Could it be sepsis?
13 September 2024
Every year, over 55,000 Australians are diagnosed with sepsis and more than 8,700 die from sepsis. Over 80% of sepsis arises in the community. Sepsis may complicate any infection such as pneumonia, urinary tract infection or skin infection. Sepsis is a medical emergency.
Clinical features
- Tachypnoea*, shortness of breath, or new oxygen requirement, or long pauses in breathing*
- Fever*, rigours or hypothermia*
- Oliguria* or infrequent wet nappies*
- Tachycardia or bradycardia
- Nausea, vomiting*, diarrhoea, or not eating/feeding*
- Drowsiness*, fatigue, delirium, confusion*, difficulty waking*, altered mental state, or seizures*
- Headache, unexplained pain*, high-pitched cry*
- Non blanching rash*, or skin blotchy*, discoloured* or abnormally cold to touch*
- Restlessness* or floppy limbs*
- Bulging anterior fontanelle*
* Features particularly relevant for children and babies
Suspect sepsis in high-risk patients
- Malnourished, frail, or older age
- Aboriginal and Torres Strait Islander people
- Newborns and young children
- Impaired immunity - chemotherapy, chronic illness, steroids, or diabetes
- Recent trauma, surgery, or procedure
- Known infection not responding to treatment
- Previous sepsis, re-presentation, deterioration, or no improvement with the same illness.
- Pregnant or recently pregnant persons.
Doctors are advised to
- Know the clinical features of sepsis and high-risk patients for sepsis as listed above.
- Consider sepsis in all patients with acute illness or deterioration who may have an infection. Recognising sepsis can be challenging but early recognition and treatment can be lifesaving.
In patients with suspected sepsis
- Take blood for culture prior to antibiotics, if possible, and send with the case to hospital. Do not delay the commencement of antibiotics.
- Immediately treat patients with suspected sepsis. Prescribe and administer antibiotics within 60 minutes; refer to the Therapeutic Guidelines and the SA Health Antimicrobial Guidelines.
- Transfer the patient urgently to hospital by ambulance. If sepsis is suspected, the patient should be promptly reviewed by an experienced clinician; the patient is escalated to a higher level of care or intensive care if transient or no response to treatment. Refer to the *SA Health Rapid Detection and Response (RDR) Observation Charts.
- Identify sepsis source, if not already clear, by taking diagnostic samples (e.g. sputum, urine, pus).
- Monitor fluid balance and urine output.
- Follow the sepsis pathway of your hospital or health network (if available). See the *Sepsis in Children: South Australian Paediatric Clinical Practice Guidelines, and *South Australian Perinatal Practice Guideline: Sepsis in Pregnancy.
- Follow local escalation pathways and, in non-tertiary healthcare settings consider early consultation with MedSTAR - Phone 13 78 27.
- See SA Health sepsis resources, Australian Commission on Safety and Quality in Health Care resources including Sepsis Awareness Resources and Sepsis Clinical Care Standard, and Sepsis Australia resources including What is Sepsis? and Post Sepsis Syndrome.
For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days).
Dr Louise Flood – Director, Communicable Disease Control Branch