Sepsis - World Health Organization

Overview

Sepsis is a serious condition that happens when the body's immune system has an extreme response to an infection. The body's reaction causes damage to its own tissues and organs.  

Sepsis can affect anyone, but people who are older, very young, pregnant or have other health problems are at higher risk.

Common signs of sepsis include fever, fast heart rate, rapid breathing, confusion and body pain. It can lead to septic shock, multiple organ failure and death.

Sepsis is usually caused by bacterial infections but may be the result of other infections such as viruses, parasites or fungi.

Treatment for sepsis requires medical care. It will include antimicrobials, intravenous fluids and careful monitoring.

Sepsis acquired in health care settings is one of the most frequent adverse events during care delivery and affect hundreds of millions of patients worldwide every year.

Healthcare-associated infections are caused by organisms / pathogens that are often resistant to drugs and can rapidly lead to deteriorating clinical conditions. Antimicrobial resistance is a major factor determining clinical unresponsiveness to treatment and rapid evolution to sepsis and septic shock. Sepsis patients with resistant pathogens have been found to have a higher risk of hospital mortality.

Implementing preventive measures against infections, such as good hygiene practices, ensuring access to vaccination programmes, improved sanitation and water quality and availability, and other infection prevention and control best practices both in the community and health care settings, are key steps in reducing the occurrence of sepsis. Early diagnosis and timely and appropriate clinical management of sepsis, such as optimal antimicrobial use and fluid resuscitation, are crucial to increase the likelihood of survival. Even though the onset of sepsis can be acute and poses a short-term mortality burden, it can also be the cause of significant long-term morbidity requiring treatment and support. Thus, sepsis requires a multidisciplinary approach.

Who is at risk?

Anyone affected by an infection, severe injury, or serious non-communicable disease can progress to sepsis but vulnerable populations are at higher risk (2) including:

• older persons,
• pregnant or recently pregnant women,
• neonates,
• hospitalized patients,
• patients in intensive care units,
• people with weakened immune systems (e.g. HIV, cancer)
• people with chronic medical conditions (e.g. kidney disease, cirrhosis).

Signs and symptoms

Sepsis is a medical emergency. It can cause different signs and symptoms at different times. People who think they may have sepsis should seek medical care right away.

Common signs and symptoms include:

• fever or low temperature and shivering
• confusion
• difficulty breathing
• clammy and sweaty skin
• extreme body pain or discomfort
• high heart rate, weak pulse or low blood pressure
• low urine output.

Symptoms in children include:

• fast breathing
• convulsions
• pale skin
• lethargy
• difficulty waking up
• feeling cold to the touch.

In children under 5 years old, it can cause difficulty feeding, frequent vomiting or lack of urination.

Common causes

In 2017, the largest contributors to sepsis cases and sepsis-related mortality across all ages were diarrhoeal diseases (9.2 to 15 million annual cases) and lower respiratory infections (1.8–2.8 million annually) (1). However, non-communicable diseases are on the rise; one-third of sepsis cases and nearly half of all sepsis-related deaths in 2017 were due to an underlying injury or chronic disease (1). Maternal disorders were the most common non-communicable disease complicated by sepsis. Among children, the most common causes of sepsis-related deaths were neonatal disorders, lower respiratory infections, and diarrhoeal diseases (1). Group B streptococcus is the leading cause of both neonatal and maternal sepsis, though Escherichia coli is an emerging threat (3,4).  Both pathogens have displayed considerable resistance to treatment and are considered priority pathogens for research and development of new antibiotics.

Prevention

Sepsis can be prevented by treating infections early and through good hygiene at home and in healthcare settings.

The best way to reduce the risk of sepsis is to avoid infections. Steps include:

• good personal hygiene, like washing hands and preparing food safely
• avoiding unclean water or unsanitary toilets
• getting vaccines recommended by local health officials
• eating a healthy diet
• breastfeeding for newborns.

Hospitals and clinics should follow effective rules for infection prevention and control. Antibiotics should be used appropriately to treat infections.

Sepsis is always a serious condition but people living with HIV, tuberculosis, malaria and other infectious diseases are at higher risk.

Treatment

Treatment for sepsis is most effective when started early.

Health workers watch for concerning signs and use tests to diagnose sepsis. They will then work to find the source of the infection. Early use of antimicrobials to treat bacteria, parasites, fungus or viruses is essential to improve outcomes from sepsis.

Low blood pressure is treated by intravenous fluids and sometimes medicines called vasopressors, which can increase blood pressure. 

Antibiotic resistance can make treatment more difficult.

Sustainable Development Goals

Sepsis is a significant cause of maternal, neonatal and child mortality. Consequently, combating sepsis will contribute to achievement of Sustainable Development Goals (SDGs) targets 3.8 on quality of care, and 3.1 and 3.2 by improving mortality rates in these vulnerable populations. Sepsis can also ultimately lead to death in patients affected by HIV, tuberculosis, malaria, and other infectious diseases that are included in target 3.3. The prevention and/or appropriate diagnosis and management of sepsis is also linked to adequate vaccine coverage, quality universal health coverage, capacity to comply with the International Health Regulations, preparedness, and water and sanitation services. The challenge, however, remains how to achieve universal prevention, diagnosis and management of sepsis.

WHO response

To combat this important global health threat, WHO responded with a WHO Secretariat Report and, in May 2017, the Seventieth World Health Assembly adopted Resolution WHA70.7 on Improving the prevention, diagnosis and clinical management of sepsis. The key pillars of Resolution WHA 70.7 are to:

1. develop WHO guidance on sepsis prevention and management;
2. draw attention to public health impacts of sepsis and estimate the global burden of sepsis;
3. support Member States to define and implement standards and establish guidelines, infrastructure, laboratory capacity, strategies, and tools for identifying, reducing incidence of, and morbidity and mortality due to sepsis; and
4. collaborate with UN organizations, partners, international organizations, and stakeholders to enhance sepsis treatment and infection prevention and control including vaccinations.

In collaboration and coordination with WHO regional offices, Member States and other stakeholders, several WHO headquarters programmes are currently working on the public health impact of sepsis and providing guidance and country support on sepsis prevention, early and appropriate diagnosis, and timely and appropriate clinical management.

 

References

1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England). 2020;395(10219):200-11.
2. Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. British Medical Journal 2016.
3. Clin Infect Dis. 2017;65(suppl_2):S89-S99.
4. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011;127(5):817-26.
   

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