Septicemia treatment. Is septicemia curable?

Septicemia treatment

What is septicemia? Types of septicemia

Sepsis or septicemia is a clinical syndrome characterized by an abnormal Systemic Inflammatory Response (SIRS), implemented by the body following the passage of pathogenic microorganisms from a sepsigenous outbreak into the blood. If the phlogistic component is missing, we no longer speak of sepsis, but of “simple” bacteremia (presence of bacteria in the blood demonstrated by at least one positive blood culture). Sepsis is a potentially very serious condition, which passes through stages of Morbidity-increasing gravity and as such requires immediate medical treatment.

What is septicemia?

Sepsis is a serious condition, formerly called blood poisoning. Sepsis means that an infection affects the entire body and causes important organs such as the heart, lungs, brain and kidneys not to function properly. Sepsis can be life-threatening. It is important that you apply for care directly if you think that you or a related party has received sepsis.

The infectious outbreak of origin is initially limited in a specific district and can be for example of:

  • ear infection,
  • endocarditis,
  • urinary tract infection,
  • abscess,
  • abortion, etc.

The disease can evolve in different phases:

Bacteremia: presence of bacteria in the blood.

Sepsis: means the presence of a systemic infection confirmed by culture, plus the following symptoms and signs, which indicate the appearance of a generalized infection.

Severe sepsis: when there is an imbalance in one or more vital organs due to hypotension and reduced blood supply to the body’s various tissues (hypoperfusion). The symptoms and signs are:

Septic shock: it is defined as a state in which hypotension is refractory to any treatment and hypoperfusion of various organs and tissues is now severe. The clinical picture of septic shock at an advanced stage is characterized by extreme hypotension, with consequent multi-organ failure:

Stages of septicemia.

Generally, sepsis occurs in patients already hospitalized. It is therefore a serious condition, potentially fatal, in which the patient’s general condition may be severely compromised. Patients with septic shock present a first phase in which the inflammatory response is high, followed by an immunodepression phase.

Finally, it should be noted that the term septicemia is sometimes used improperly as a synonym for sepsis, while in reality it is related to the specific case in which sepsis is accompanied by bacteremia (sepsis bacteremia) instead of other types of infections.

Septicemia symptoms in adults

The clinical symptomatology of sepsis is supported by the interaction between the toxic products of the causative agent (bacteria, viruses, fungi) and the response of the host. These symptoms are rather non-specific and include fever, tachycardia, skin discoloration and increased respiratory rate.

Septicemia symptoms in adults

It is no coincidence that the diagnosis of sepsis is made following the finding of at least two of the following criteria that identify the SIRS, provided they are accompanied by an infectious, intravascular (endocarditis, endarteritis, arteriovenous shunt infections) or extravascular (abscesses, wounds etc.), which is the determining factor:

  • body temperature > 38 ° C (hyperthermia) or < 36 ° C (hypothermia);
  • heart rate > 90 beats / min or 2 standard deviations higher than the normal value for age (tachycardia);
  • hyperventilation with respiratory rate > 20 acts / min (tachypnea);
  • hyperventilation demonstrated by a PaCO2 < 32 mmHg;
  • alteration of the leocucitary formula, with white blood cell count > 12000 cells μL-1 (leukocytosis) or < 4000 μL-1 (leukopenia).

It diagnosed as severe sepsis when at the previous diagnosis is added at least one of the following signs related to organ failure:

  • significant decrease in urine production (oliguria, diuresis < 0.5 ml / Kg / h);
  • abrupt change in mental state;
  • breathing difficulties (hypoxemia);
  • abnormal cardiac activity;
  • reduction in the number of platelets in the blood (thrombocytopenia / thrombocytopenia);
  • appearance of small red-dark patches on the skin or general redness.

In the last and most serious stage, septic shock, the characteristic signs and symptoms of severe sepsis are added to an extremely low blood pressure (severe hypotension), which is maintained even in the presence of an adequate volume state and despite the restoration of volume through fluid therapy.

