Human body is naturally endowed with the immune system to fight against the germs invading the blood stream, thus protecting us from the onset of any infections or illnesses.
But if the immune system over reacts to infections– caused by bacteria, virus, fungal or parasites– it will create adverse impact on health; even it will lead to a life-threatening situation. Such a condition is termed as “sepsis” which is further classified into “severe sepsis” and “sepsis shock,” depending upon its severity.
The terms “sepsis” and “severe sepsis” are sometimes used interchangeably to describe the syndrome of infection complicated by organ dysfunction.
According to Dr T.Ramachandran, Consultant Physician of KG Hospital, sepsis is one of the oldest and most elusive syndromes in medicine. “We have not fully defined the term ‘sepsis.’ The more you read about sepsis, you will know how little you know about it,” he said while giving a lecture on the topic “Controversies in sepsis” to Post-Graduate Students of KG Hospital & Post Graduate Institute at KG Hospital Auditorium, Coimbatore, recently.
Questions & Answers
He also sought to answer the queries:
- Would a better definition aid earlier diagnosis?
- Are two antibiotics better than one?
- Should I give beta lactams by continuous infusion?
- Can I use biomarkers to restrict antibiotic use?
High mortality rate
Sepsis is a dangerous condition as it continues to take a heavy toll on humanity in the developed and developing countries alike. In the US, the mortality rate due to sepsis is about 2% and in India it ranges from 3 to 5%.
The victims happen to be mostly those above 40-45 years of age. The diagnostic level of sepsis differs from hospital to hospital, doctor to doctor and from time to time, because the pathological condition is not the same for all. It varies on the basis of factors such as genetic disposition, the sturdiness of the immune system and the ability to cope with the invading organisms.
Dr Ramachandran said that over the ages various definitions on sepsis were offered. Hippocrates claimed that sepsis was the process by which flesh rots, swamp generates foul air and wounds fester. Gales later considered sepsis a laudable event, necessary for wound healing.
With the confirmation of Germ Theory by Semmelweis, Louis Pasteur and others, sepsis was recast as a systemic infection, often described as “blood poisoning,” and assumed to be the result of the invasion by pathogenic organism that then spread into the host’s bloodstream.
Advent of modern antibiotics
However, with the advent of modern antibiotics, Germ Theory did not fully explain the pathogenesis of sepsis; many patients with sepsis died despite successful eradication of the inciting pathogen. Thus, researchers suggested that it was the host, not the germ that drove the pathogens of sepsis.
Dr Ramachandran pointed out that in 1992, an international consensus panel defined sepsis as a “Systemic Inflammatory Response Syndrome (SIRS) to infection, noting that sepsis could arise in response to multiple infectious causes.
The SIRS is known from the assessment of temperature, pulse, respiration and blood group. It may be noted that the increase or decrease in all these parameters will occur in non-infectious condition too. He underscored the point that displaying the SOFA (Sequential Organ Failure Assessment) score of the patients at the Intensive care unit is useful and important.
If the score is less than 9, the mortality rate would be 33%, and if the score crosses 9, the mortality rate would be 53%. The predictive value of SOFA and qSOFA (Quick SOFA) scores go hand in hand. Dr Ramachandran also explained about the inflammatory variables, hemodynamic variables, organ dysfunction variables and the adequacy of antibiotic therapy in treating sepsis