Sepsis, what is it? Symptoms in adults and clinical guidelines

Blood poisoning (sepsis) - is an acute or chronic disease which occurs in the body due to the penetration of bacterial, viral or fungal flora.

Many people believe that the blood of sepsis develops after severe festering wounds, but in reality there are many other "gates" through that infection can enter the bloodstream, and very often it turns out that the true causes of disease and find out you can not.

What it is?

Sepsis - a severe infectious process, which is formed as a result of permanent residence or periodic contact with different kinds of pathogens in the human circulatory system.

The clinical picture is dominated by symptoms of the work of the whole body, rather than a local reaction.

Classification

Depending on the speed of development of the infectious process are the following types of septic states:

1. fulminant sepsisThat develops within three days after infection pathogens;
2. AcuteIn which the clinical symptoms develop not earlier than one week after the detection of the primary site of infection;
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3. Subacute septic condition formed from one week and up to four months;
4. chronic sepsis adults will be considered when the first symptoms are not earlier than six months; it usually develops in immunocompromised patients of different etiology.

In epidemiological terms when describing this pathology are the following types:

1. nosocomial infection. It develops as a result of surgical, gynecological, diagnostic or other medical procedures that occur after care.
2. Community-acquired infection. It becomes cause any infectious disease, such as an intestinal infection, meningitis, ENT pathology and t. D.

According to the features of clinical symptoms of sepsis is isolated:

1. ToksimiyuAt which it develops systemic inflammatory process caused by the spread of infection from the primary lesion;
2. septicemiaWhich is characterized by the absence of formation of secondary septic foci;
3. pyosepticemiaWhen there are lesions are present.

Causes of blood poisoning

As sepsis pathogens are the most different organisms: staphylococcus, meningococcus, pneumococcus, Escherichia coli, Mycobacterium tuberculosis, Klebsiella, Candida fungi such as viruses gerpetimorfnoy group.

It is worth noting that the development of sepsis has less to do with the properties of pathogens themselves, but with the condition of the human body and its immune system. Reduced effectiveness of protective barriers leads to the fact that our security systems are not already time localize harmful pathogens, and especially to prevent their penetration into the various authorities.

If we talk about the most common methods of infection sepsis, it is worth noting that they depend on the type of a specific pathogen. For each of them has its own features and epidemiological conditions. Independently there are only cases when patients develop nosocomial sepsis, the symptoms sometimes make themselves know even after inhalation of poorly purified air in chambers (60% of the samples revealed potentially dangerous microorganisms).

You can also select other ways of infection, determining the main symptoms of sepsis:

• Obstetric;
• otogenny;
• cryptogenic;
• percutaneous sepsis;
• oral;
• blood poisoning, which occurs as a result of surgical and diagnostic procedures.

Identification of "gates" through which penetrated sepsis, is of paramount importance for the successful treatment of patients. Early diagnosis of sepsis allows time to detect the infection, to separate it from the case of short of finding microbes in the blood and strengthen the body's defense system.

As we said above, the development of sepsis must be subject to certain conditions, in particular:

• formation of secondary foci which hereinafter also deliver agents;
• the presence of primary focus (it should be connected to the circulatory system or lymphatic vessels);
• repeated penetration of pathogens in the blood;
• inability to provide the necessary protection and provoke an immune reaction against the harmful microbes.

Only when all these conditions are met and the patient has appropriate clinical signs of infection, doctors diagnose sepsis blood. The development of sepsis triggered by severe diseases (diabetes, cancers, rickets, HIV, congenital defects of the immune system), therapeutic interventions, trauma, prolonged use of immunosuppressive drugs, radiotherapy and certain other factors.

The first symptoms of sepsis

The clinical course of sepsis in adults may be fulminant (rapid development of displays for 1-2 days), acute (5-7 days), subacute or chronic. Often there are atypical, or "effacement" symptoms thereof (so in the midst of the disease can not be high temperature), which is associated with a significant change in disease-causing properties of pathogens as a result of the massive use of antibiotics.

