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Sepsis

Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition caused by a severe infection. The more critical subsets of sepsis include severe sepsis (sepsis with acute organ dysfunction) and septic shock (sepsis with refractory arterial hypotension). If a proven source of infection is lacking but the other criteria of sepsis are met the condition is known as systemic inflammatory response syndrome. more...

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Septicemia is sepsis of the bloodstream caused by bacteremia, which is the presence of bacteria in the bloodstream. The term septicemia is also used to refer to sepsis in general.

Symptoms

The systemic inflammatory response leads to widespread activation of inflammation and coagulation pathways. This may progress to dysfunction of the circulatory system and, even under optimal treatment, multiple organ dysfunction syndrome and eventually death.

Sepsis is common and also more dangerous in elderly, immunocompromised, and critically ill patients. It occurs in 2% of all hospitalizations and accounts for as much as 25% of intensive care unit (ICU) bed utilization. It is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for septic shock. In the United States, sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common cause of death overall according to 2000 data from the Centers for Disease Control and Prevention.

A problem in the adequate management of septic patients has been the delay in administering the right treatment after sepsis has been recognized. A large international collaboration was established to educate people about sepsis and to improve patient outcomes with sepsis, entitled the "Surviving Sepsis Campaign." The Campaign has published an evidence-based review of management strategies for severe sepsis, with the aim to publish a complete set of guidelines within 3 years.

Definition of sepsis

Sepsis can be diagnosed if there is a proven source of infection, such as a positive blood culture and two or more of the following:

  • Heart rate > 90 beats per minute
  • Body temperature < 36 (96.8°F) or > 38°C (100.4°F)
  • Hyperventilation (high respiratory rate) > 20 breaths per minute or, on blood gas, a PaCO2 less than 32 mm Hg
  • White blood cell count < 4000 cells/mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/L).

Treatment

The therapy of sepsis rests on antibiotics, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. This may include hemodialysis in kidney failure, mechanical ventilation in pulmonary dysfunction, transfusion of blood plasma, platelets and coagulation factors to stabilize blood coagulation, and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition, if necessary by parenteral nutrition, is important during prolonged illness.

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Indepth database of severe sepsis patients shows fewer cardiac events in drotrecogin alfa patients vs placebo patients
From CHEST, 10/1/05 by Darell Heiselman

PURPOSE: This study was done to better understand treatment risks and benefits of drotrecogin alfa (activated) (DrotAA).

METHODS: A blinded, independent clinical evaluation committee evaluated all serious adverse events (SAEs) within INDEPTH, a 4459 patient integrated database of five clinical trials of patients with severe sepsis. Trials were conducted by a single sponsor (Eli Lilly and Company). We report the incidence of cardiac serious adverse events in placebo treated patients (n=1231) and in those treated with DrotAA (n=3228).

RESULTS: SAEs were characterized as occurring either during the study drug infusion period or during the 28-day survival observation period. Sepsis-related clinical outcomes and sepsis-related deaths were not considered SAEs unless attributable to study drug. Despite higher survival in DrotAA, overall SAEs rates were similar in both groups. Observed rates for MI and arrhythmia were significantly lower during infusion period and at 28 days.

CONCLUSION: These data show a possible association between DrotAA administration and a reduced rate of cardiac events in patients with severe sepsis.

CLINICAL IMPLICATIONS: Further investigation may be justified.

DISCLOSURE: Darell Heiselman, Consultant fee, speaker bureau, advisory committee, etc. Advisory panel fee.

Darell Heiselman DO * Stephen Lowry MD Jean-Francois Dhainaut MD Pierre-Francois Laterre MD Roland Schein MD Michael Seneff MD Jean-Pierre Sollet MD Antonio Artigas MD Jonathan Janes Frank Booth MD Andreas Sashegyi PhD Michael Cobas Meyer MD Akron General Medical Center, Akron, OH

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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