Sepsis and Severe Infection

Sepsis is what happens when the body's response to an infection begins to damage its own organs. It is a common reason for admission to intensive care and a common cause of death, and the single largest determinant of survival is how quickly it is recognised and treated.

The first hours

There is a well established bundle of actions that should happen within the first hour of recognising sepsis, and delivering it reliably saves more lives than any individual drug.

• Measure lactate, which indicates how badly tissues are being deprived of oxygen
• Take blood cultures before antibiotics are given, so the organism can still be identified
• Give broad spectrum antibiotics without waiting for culture results
• Give intravenous fluid resuscitation for low blood pressure or raised lactate
• Start vasoactive drugs where blood pressure does not respond to fluid
• Find and control the source, whether that means draining an abscess, removing an infected line or operating

Source control matters as much as antibiotics

Antibiotics cannot sterilise a collection of pus. Where there is an abscess, an obstructed and infected urinary system, a perforated bowel, dead tissue or an infected catheter, that source has to be physically dealt with. Sepsis that does not improve on appropriate antibiotics is very often sepsis with a source that has not been controlled.

What recovery looks like

Survivors of severe sepsis frequently take months rather than weeks to feel themselves. Profound weakness, fatigue, weight loss, poor concentration and low mood are common and are not a sign that something further is wrong.

This matters because families are often told the patient is out of danger and then alarmed by how unwell they remain. Recovery from critical illness is slow, and knowing that in advance makes it easier to bear.