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Sepsis: often underestimated, swiftly life-threatening

© Britt Schilling / UKF

A lung or urinary tract inflammation, an infected wound, a purulent tooth: the causes of sepsis are manifold. Around 280,000 people are afflicted with this deadly infection every year in Germany, and for about 60,000 the disease is fatal. "Sepsis is always an emergency. Therefore a doctor should be consulted immediately if it is suspected," stresses Dr. Johannes Kalbhenn, Managing Senior Critical Care Physician in the Department of Anesthesiology and Critical Care at the Medical Center - University of Freiburg.

Especially vulnerable are people with weakened immune systems, such as premature infants, diabetic or cancer patients, as well as patients immediately after surgery. In order to reduce the risk of sepsis, these people should take particular care to disinfect wounds carefully, and to have poorly-healing wounds checked regularly by a doctor. "In order to avoid so-called catheter-associated sepsis, we avoid using vascular and urinary catheters wherever possible in the critical care unit," explains Dr. Kalbhenn.

Excessive immune response to infection

Sepsis is usually triggered by a bacterial infection. If the body does not succeed in defeating the pathogens at the inflammation site, they can in some cases enter the bloodstream in large numbers, then a generalized infection occurs. The body is flooded with pathogens and the toxins they produce, which very strongly activates the immune system. "Sepsis is a physiological and biochemical expression of an increased immune response of the patient to infection. We must quickly identify and treat the focus of infection in a targeted manner in order to save the patient," says the critical care physician.

Varied warning signs

Sepsis may be characterized by a number of symptoms: typical signs are fever, malaise, chills, very low blood pressure, high pulse, and rapid, shallow breathing. Untreated, the blood pressure drops so severely that vital organs such as the heart, lungs and brain are no longer adequately supplied with oxygen. This can manifest itself in confusion and in disturbed renal function. If several organs are affected, this is called multiple organ failure. "This kind of condition is acutely life-threatening and must be treated as quickly as possible in a critical care unit," says Dr. Kalbhenn.

Treatment at many points simultaneously

Using blood tests, among other things, the doctors identify the causative microorganisms. These are then treated with suitable antibiotics if possible - an ever more difficult task in times of increasing antibiotic resistance. In addition, the doctors administer an infusion of fluid and medication to stabilize the blood pressure and avoid further organ malfunctions. If the kidneys have failed, organ replacement treatment is used, called blood purification or dialysis. If the patient is threatened by respiratory failure, oxygen or artificial ventilation is then necessary. At the same time, the doctors try to remove or clean the focus of infection. This can be done by opening and rinsing wounds or dental implants, or by surgically removing infected tissue.

Red line as warning sign?

There is a common belief that a red stripe on the skin, rising toward the heart, indicates blood poisoning and is fatal when it reaches the heart. In general this does not apply. "The red stripe indicates an inflammation of the lymph vessels. It may not, but can, develop into sepsis. Therefore those affected should be treated as soon as possible by a doctor," says Dr. Kalbhenn.

Further research urgently needed

For many years, intensive research has been carried out in the field of sepsis treatment, including at the Medical Center - University of Freiburg. In addition to new antibiotics, medicines and filters are also being tested in order to control the overreactive immune response of sepsis patients. But so far, these are only experimental treatment methods.

"Basically you can say that rapid diagnosis, consistent germ identification, antibiotic therapy and cleaning the source of infection are all indispensable for sepsis treatment," Dr. Kalbhenn summarises.