For about eight in 10 patients, sepsis begins outside the hospital. And, according to a CDC Vital Signs report(www.cdc.gov) released Aug. 26, about seven in 10 patients with sepsis had used health care services within the previous month or had a chronic disease that required frequent medical care.
Consequently, said CDC officials, health care visits present important opportunities for physicians to prevent, recognize and treat sepsis before it causes life-threatening illness or death.
An accompanying Morbidity and Mortality Weekly Report(www.cdc.gov) related findings from a retrospective review of medical records for 246 adults and 79 children (ages birth to 17 years) whose discharge information included diagnosis codes for severe sepsis or septic shock. The records were obtained from four general, acute-care hospitals in New York. Patients were eligible for inclusion if they had a hospital admission from Oct. 1, 2012, to Sept. 30, 2013, or from Oct. 1, 2014, to Sept. 30, 2015.
Among key findings from the evaluation was that pneumonia was the most common infection leading to sepsis, followed by urinary tract infections, gastrointestinal infections and skin/soft tissue infections. Infants younger than age 1 year and adults 65 or older were particularly susceptible, as were patients with weakened immune systems and those who had a chronic medical condition. Although much less common, healthy children and adults also can develop sepsis, especially when the precipitating infection is not recognized early.
In most cases, the specific pathogens that caused the infection leading to sepsis were not identified; when they were identified, the most common were Staphylococcus aureus, Escherichia coli and various Streptococcus and Klebsiella species.
Of the 246 adult patients included in the chart review, 65 (26 percent) died during their sepsis hospitalization. Of the 79 pediatric patients whose medical records were reviewed, 17 (22 percent) died while hospitalized for sepsis.
"When sepsis occurs, it should be treated as a medical emergency," said CDC Director Tom Frieden, M.D., M.P.H., in a news release(www.cdc.gov). "Doctors and nurses can prevent sepsis and also the devastating effects of sepsis, and patients and families can watch for sepsis and ask, 'Could this be sepsis?'"
What Family Physicians Can Do
According to agency officials, health care professionals, including family physicians, can play a critical role in protecting patients from infections that may lead to sepsis, as well as in recognizing this complication early, by following a few simple recommendations:
- Prevent infections. Follow infection control requirements, such as proper handwashing protocols, and ensure patients get recommended vaccines (e.g., influenza and pneumococcal).
- Educate patients and their families. Stress the need to prevent infections, manage chronic conditions and promptly seek care if signs of a severe infection or sepsis develop.
- Think sepsis. Know the signs and symptoms to identify and treat patients early.
- Act fast. If sepsis is suspected, order tests to determine whether an infection is present, where it is and what caused it. Start antibiotics and other recommended medical care immediately, and document all aspects of the antibiotic regimen.
- Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy at 24-48 hours or sooner to modify therapy as needed. Determine whether the type of antibiotics, dose and duration are correct.
What the CDC Is Doing
The CDC and other health officials are targeting a number of key areas related to sepsis by working to
- increase awareness by engaging clinical professional organizations and patient advocacy groups;
- align infection prevention practices, chronic disease management and appropriate antibiotic use to promote early recognition of sepsis;
- study risk factors for sepsis that can guide focused prevention efforts and early recognition;
- develop more accurate methods for tracking sepsis trends to measure impact of intervention programs; and
- prevent infections that can lead to sepsis by promoting vaccination, chronic disease management, infection prevention and appropriate antibiotic use.
More From AAFP
American Family Physician: Early Recognition and Management of Sepsis in Adults: The First Six Hours