Anatomy of Sepsis: Most Cases Start Outside the Hospital

Most health care providers think of sepsis as a problem in the ICU, but a recent report by the CDC has found that 80% of patients diagnosed with sepsis developed the condition outside the hospital. In addition, seven in 10 patients with sepsis used health care services or had chronic diseases that required frequent medical care (Vital Signs 2016 Aug 24.

This is new and surprising information, CDC Director Tom Frieden, MD, MPH, said in a press briefing. “We’ve been focusing on and making progress reducing sepsis in the hospital in ICUs, long-term care facilities and elsewhere.”

The finding that patients developing sepsis are more likely to have had a preceding health care encounter is particularly important, he added, because those encounters could be an opportunity to educate patients and to recognize sepsis and treat it.

Although healthy individuals can come down with sepsis, the condition is more likely to occur in those aged 65 years and older or infants younger than 12 months, as well as those with chronic conditions such as diabetes, or with weakened immune systems. Smokers are also at risk, Dr. Frieden said.

“We also found that sepsis is most often associated with four different types of infections: lung, urinary tract, skin and intestinal tract,” he said. In most cases, the organism that caused the infection leading to sepsis is not identified. However, when the organism is known, the leading causes are Staphylcoccus aureus, Escherichia coli and some types of Streptococcus.

Sepsis is a critical health issue, according to Mitchell Levy, MD, MCCM, a founding member of the Surviving Sepsis Campaign. He said health care providers must understand the importance of early identification and treatment. That recognition has already improved survival “through routine screening and treatment that is integrated in the workflow of hospitals,” he said. “Front-line providers really do make a difference.”

Health care providers play a critical role in protecting patients from infections that can lead to sepsis and recognizing sepsis early. “Sepsis is not just happening in critical care units; it is happening on the hospital floors,” Dr. Levy said.

Health care providers can do the following:

• Prevent infections by following infection control protocols, such as hand-washing, and ensuring patients get recommended vaccinations, such as influenza and pneumococcal vaccines.
• Educate patients and their families and stress the need to prevent infections, manage chronic conditions and seek care promptly if the infection is not improving. Don’t delay, Dr. Frieden said: “Sepsis is a medical emergency.”
• Think about sepsis: Know the signs and symptoms to identify and treat patients earlier.

 

• Act fast. If sepsis is suspected, order tests to help determine if an infection is present, where it is and what caused it. Start antibiotics and recommend other medical care immediately.
• Reassess patient management. Check patient progress frequently and reassess antibiotic therapy within 48 hours or sooner to make changes in therapy as needed. Dr. Levy added that antibiotic choices should be reassessed to assure good stewardship. Determine whether the type of antibiotics, dose and duration are correct, he recommended.