Septicemia symptoms in elderly

The elderly who survive severe sepsis are at greater risk in the long term than cognitive deficits and physical limitations compared to those hospitalized for other reasons, according to researchers from the University of Michigan Health System.

Septicemia symptoms in elderly

Being the body’s response to an infection, the first symptom to recognize it is this: the presence of an infection even if it is being treated or the suspicion of an infection. If the elderly person experiences one of the following symptoms in conjunction with an infection it is necessary to seek medical attention promptly:

  • Tachycardia: heart rate is higher than usual; in the elderly it tends to be considered tachycardia a heart rate greater than 90 beats per minute.
  • Abnormal body temperature: the symptoms range from fever to hypothermia.
  • Rapid breathing: the frequency of breaths must be greater than 20 per minute.

In addition to the symptoms mentioned it is also important to evaluate the presence of:

  • weakness;
  • chills;
  • mental confusion;
  • bluish color of the skin.

In the presence of one or more of these symptoms it is very important to admit the patient to emergency healthcare ward to take further laboratory tests and do more monitoring, because the symptoms can indicate the presence of sepsis. If the situation is neglected the elderly could enter septic shock, an extremely dangerous condition due to its high mortality rate.

What causes septicemia?

Sepsis is triggered by the concurrence of two factors: on the one hand the infection of a normally sterile tissue by pathogens (bacteria, fungi, viruses) and on the other the exaggerated systemic inflammatory response (SIRS) of the organism. Among the microorganisms most frequently involved in septic episodes are Escherichia coli, Klebsiella spp., Pseudomonas spp., Candida spp., Methicillin-resistant staphylococci.

Causes of septicemia

Inflammation is one of the weapons our body uses to fight infections. While in normal conditions there is a balance between the pro and anti-inflammatory factors, in sepsis the inflammatory response becomes exaggerated and systemic (it spreads from the site of infection to the whole organism). Consequently, microscopic clots (thrombi) form inside the blood vessels, due to the increase in the biochemical phenomena that generate them and the reduction of those that “dissolve” them. The heart is thus forced to pump blood in circulation with greater force, while the organs suffer from the reduced supply of oxygen and nutrients.

Regarding the risk factors of sepsis, this condition can potentially affect any subject. There is no doubt, however, that the very young age (childhood) and old age (> 65 years) expose the individual to a greater risk of suffering a septic phenomenon.

Other predisposing factors are alcohol and drug abuse, impaired immune system and organic debility (renal or hepatic failure, AIDS, cancer or anticancer therapies, anti-rejection therapy after organ transplantation, prolonged cortisone therapy) , from the black race to the Caucasian one and from particular medical conditions (bacterial invasion of blood or septicemia, dental abscesses, pneumonia, urinary infections, perforated appendicitis, meningitis, diabetes and severe traumas such as extensive burns or gunshot wounds).

We must not forget that sepsis is a fairly frequent occurrence in people admitted to intensive care, who are the ones most exposed to septic risk and its most feared consequences. Also the intubation, the application of urinary catheters or other invasive devices significantly raises the risk of suffering septic phenomena.

Septicemia vs Sepsis. Is Sepsis the same as Septicemia?

Finally, it should be noted that the term septicemia is sometimes used improperly as a synonym for sepsis, while in reality it is related to the specific case in which sepsis is accompanied by bacteremia (sepsis bacteremia) instead of other types of infections.

Septicemia vs Sepsis: Difference

Septicemia means literally “blood poisoning”. Sepsis was previously called blood poisoning. It is rarely used today because it is misleading. Blood poisoning suggests that blood has been poisoned. It also suggests that it is the bacteria in the blood that is the serious condition, while sepsis is the body’s response to a serious infection.

If septicemia is treated promptly, usually with antibiotics and large amounts of fluids administered through an IV, the patient’s chances of survival increase. The term septicemia is sometimes used improperly as a synonym for sepsis, but in reality it indicates the specific case in which sepsis is accompanied by bacteremia (sepsis bacteremia) instead of other types of infections.