Sepsis (see. pictures) can take place with the formation of local abscesses in various organs and tissues (drift of primary focus of infection) - t n.. pyosepticemia at which during sepsis is dependent on the location of ulcers (e.g., in the brain abscess with corresponding neurological disorders), and no metastatic ulcers - t n.. septicemia, often with a more rapid flow, pronounced general symptoms. With the development of sepsis in neonates (source - purulent process in the tissues and blood vessels pupoviny- umbilical sepsis) is characterized by vomiting, diarrhea, a complete rejection of the child from the breast, rapid weight loss, dehydration; skin lose their elasticity, become dry, sometimes sallow; often determined by local abscess at the navel, deep cellulitis and abscesses of different localization.

In the diagnosis of sepsis are distinguished:

1. systemic inflammatory response syndrome. Characterized by a change in body temperature (as upward more than 38 ° C, and downward - below 36 ° C), palpitations (More than 90 beats per minute) and respiration (more than 20 breaths per minute), changing the number of leukocytes in the blood (at least 4 × 109 or more than 12 × 109 cells per liter blood).
2. Sepsis. Under the same symptoms as in the case of systemic inflammatory syndrome in a normally sterile tissues (blood, cerebrospinal fluid, urine ...) show one of the known pathogens, identify signs of peritonitis, pneumonia, purpura and other local inflammatory processes.
3. Severe sepsis. Characterized in the same way as a normal sepsis, but hypotension, hypoperfusion or dysfunction of individual organs.
4. septic shock. The most serious condition, after which every second patient due to circulatory disorders of organs and tissue death occurs. Determined by the same symptoms as that of septicemia, where intensive resuscitative measures do not lead to the normalization of blood flow and blood pressure. Other signs of septic shock are slowing down the formation of urine and confusion.

In February 2016 the concept and diagnostic criteria for sepsis have been revised. The concept of systemic inflammatory response syndrome, and severe sepsis deemed irrelevant, the concept of sepsis and septic shock are the new definitions.

For the detection and diagnosis of sepsis recommended use and SOFA qSOFA scale.

neonatal sepsis

In children, due to sepsis is a violation of many processes in the body (blood flow, perfusion). Statistics show that the incidence of the disease in infants is still high, but this problem has been studied extensively.

Sepsis in children able to develop as a companion to other symptoms of the disease and can not have their own characteristics. This disease is a reaction to the penetration of pathogenic organisms into it. When inflammation occurs uncontrolled formation of pus. In newborn sepsis can occur under the influence of Klebsiella and Pseudomonas aeruginosa, and Streptococci, Enterobacteriaceae, or candida. Sometimes the disease occurs upon exposure of several microorganisms. Most often sepsis affects children up to one year with low birth weight.

With the development of lightning shape sepsis septic shock occurs, which in most cases ends lethal. The disease leads to a sharp decrease in body temperature, accompanied by severe weakness, lethargy, bleeding disorders, pulmonary edema, cardiovascular disorders, acute renal insufficiency.

Diagnostics

blood poisoning is diagnosed based on symptoms and these blood tests for the presence of bacteria, given that at the stage Toxic resorptive fever and chronic course of remission in step bacteremia (the presence of bacteria in blood) without detected.

When the diagnosis is required to take into account changes in blood parameters, which are characterized by:

• high levels of bilirubin and residual nitrogen;
• lower content of calcium and chloride;
• progressive anemia;
• high leukocytosis (abnormally high levels of white blood cells) or in the case of weakened patients - leukopenia (reduction in the number of white blood cells);
• thrombocytopenia - platelet count decreased.

Urine protein is detected, leukocytes, erythrocytes, increased amounts of urea and uric acid.

The laboratory methods include:

1. Determination of procalcitonin in blood quantities: its high content is considered as a characteristic feature of septicemia
2. Isolation of genetic material of the pathogen, sepsis caused by a polymerase chain reaction (PCR) by rapid methods. Within 2 hours it is possible to identify 25 kinds of pathogenic microorganisms and fungi.
3. Bacteriological analysis of blood to detect the active microbe and its response to the action of different antimicrobial drugs (antibiogram) for the development of an optimal treatment regimen. Fence carried out from two different saphenous vein in a volume of 5 - 10 ml, conducting seed into the culture medium.

Procalcitonin test has high diagnostic value, allowing you to confirm the diagnosis "Bacterial sepsis", septic shock, to differentiate the disease from other disorders with similar clinical signs.

What consequences?

