Sepsis

Disease Description (Causes and Symptoms)

• Definition: Sepsis is a condition in which organ dysfunction is caused by a systemic, dysregulated inflammatory response to infection. Persistent hypotension resulting in inadequate tissue perfusion is classified as septic shock.
• Pathophysiology: An imbalance between invading pathogens and the host response causes excessive secretion of inflammatory mediators, leading to vasodilation, increased vascular permeability, and coagulation and microcirculatory disorders, which can progress to organ ischemia and injury. In severe cases, DIC (disseminated intravascular coagulation) and multiple organ failure may occur.
• Main causes (sources of infection): It can be triggered by various localized infections, including meningitis, skin suppuration (abscesses), pressure ulcers, pneumonia, acute cholecystitis, pyelonephritis (urinary tract infection), osteomyelitis, and an infected uterus.
• Common pathogens: Streptococcus, Staphylococcus aureus (including MRSA/VRSA), Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella, fungi, and others.
• Main symptoms: Fever or hypothermia, chills, tachycardia (rapid pulse), tachypnea (shortness of breath/rapid breathing), hypotension and dizziness, decreased level of consciousness (confusion), decreased urine output (oliguria), generalized fatigue and muscle aches, and signs of shock (pale skin and cold sweating).

Treatment Methods (Standard Treatment · Medication · Procedures/Surgery · Lifestyle Management · Precautions)

• Initial measures
  • Immediately upon suspicion, perform blood cultures (collect before administering antibiotics if possible) and cultures from suspected sites of infection. At the same time, start empiric broad-spectrum antibiotics (intravenous administration) without delay (within 1 hour in severe sepsis or shock).
  • Initial supportive treatment with intravenous fluids (crystalloid solution) (generally 30 mL/kg is recommended, adjusted according to the patient’s condition).
  • If tissue perfusion is inadequate, measure and remeasure serum lactate initially.
• Medication
  • Empiric broad-spectrum antibiotics → adjust according to culture and susceptibility results (de-escalation).
  • First-line vasopressor in shock: norepinephrine. If necessary, additional vasopressors (epinephrine, vasopressin, etc.) may be used.
  • If hemodynamic instability persists, consider low-dose corticosteroids (e.g., hydrocortisone) (according to guidelines and individual circumstances).
  • Administer antifungal agents if a fungal infection is suspected.
• Procedures/Surgery (etiologic treatment)
  • Immediate treatment of the primary source of infection (abscess drainage, removal of contaminated catheters, debridement of necrotic tissue, cholecystectomy, etc.) — “source control” is extremely important.
  • Mechanical ventilation for respiratory failure, and hemodialysis (renal replacement therapy) for acute renal failure.
• Monitoring
  • Monitoring of vital signs, urine output, electrolytes, lactate, blood tests (CBC, CRP, PCT, etc.), and hemodynamics is necessary.
• Treatment duration
  • Varies according to the site of infection, pathogen, and clinical course (generally 7–14 days is recommended; some conditions, such as meningitis, require longer treatment).
• Lifestyle management and precautions after discharge
  • Early rehabilitation (recovery of physical strength), wound care, and monitoring for signs of recurrent infection (fever, redness of a wound, decreased urine output, etc.).
  • Isolation is necessary in cases of infection with resistant organisms; comply with hand hygiene and infection control measures.
• Risk of complications and precautions
  • Multiple organ failure, DIC, long-term organ-related sequelae (neurological damage after meningitis, growth impairment after septic arthritis, etc.), and antibiotic-related adverse effects (nephrotoxicity, hepatotoxicity, disruption of the intestinal microbiota).
  • Early administration of antibiotics and appropriate source control have a decisive impact on prognosis.

Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

• Items/documents to prepare
  • A list of all medications currently being taken (prescription drugs, OTC drugs, herbal medicines, etc.) and a history of allergies (especially drug allergies).
  • Important past medical history (immunocompromised state, diabetes, chronic kidney failure, heart disease, etc.), recent hospitalizations, surgeries, or invasive procedures, and recent antibiotic use.
  • Records of recent fever (body temperature), changes in urine output, and changes in vital signs (heart rate, respiratory rate, and blood pressure data are useful if available).
  • Photos or notes regarding wounds, abscesses, catheters, urinary catheters, or other possible sources of infection.
  • Previous urine and blood test results (if possible).
• Examples of key questions to ask the patient
  • When did the symptoms begin? (Fever, chills, changes in consciousness, etc.)
  • Have you recently had a wound or abscess, or undergone surgery or a procedure? Do you have a catheter or urinary catheter?
  • Has your urine output decreased? Do you have pain or an unusual odor when urinating?
  • Have you recently taken antibiotics or received treatment for an infectious disease?
  • Do you have any chronic diseases (diabetes, reduced liver or kidney function, immunosuppressive treatment, etc.)?

Examples of General Questions to Ask the Doctor

• "Where does the source of my infection appear to be? What additional tests are needed?"
• "What type of antibiotic are we starting now, and what are the expected side effects? How long will I need to take the antibiotic?"
• "What monitoring will be performed in the hospital (blood pressure, urine output, lactate, etc.)?"
• "After I return home, what symptoms should prompt me to come back to the hospital immediately?"
• "Are there any lifestyle or vaccination recommendations (e.g., pneumococcal vaccination) to prevent recurrence?"

Examples of Disease-Specific Questions

• "When the test for the causative microorganism is available, how will you plan to change the antibiotics? How long will we wait based on the antimicrobial susceptibility test results?"
• "My blood pressure and perfusion status are currently unstable. What is the plan for using fluids and vasopressors, and what are the expected adverse effects (worsening heart failure, imbalanced tissue perfusion, etc.)?"