Can septicemia be cured?

Severe sepsis, blood poisoning, is a common disease that involves extremely high mortality. But often the condition of the ambulance is missed before the patient comes to hospital. Therefore, researchers at should produce an assessment tool that makes it easier for ambulance staff to initiate treatment earlier.

How is septicemia treated?

Ambulance-treated patients with heart attack or stroke have a greater chance of survival compared to those with blood poisoning. In the case of heart attack and stroke, pre-hospital identification has almost halved the time to treatment for patients, which has saved more lives. And it is important that sepsis is also identified early.

Sepsis is treated with oxygen, intravenous fluid and antibiotics. The chance of survival is good if treatment is done quickly. In addition, the suffering of the patient decreases. It is usually called “the golden hour”. The golden hour is a concept in emergency care where it is observed that rapid action and operations reduce the number of deaths. The low reporting of sepsis is explained, among other things, by the diffuse nature of the condition, which means that other diseases are often suspected instead.

Sepsis is because bacteria spread to the bloodstream and cause a general infection. This can in turn be due to an underlying infection such as urinary tract, respiratory or wound infection. Sometimes you find no clear cause. When patients become ill, neurotransmitters, cytokines, which affect the body in several ways, such as increased heart rate and lower blood pressure, are excreted. It is like a catch 22.

Methods for the treatment of septicemia.

At an early stage it is difficult to identify sepsis, which means that the patient does not receive treatment. At a late stage, it is easier to make a diagnosis, for example through blood tests, but then it may be so late that the treatment does not help. Therefore, it is of utmost importance to make early diagnosis, preferably already in the ambulance.

If you have symptoms suggesting that you have sepsis, your doctor will do a physical examination to try to find out what is causing the infection. The doctor also checks your heart rate, blood pressure, blood oxygenation and your breathing.

You will be given a blood sample that measures your white blood cells and what is called rapid sinking, or CRP. In hospitals, samples from your blood, your urine, your nose and any infected wounds are usually taken before you receive antibiotic treatment. The investigation is often supplemented with various types of X-ray examinations.

How serious is septicemia?

Sepsis begins with an infection somewhere in the body, which causes the body’s immune system to be activated. It can sometimes cause several large organs in the body to begin to work worse. In sepsis, the body forms substances that cause the blood vessels to leak fluid. This causes blood pressure to drop. This makes the blood difficult to transport oxygen to the body’s important organs. It contributes to the large organs being very strained. Then you usually need hospital care to feel good again.

It is very rare to become seriously ill in sepsis if you are under 50 and otherwise healthy. Some who get sepsis become so severely ill that they need to be cared for in intensive care units by special intensive care personnel. There you can get help with maintaining blood pressure and blood circulation using special drugs. You can also get help with breathing, for example via respiratory care. If your kidney function has become severely impaired, you may need dialysis.

In Germany, both the Minister of Research and the Minister of Health are sepsis ambassadors. In the United States, where 258,000 people die from sepsis annually, September has been designated September for the sepsis month with September 13, is the international sepsis day.

Sepsis is actually a reaction in the body to a serious infection. When an infection becomes so severe that the immune system overreacts, the body loses control.

When the body suffers from an infection, the immune system reacts with a variety of events. The blood cells secrete toxins to take cabbage on what attacks the body, but unfortunately this process also has a negative impact on the body’s own cells. The person affected by sepsis has poor blood circulation. The whole body is attacked and if the condition is not lifted it can go bad.

A local inflammation has suddenly affected the entire system. So even if the patient initially suffered from pneumonia, these changes can be seen elsewhere in the system, as in the brain. Pulmonary inflammation was the origin problem, but now the patient’s kidneys can suddenly cease to function.

How to treat bacterial septicemia?

