C. diff. Infection (CDI) and Sepsis

What is Sepsis?

Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail.  If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death.

Anyone can develop sepsis, but it’s most common and most dangerous in older adults or those with weakened immune systems. Early treatment of sepsis, usually with antibiotics and large amounts of intravenous fluids, improves chances for survival.

Definition of Sepsis:  sep•sis (ˈsep-səs) n. Sometimes called blood poisoning, sepsis is the body’s often deadly response to infection.

Patients are given a diagnosis of sepsis when they develop clinical signs of infections or systemic inflammation; sepsis is not diagnosed based on the location of the infection or by the name of the causative micro-organism. Physicians draw from a list of signs and symptoms in order to make a diagnosis of sepsis, including abnormalities of body temperature, heart rate, respiratory rate, and white blood cell count. Sepsis may be diagnosed in a 72-year-old man with pneumonia,, fever, and a high white blood cell count, and in a 3-month-old with appendicitis, low body temperature, and a low white blood cell count.

What causes Sepsis?

Sepsis is a response to an infection. When you get an infection, your immune system releases chemicals into your blood to fight the infection. The chemicals sometimes cause body-wide inflammation, which can lead to blood clots and leaky blood vessels. This impairs blood flow, which damages the body’s organs by depriving them of nutrients and oxygen.

Different types of infections can lead to sepsis, including infections of the skin, lungs, urinary tract, abdomen (such as appendicitis), or other part of the body. Healthcare-associated infections (HAI’s), including pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and surgical site infections can sometimes lead to sepsis. MRSA infections of the skin and soft tissue can also lead to sepsis.

Sepsis infected blood cell

 TO DOWNLOAD A “SEPSIS AND C. difficile” Information guide, courtesy of Sepsis Alliance, CLICK ON THE FOLLOWING LINK:

http://www.sepsis.org/files/sig_sepsisandcdifficile.pdf

 

Who gets Sepsis?

Anyone can get sepsis, but the risk is higher in:

  • people with weakened immune systems
  • infants and children
  • elderly people
  • people with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease
  • people suffering from a severe burn or physical trauma

How many people are diagnosed with Sepsis?

According to the CDC’s National Center for Health Statistics estimates that, based upon information collected for billing purposes, the number of times people were in the hospital with sepsis or septicemia (another word for sepsis) increased from 621,000 in the year 2000 to 1,141,000 in 2008.1  Between 28 and 50 percent of people who get sepsis die.2

The number of cases of sepsis each year has been going up in the United States.  This could be because of the following reasons:   the population is aging, people have more chronic illnesses, people are getting more invasive procedures, immunosuppressive drugs, chemotherapy, and organ transplants;  increasing antibiotic resistance,  increasing awareness and tracking of sepsis

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For Healthcare Professionals: Use this optional tool to screen patients for severe sepsis in the emergency department, on the medical/surgical floors, or in the ICU http://survivingsepsis.org/SiteCollectionDocuments/ScreeningTool.pdf

 

Recommendations: Special Considerations in Pediatrics*

 

 http://survivingsepsis.org/Guidelines/Documents/Pediatric%20table.pdf

 

4. Clostridium difficile colitis should be treated with enteral antibiotics if tolerated. Oral
vancomycin is preferred for severe disease (grade1A).
Sepsis Pocket Card for Healthcare Professionals:
Surviving Sepsis Campaign Bundle
Initial Resuscitation Bundle
To Be Completed in 3 hours:
1)Measure lactate level
2)Obtain cultures prior to administration of antibiotics
3)Administer broad spectrum antibiotics
4)Administer 30ml/kg crystalloid for hypotension or lactate greater
than or equal to 4mmol/kg
Septic Shock Bundle
To be Completed Within 6 Hours:
1)Apply vasopressors (for hypotension that does not respond to
initial fluid resuscitation) to maintain a mean arterial pressure
(MAP) greater than or equal to 65mmHg
2)In the event of persistent arterial hypotension despite volume
resuscitation (septic shock) or initial lactate greater than or equal
to 4mmol/L
a.Measure central venous pressure (CVP)*
b.Measure central venous oxygen saturation (ScvO2)*
3)Remeasure lactate if initial lactate was elevated*
*Targets for quantitative resuscitation included in the guidelines are CVP
greater than or equal to 8mmHg, ScvO2 greater than or equal to 70% and
normalization of lactate
> To print a pocket card please access the following link
References:
*International guidelines for management
of severe sepsis and septic shock: 2012.Crit Care Med. 2013; 41:580
*Mayclinic
*Survivingsepsis.org
1. NCHS Data Brief No. 62 June 2011 – Inpatient Care for Septicemia or Sepsis: A Challenge for Patients and Hospitals 2. Wood KA, Angus DC. Pharmacoeconomic implications of new therapies in sepsis. PharmacoEconomics. 2004;22(14):895-906
* Sepsis Alliance  http://www.sepsisalliance.org
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