Sepsis for health professionals

Sepsis is a life-threatening condition that arises when the body’s response to an infection damages its own tissues and organs and is a major cause of morbidity and mortality worldwide.

Causes of sepsis

Sepsis can occur with any infection, most commonly respiratory, abdominal, urinary, and skin and soft tissue infections. Many different organisms can cause sepsis, including bacteria, fungi and viruses, but bacteria are the most common. Sepsis can occur in widespread or localised infection.

Recognising sepsis

Sepsis may occur in patients both in the community and those already being treated in hospital.  In hospitalised patients, the Rapidly Deteriorating Patient Observation Chart may provide early indicators of possible sepsis. See example RDR chart (PDF 272KB).

Early diagnosis and prompt treatment of sepsis is essential, including the administration of antibiotics and supportive therapy.

Signs and Symptoms of sepsis

In addition to signs of infection, signs suggestive of sepsis include:

  • Temperature > 38.3C or < 36C (normal temperature does not exclude sepsis)
  • Respiratory rate > 20 / minute
  • Heart rate > 90/minute
  • Acute confusion or decreased level of consciousness
  • Hyperglycemia (blood glucose > 7.7 mmol/L in patient without diabetes)
  • Oliguria (urine output less than 0.5 mL/kg/hour)

Children and infants with sepsis may deteriorate rapidly.  Signs suggestive of sepsis include:

  • Temperature > 38.3C or < 36C (normal temperature does not exclude sepsis)
  • Tachycardia (or bradycardia in children <12 months) relative to age
  • High respiratory rate relative to age
  • Altered mental state, decreased level of consciousness (decreased tone in infants), or seizures
  • Signs of dehydration or discoloured skin
  • Oliguria (or no wet nappy) for several hours
  • Persistent vomiting, not feeding

Signs suggestive of septic shock

  • Mottled or cold peripheries
  • Capillary refill time > 3seconds
  • Systolic BP < 90 mmHg or MAP < 60 mmHg
  • Purpuric rash
  • Arterial or venous lactate > 2 mmol/L
  • Oliguria (urine output less than 0.5 mL/kg/hour)

Treatment of sepsis

Sepsis is a medical emergency

Treatment of sepsis includes the prompt administration of antibiotics (aim to administer within one hour of suspecting sepsis), source control, intravenous fluid therapy and organ system support with vasopressor drugs, mechanical ventilation, and renal replacement therapy, as required.

Immediate management of sepsis

  • Assess for airway patency and administer oxygen
  • Obtain IV access, blood cultures and baseline blood tests (including lactate)
  • Other diagnostic samples if they will not delay antibiotic treatment (e.g. sputum, urine, pus)Prescribe and administer antibiotics (should be administered in first hour) – Refer to SA Health Antimicrobial guidelines
  • IV fluid bolus if patient showing signs of shock/hypoperfusion – 250-500 mL crystalloid (e.g. N/Saline, Hartmanns or Plasmalyte) repeated as required
  • Seek senior help and transfer to Intensive Care Unit if transient or no response to treatment
  • Examination for source of sepsis if not already clear
  • Monitor fluid balance and urine output

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