1 liter of blood isotonic crystalloid solution, eg Ringer acetate should be administered immediately. In case of poor clinical response crystalloid solution should be given to the patient. If the patient does not respond to 1500-2000 ml of fluid in the first hour, intensive care is recommended. If very large amounts of crystalloid fluid are needed to maintain circulation, the addition of albumin is recommended. Synthetic colloids are no longer recommended. If the patient has a good diuresis, the treatment is on the right path.

Antibiotic treatment should be started immediately after blood culture, always given as an intravenous injection or infusion.

In community-acquired sepsis of completely unknown etiology the therapy is initiated with aminoglycoside administered intravenously, eg Tobramycin (Nebcin) or Gentamycin (Gensumycin) 5-7 mg / kg x 1 (thereafter adapted to renal function). In the case of obvious focus from airways or soft tissues, aminoglycosides usually have limited effect and treatment according to PM pneumonia and PM severe soft tissue infections.

The previous manipulations are followed with aminoglycoside with intravenous Cefotaxime (Claforan) 2 g x 3-4 or Piperacillin / Tazobactam (Tazocin) 4 g x 4. Benzylpenicillin 3 g x 3-4 in combination with aminoglycoside also provides a broad antibacterial effect in community-acquired uncertain sepsis and is recommended in many infection clinics to use in routine cases to reduce the risk of the emergence and spread of resistant bacteria (ESBL).

In case of suspected anaerobic or mixed infection (eg abdominal focus), give intravenous Meropenem (Meronem) alt Imipenem / Cilastatin (Tienam) 1 g x 3-4 total piperacillin / Tazobactam (Tazocin) 4 g x 4 together with aminoglycoside.

Clinical studies have not shown any positive effects of buffer administration on lactic acidosis. Acidosis is usually normalized when respiration and circulation stabilize.

If low blood pressure and low urine output continue despite initial fluid treatment, central venous catheter is set. If blood pressure and diuresis do not increase, norepinephrine (initial dose 0.02-0.05 µg / kg / min, in case of insufficient response then 0.05-0.5 µg / kg / min may be given). A mean arterial pressure of at least 65-70 mmHg should be achieved. Heart ultrasound heart is of great value to assess the heart function and filling of the right chamber. If blood pressure rises when the patient raises their legs, it is a sign of insufficient fluid supply. At heart failure, Dobutamine (Dobutrex) is added at increasing dose (> 5-10 µg / kg / min).

Steroids have been a controversial issue for many years, but are now not used routinely. However, Hydrocortisone 50 mg x 4 i.v. is administered for a few days to adult patients, to compensate for a relative adrenal insufficiency, a few studies have shown efficacy and may have a positive effect in selected cases of unstable blood pressure despite adequate inotropic support.

Patients arriving in the severe phase of septicemia require careful medical monitoring and hospitalization in the intensive care unit of the hospital; septic shock is immediately treated with ventilation and intubation to facilitate the patient’s respiratory movements, compromised by sepsis. Some patients are subjected to dialysis, useful in the context of renal failure. Clearly, even the severe phase and septic shock must also be treated with antibiotic drugs to remove the pathogen.

Some patients may take steroid drugs to lighten inflammation, vasopressor drugs (to increase blood pressure), insulin (to maintain normal blood sugar levels), painkillers and, when necessary, modulators of the immune system.

Some patients must undergo surgery to remove the source of infection (eg pus, as in the case of abscesses).

How long to recover from septicemia?

The following manipulations must be done within 3 hours!

  • Measure the lactate
  • Blood donation before antibiotics are given
  • Provide broad-spectrum antibiotics
  • Give crystalloids 30 ml / kg for hypotension or lactate ≥ 4 mmol / l

The following manipulations must be done within 6 hours!

  • Give Vasopressor Drugs (if the hypotension is not responding to initial fluid) and seek an intermediate arterial pressure ≥ 65 mmHg
  • About persistent arterial hypotension despite fluid delivery (septic shock)
  • Measure central venous oxygen saturation (ScvO2)
  • Measure if lactate if previous value has been increased

Consult with coagulation specialist in severe disseminated intravascular coagulation with bleeding from the skin and mucous membranes. Platelet transfusion can significantly activate the inflammatory process and this disadvantage may be weighed against the risk of bleeding in severe thrombocytopenia.

