Sepsis
Everything you need to know about Sepsis - symptoms, causes, treatment options available in Australia, and when to see a doctor. Evidence-based medical information.
Overview
Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.
How it works in your body (pathophysiology):
Sepsis affects your body through specific biological processes:
- Dysregulated immune response: Your immune system (body's defence system) overreacts to an infection. This causes widespread inflammation (swelling and redness).
- Release of inflammatory mediators: Your body releases chemicals called inflammatory mediators. These chemicals cause more inflammation and can damage tissues.
- Disruption of normal coagulation: The normal blood clotting process (coagulation) gets disrupted. This can lead to problems with blood flow and increase the risk of bleeding.
- Multi-organ failure: If not treated quickly, these processes can lead to failure of multiple organs. This means organs like the heart, lungs, or kidneys may stop working properly.
Statistics and Prevalence in Australia
The prevalence of sepsis in Australia has shown a marked increase over the years. According to the latest data, the population-based incidence of sepsis-coded hospitalisations rose from 18.6 per 10,000 people in 2002–03 to 51.3 per 10,000 in 2021–22 [2]. Similarly, the hospital-based incidence, which reflects sepsis as a proportion of all hospitalisations, more than doubled during the same period, increasing from 55.1 to 111.4 per 10,000 hospitalisations [2]. These statistics underscore the growing burden of sepsis on the Australian healthcare system and highlight the need for effective prevention and management strategies.
Symptoms and Clinical Presentation
Sepsis can present with a wide range of symptoms, which can vary depending on the stage of the condition and the individual's overall health. Early signs of sepsis may include fever, chills, rapid heart rate, and confusion. As the condition progresses, symptoms can become more severe, leading to difficulty breathing, decreased urine output, and altered mental status. In some cases, sepsis may present atypically, particularly in older adults or those with comorbidities, where symptoms may be subtle or nonspecific [1].
Red flag symptoms that require immediate medical attention include extreme drowsiness, severe breathlessness, mottled or discoloured skin, and a significant drop in blood pressure. Prompt recognition of these signs is critical to initiating timely treatment and improving patient outcomes [1], [2].
Causes and Risk Factors
Sepsis is typically triggered by an infection, which can be bacterial, viral, or fungal in origin. Common sources of infection include the lungs, urinary tract, abdomen, and skin. The risk of developing sepsis is higher in individuals with weakened immune systems, chronic illnesses, or recent surgeries. Other risk factors include advanced age, malnutrition, and the presence of invasive devices such as catheters or ventilators [1].
The pathophysiological mechanisms underlying sepsis involve a complex interplay between the host's immune response and the invading pathogen. The excessive release of pro-inflammatory cytokines can lead to widespread endothelial damage, increased vascular permeability, and impaired tissue perfusion, ultimately resulting in organ dysfunction [1].
Diagnosis
The diagnosis of sepsis in Australia is guided by national and RACGP-endorsed standards, which emphasise a systematic and thorough clinical appraisal. Key diagnostic approaches include a detailed clinical assessment, laboratory investigations such as blood cultures and biomarkers (e.g., C-reactive protein, procalcitonin), and imaging studies to identify the source of infection [1], [2].
The NICE sepsis assessment tool is recommended for risk stratification, helping clinicians determine the severity of the condition and guide treatment decisions. Early identification and intervention are critical, as delays in diagnosis can lead to worse outcomes [1].
Treatment Options in Australia
The management of sepsis involves a combination of pharmacological and non-pharmacological interventions, tailored to the individual's clinical status and underlying health conditions. First-line treatment typically includes the prompt administration of broad-spectrum antibiotics, which should be initiated as soon as sepsis is suspected. Fluid resuscitation is also crucial to maintain adequate tissue perfusion and prevent organ failure [1].
In Australia, treatment protocols are informed by NHMRC clinical practice guidelines and consider the availability of resources through the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. In severe cases, advanced therapies such as vasopressors, mechanical ventilation, or renal replacement therapy may be required to support failing organs [1], [2].
Living with Sepsis
Recovery from sepsis can be a prolonged process, with many patients experiencing long-term physical, cognitive, and psychological effects. Comprehensive patient management strategies are essential to support recovery and optimise quality of life. These may include regular monitoring and follow-up appointments, patient education on recognising early signs of infection, and strategies for self-management [1].
Psychosocial support is also important, as sepsis survivors may experience anxiety, depression, or post-traumatic stress disorder. Care coordination and rehabilitation services can aid in the recovery process, helping patients regain independence and improve their overall well-being [1].
Prevention
Preventing sepsis involves a multifaceted approach, focusing on reducing the risk of infection and promoting early recognition. Key strategies include vaccination, good hygiene practices, and timely treatment of infections. Healthcare providers play a crucial role in educating patients about the importance of these preventive measures and ensuring adherence to recommended guidelines [1], [2].
In healthcare settings, infection control measures such as hand hygiene, aseptic techniques, and antimicrobial stewardship are vital to preventing healthcare-associated infections that can lead to sepsis. Public health initiatives aimed at raising awareness and improving access to healthcare services can also contribute to reducing the incidence of sepsis in the community [1].