can lead to people dying from infection,” explained Dr. Mohr. “It's a leading killer of people who are in hospitals in the United States.
“And most people develop sepsis when they're at home after they've had an infection that otherwise might not seem like it was going to be so severe,” he added. For example, Kyle Busch died at the age of 41 after severe pneumonia rapidly progressed to sepsis.
“That's when many people first hear about sepsis. It's usually related to somebody who was in the news,” Dr. Mohr noted.
Symptoms are of the infection that causes sepsis
“Sepsis can be caused by any infection, so the symptoms that people usually have are the symptoms of the infection that causes sepsis,” Dr. Mohr said. “A lot of patients will have fever, trouble breathing or pain, or they'll feel achy--just feel lousy.”
“Those are all early signs that somebody might have sepsis,” he said. “In its more severe form, sometimes people will be confused, or they'll even be sleepy.
“Early on, sepsis just looks like any other infection,” Dr. Mohr added. “That's one of the things that makes it important to find early, but it's also one of the things that sometimes makes it masquerade like other diseases.”
Sepsis is not contagious, the infections that cause it are
“The infections that cause sepsis can be contagious,” Dr. Mohr said. “Sepsis itself is our body's response to those infections and that response isn't contagious.”
“A lot of patients develop sepsis after pneumonia and that can be contagious. It can also be from influenza, which can be contagious,” he said, noting that “sepsis can be caused by really any bacterial or viral infection and that's part of why early sepsis can look just like a lot of other diseases.”
Severe sepsis can lead to septic shock
“Sepsis in its most basic form is when people start to develop organ failure, and that organ failure can be any of our organs,” Dr. Mohr said, noting that “our organs are susceptible to severe infections.”
“In its most severe form, what we would call septic shock, it can cause people to have low blood pressure or to pass out,” he explained. Sepsis can also “cause people to have kidney failure or not be able to breathe and, in some cases, need life support.”
Certain people are at increased risk of sepsis
“The biggest risk factors are things that suppress the immune system function,” Dr. Mohr said. “So, people who are older are at higher risk of sepsis.
“People who are on medicines to suppress their immune function because they've had organ transplants, for instance, or because they have autoimmune diseases, are also at increased risk of sepsis,” he added. “People who have some chronic medical conditions such as diabetes are at higher risk of developing sepsis.”
“Because sepsis is related to the body's response to infection, the ability to mount a robust immune response to respond to that infection is one of the things that's really important. That’s especially critical for people who are on immune suppressing medicines or who have underlying conditions that prevent them from mounting that immune response are at higher risk,” Dr. Mohr explained.
Sepsis is diagnosed in a combination of ways
“Sepsis is diagnosed by a combination of laboratory tests, X-rays, and cultures to find what the actual infection is,” said Dr. Mohr. “Those are some of the things that people might have tested when they go to an emergency department or they're admitted to the hospital with sepsis.”
“There are a number of different laboratory tests that doctors will use to figure out how severe the sepsis is, what the right treatments for sepsis might be, or how to target antibiotics, which is a really important part of the treatment,” he noted.
Early treatment of sepsis is very important
“We know that early treatment is the best way for people to survive after they've been diagnosed with sepsis,” Dr. Mohr said. “That early treatment involves a number of different therapies, probably the most important of which is antibiotics.”
“The reason that it is so important to treat early is because antibiotics stops the course of sepsis, and it allows the body to start fighting the infection that led to sepsis,” he explained. “There are a number of other treatments that include intravenous fluids, steroids and medicines to support blood pressure, in some cases, that are used to treat patients with sepsis.
“Right now, 40% of all the intensive care that's delivered in the United States is for people who have sepsis,” Dr. Mohr added. “The treatments that are given are time sensitive. It often involves life support. Sometimes, it requires things like mechanical ventilation, being on a ventilator and dialysis. But what's required for each individual patient can be different based on how severe the disease is.”
The time to recover from sepsis varies
“Sepsis is a serious condition. Most people who have sepsis are in the hospital for at least a couple days and sometimes quite a bit longer than that,” Dr. Mohr said. “It’s hard for anybody to recover from when they've been in the hospital for a long time, especially with a condition that's as serious as sepsis.”
“Many sepsis patients continue to feel weak or are more susceptible to infections even after their recovery,” he noted. “Many patients who go home after sepsis require rehabilitation to regain their strength and start to feel normal again.”
Also, “some people have brain fog or confusion after they've been treated for sepsis,” Dr. Mohr said. “We think of sepsis as an acute condition, and it is. But most people still deal with the lingering effects of sepsis for quite some time after they get out of the hospital.”
Reduce your risk of infection to prevent sepsis
“There are a handful of things that people can do to protect themselves from getting sepsis,” Dr. Mohr said. “One of the things people can do is to try to reduce their risk of infection. That involves things like washing your hands, wearing a mask when there's high transmission of disease during certain times of the year and getting vaccinated.”
“A number of vaccines that are really effective and have reduced the incidence of sepsis certainly in children and infants,” he said, “and vaccines for adults and older adults are really effective at reducing the incidence of sepsis too.”
That means it is important to get vaccinated against the flu, COVID-19, pneumonia, RSV and others.
“It is so important because preventing the underlying infection prevents sepsis,” Dr. Mohr said. “Even for people who develop some of those underlying infections, if they have chronic medical conditions that are well controlled, they're much less likely to have the most severe forms of sepsis.”
Manage your chronic diseases
“The other thing that is important is managing chronic diseases,” Dr. Mohr said, noting that conditions such as “diabetes or chronic lung disease can be risk factors for sepsis.”
“If those chronic diseases are well-controlled, then people are much less susceptible to develop sepsis,” he said. This includes making key lifestyle changes, such as eating a healthy diet and exercising. That reduces the risk of all of the chronic diseases that we talk about.
“We know that people who have an immune system that doesn’t function well are people who are at risk for sepsis,” Dr. Mohr said. “And people who are healthy and active are much more protected.”
Contact your doctor if you have symptoms of infection
“Anybody who has symptoms of an infection, especially severe symptoms, should be seen by their doctor or in an emergency department,” Dr. Mohr said. “One of the things that's really important in sepsis is that it's recognized early.
“And for people who have a serious infection but who don't have sepsis, being treated with antibiotics might prevent sepsis from happening,” he added. “Anybody who has severe symptoms of infection or who has confusion should be seen by a doctor and evaluated.”
It is also important to “pay attention when family members are sick, because your family members might need you to help them get to the doctor or hospital for sepsis,” Dr. Mohr said.