In severe streptococcal septicemia, high dose (0.5-1.0 g / kg) intravenous immunoglobulin is a treatment that in studies with historical control patients has been shown to increase survival, but studies with equivalent controls are missing.

Blood sugar control with values ​​that should not exceed 8-8.5 mmol / l is considered to reduce the number of complications. In some, minor and uncontrolled studies, plasmapheresis is claimed to be of value in progressive meningococcal septicemia. However, no randomized study has shown significantly lower mortality.

Not everyone who becomes severely ill in sepsis can be completely restored to health and about one in ten people who have sepsis will die.

How to cure septicemia with antibiotics?

Given the seriousness of the condition, it is understandable how the immediate intervention of medical aid is conditioning in order to guarantee the recovery of the patient suffering from sepsis: in other words, it is recommended to warn the doctor from the very first signs, even if only suspected septicemia, since the delay in front of a similar condition can cost the life.

As can be guessed, the mild phase of sepsis is easier to cure, even with only the help of drugs; different discourse must be made for the severe septicemic form and for septic shock, in which hopes of a positive prognosis are rather scarce.

The middle phase of sepsis should be treated with specific antibiotic drugs, directed against the pathogen involved in the infection.

Antibiotic therapy, usually administered intravenously, is usually accompanied by a rehydration treatment, in which the patient receives intravenous amounts of liquid.

Antibiotics for the treatment of septicemia:

  • Ceftriaxone (eg Ceftriaxone, Pantoxon, Ragex, Deixim): the drug is a third-generation cephalosporin, used in therapy for the treatment of severe sepsis. The dosage suggests taking 2 grams, intravenously, once a day, for at least two weeks, depending on the nature and severity of the condition.
  • Cefuroxime (eg. Cefoprim, Tilexim, Zoref, Zinnat): belongs to the second generation cephalosporin class. For sepsis, it is recommended to start therapy from the earliest symptoms, and possibly to associate an aminoglycoside drug. Take 1.5 g of drug intravenously, every 6-8 hours. Continue therapy for 2-3 weeks, in full compliance with the instructions given by the doctor.
  • Ceftazidime (eg Etazim, Liotixil, Fribat): the antibiotic drug is a third-generation cephalosporin, also indicated for the treatment of sepsis. We recommend taking 2 grams, intravenously, every 8 hours for 14 days. For more information: consult a doctor.
  • Cefotaxime (eg Cefotaxima, Aximad, Lirgosin): another third-generation cephalosporin, used in therapy for the treatment of sepsis at a dose of 2 grams e.v., to be taken every 6-8 hours. Do not exceed the dose of 2 g e.v. every 4 hours. Continue the therapy for 14 days.
  • Tobramycin (eg Tobi podhaler): the drug is an exponent of aminoglycosides, also used to treat patients with sepsis. Start the treatment with a dose of 2 mg / kg of drug, to be taken intravenously; proceed with 1.7 mg / kg every 8 hours or with 5-7 mg / kg every 24 hours. Continue with the dosage just described for 10-14 days, depending on the nature and severity of the condition.
  • Vancomycin (eg Zengac, Levovanox, Maxivanil): the drug (glycopeptide class) should be administered at a dose of 15 mg / kg intravenously, twice a day, for 10-14 days, for the treatment of sepsis.
  • Ampicillin (eg Augmentin, Klavux) and Gentamicin (eg Ciclozinil, Genbrix, Gentalyn): combination of antibiotics (respectively: beta lactam antibiotic + aminoglycoside) widely used in therapy for the treatment of neonatal septicemia. For the dosage: consult a doctor.

Author: Dr. Eddie Louie , Infectious Diseases & Immunology, Internal Medicine, Phone: (212) 682-9202