Complications Sepsis is very dangerous, difficult to treat, even in an intensive care setting. Let us consider the most common ones.

1. severe bleeding - may result in special sporting deficiency (coagulation factors and platelets), produced by the liver.
2. Acute renal and hepatic failure - developed under the direct influence of toxins in the kidney, or as a result of blockage of the filter apparatus of the kidneys microbial fragments, and pus. Disturbed and completely ceases excretion of metabolic products, which further aggravates the condition.
3. Toxic shock (ITSH) - a sharp drop in blood pressure under the influence of a large number of microbial toxins. Without emergency medical care can die within hours or even minutes. ITSH treated under intensive care unit.
4. bacterial endocarditis - develops when bacteria enters into the heart cavity. Triggering inflammation, they contribute to the formation of clots in its cavity. Subsequently, these thrombi, coming off and falling with the blood flow in the cerebral blood vessels, can lead to stroke.

In general sepsis leads to dysfunction and damage to all the internal organs.

What is needed for the treatment of sepsis?

It is well known that sepsis is extremely difficult to treat. Mortality is extremely high when it reaches 50%, and in some situations. However, the timeliness of care reduces this figure significantly.

According to clinical guidelines in 2019 septic patients are treated in intensive care units or intensive care unit. This is due to the need for continuous monitoring of vital signs. During the first 6 hours of effort directed to physicians communicating these numbers to a specific value and to stabilize them:

• Quantity urine - 0.5 ml / (kg * h) or more;
• saturation of the mixed venous blood oxygen - 70% or more;
• central venous pressure - up to 8-12 mm. Hg .;
• blood pressure - to 65 mmHg and higher.

This is usually achieved using various infusion solutions that flow through the "dropper", often to multiple peripheral vein or a central. Sometimes it is necessary to transfuse blood products and solutions add in drugs that increase blood pressure. Once these activities have already been reduced (from 50 to 33), the mortality rate of patients by 17%.

Treatment consists in the elimination of complications, most of which are intensive care.

For example in case of acute renal failure haemofiltration is used, and gepatoprotektory hemodialysis, disorders hemodynamic - restore vascular permeability and volume of circulating blood at kardionedostatochnosti - kardiostimuliruyuschy and vasotropic means ventilator used in respiratory failure, bleeding under stress applied histamine H2 blockers / blockers, proton pump / sucralfate. With regard to antibiotic therapy, antibiotics should be prescribed based on the results of studies of bacterial or against the most likely pathogens.

For the latter case also create a table:

Localization of the primary lesion	The most likely pathogens
Light (nosocomial pneumonia which developed out of the ICU)	Streptococcus pneumonia, Enterobacteriaceae (E.colli), Staphylococcus aureus
Light (nosocomial pneumonia evolved ICU)	Pseudomonias aeruginosa, Acinetobacter spp, as well as pathogens aforenamed
Abdomen	Bacteroides spp, Enterococcus spp, Streptococcus spp, Pseudomonias aeruginosa, Staphylococcus aureus
Skin and soft tissue	Streptococcus spp, Staphylococcus aureus, Enterobacteriaceae
kidneys	Enterobacteriaceae, Enterococcus spp
guttur	Staphylococcus spp, Streptococcus spp, anaerobes
after splenectomy	Streptococcus pneumonia, Haemophilis influenzae
intravenous catheter	Staphylococcus epidermididis, Staphylococcus aureus, enterococci, and Candida

In forming the secondary septic foci need of surgical treatment - opening of abscesses, pus, removal and washing of wounds, excision of lesions.

prevention

Prevent blood poisoning following measures can help:

• careful application of antibiotics;
• observance of basic rules of hygiene;
• timely treatment of purulent processes;
• aseptic conditions during medical procedures;
• immunization of people at risk.

Pyo-septic diseases is much easier to prevent than to cure, so patients need not only carry out individual preventive measures, but also to ensure that the procedure is held in the medical office. Compliance with these simple measures will help prevent the development of disease.

The prognosis for sepsis

The outcome of sepsis determined virulence microflora, general state of organism, timely and appropriate therapy. By the development of complications and poor prognosis patients predisposed elderly with concomitant common diseases, immunodeficiencies. When various kinds of sepsis mortality is 15-50%.

With the development of septic shock, the probability of death is extremely high.