Blood poisoning

Fabian Dupont is a freelance writer in the medical department. The human medicine specialist is already doing scientific work in Belgium, Spain, Rwanda, the USA, Great Britain, South Africa, New Zealand and Switzerland, among others. The focus of his doctoral thesis was tropical neurology, but his special interest is international public health and the comprehensible communication of medical facts.

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Blood poisoning (sepsis) describes an inflammatory reaction in the body to an infection that spreads throughout the body via the blood. The German word poisoning is often misunderstood here because it is actually an immune defense reaction that cannot eliminate an infection of the blood by pathogens. Read more about the development and treatment of blood poisoning here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A39A41A40R57P36R65

Blood poisoning: description

Blood poisoning is not caused by the presence of pathogens in the blood, as is often assumed, but by the body's reaction to them. Blood poisoning is usually caused by bacteria. In rare cases, blood poisoning is triggered by viruses, protozoa or fungal pathogens (Candida). The immune system tries to defend itself against the pathogens, but this fight not only harms the intruders, but also the body itself. Sepsis is a potentially life-threatening disease and should be treated consistently as quickly as possible. A distinction is made in the definition of sepsis depending on the severity of the blood poisoning.

Forms of sepsis

If you find bacteria in the blood (bacteremia), it does not mean that you have blood poisoning. Such a find does not in itself have any disease value. For example, small amounts of bacteria penetrate the bloodstream through micro-injuries in the gums when brushing teeth, without triggering a body-wide inflammatory reaction. The body's healthy immune system can easily cope with such small amounts of pathogens. Only when this is no longer the case and one becomes ill as a result of this fight, one speaks of blood poisoning (sepsis). The most important signs of blood poisoning are the following symptoms in adults:

a deviation in body temperature up or down (38 ° C)
an increased heart rate (> 90 beats / minute)
an increased breathing rate (> 20 breaths / min)
a change in the number of white blood cells in the blood (leukocytes) (12,000 / µL)

If these points are met, one speaks of SIRS (Systemic Inflammatory Response Syndrome), but not yet of sepsis.

SIRS (Systemic Inflammatory Response Syndrome)

You can find out more about the triggers and events of a systemic inflammatory reaction in the body in the SIRS article.

The criteria for blood poisoning (sepsis) are met as soon as an infectious cause for the body reaction can be determined. If organs are impaired in their function, one speaks of severe sepsis according to the definition of sepsis. Organ failure can be caused by blood clots, greatly reduced blood pressure or reactions to the body's own messenger substances, which actually serve to fight the pathogens. The risk of dying as a result of severe sepsis is around 47 percent.

If, due to this endogenous inflammatory reaction, the blood pressure can no longer be kept at a sufficient level, one speaks of a "septic shock". This end stage of blood poisoning consequently endangers the blood supply to vital organs and leads to death in more than half of those affected.

Septic shock

In the article Septic shock you can find out more about the risks in the end-stage of blood poisoning.

Neonatal sepsis

A special case of blood poisoning is so-called newborn sepsis. She describes blood poisoning in babies in the first month of life. A distinction is typically made between two types, depending on how quickly the sepsis occurs after birth.So-called early onset sepsis, in which the pathogen was most likely transmitted by the mother during the birth process, occurs within the first four days of life. Then one speaks of a late onset sepsis. However, new studies show that this subdivision has no significant relevance for treatment.

The sepsis criteria for neonatal sepsis are more difficult to identify than in adult patients. Newborn sepsis is feared because of its fulminant course. In babies, blood poisoning can turn into a life-threatening disease much more quickly. As a rule, the mother is examined for bacteria in her vagina before the birth that could potentially endanger the child. Because of this investigation and strict hygiene regulations, the incidence of newborn sepsis cases in industrialized nations has been drastically reduced over the past decade.

Blood poisoning: symptoms

You can read everything you need to know about the typical signs of sepsis in the article Blood poisoning - symptoms.

Blood poisoning: causes and risk factors

In principle, every infection can lead to sepsis (blood poisoning), but it does not have to be. Blood poisoning cannot be prevented in a targeted manner. In principle, however, it is advisable to have any infection treated by a doctor at an early stage, even if it initially appears harmless.

At the beginning of sepsis (blood poisoning) there is a localized infection, the causes of which are usually bacteria, sometimes viruses, fungi (Candida sepsis) or so-called protozoa (single-celled organisms). The immune system starts defense reactions against the intruders in the form of inflammation: the blood flow to the tissue in question is increased and the permeability of the blood vessels increased. In this way, large amounts of white blood cells (leukocytes) can reach the site of infection and enter the tissue, where they eliminate the pathogens and destroyed cells.

However, the concentrated defenses of the immune system are sometimes insufficient to limit the infection where it originated and ultimately to eliminate it. The pathogens then gain the upper hand: the pathogens and their toxins enter the bloodstream. According to the definition of sepsis, this is not yet referred to as blood poisoning, but initially as bacteremia (bacteria in the blood).

If these substances trigger a body-wide inflammatory reaction, one speaks of the typical course of sepsis. The corresponding symptoms of sepsis are related to this body-wide battle between the immune system and pathogens. The vessels in the whole body widen and lead to a drop in blood pressure, signs of inflammation in the blood rise drastically, the heart and lungs try to compensate for the lack of return flow of the blood and its enrichment with oxygen by increased work, which increases the breathing and heart rate.

The blood coagulates faster due to the changed blood flow as well as damage to vessels and tissue by the pathogens and the immune system. On the basis of the sepsis criteria, one speaks of severe sepsis as soon as organs are damaged in their function by small clogged vessels (thrombi) or other harmful substances.

If the heart's pumping power is no longer sufficient to transport enough blood to the vital organs, it is also referred to as septic shock.

Risk groups: sepsis

Blood poisoning can in principle be caused by any localized infection (such as pneumonia or urinary tract infections). It is not uncommon for hospital infections (nosocomial) to be the cause of sepsis. The risk of blood poisoning is particularly high in:

very young (newborns) as well as very old people
a weakened immune system (e.g. due to chemotherapy for cancer or high-dose cortisone therapy for rheumatism or respiratory diseases)
Wounds or injuries (e.g. large burns)
Certain treatments and examinations (e.g. catheters in blood vessels, urinary catheters, wound drainage)
Addictions (e.g. alcoholism, drug addiction)
Genetic predisposition to sepsis

Blood poisoning: examinations and diagnosis

If blood poisoning is suspected, the following sepsis criteria are checked:

The presence of an infection, e.g. through microbiological detection of pathogens in a patient sample (blood sample, urine sample, wound swab) or pneumonia based on an X-ray
Fever (at least 38 degrees Celsius) or low temperature (36 degrees Celsius or less), measured with a thermometer in the anus (rectal), in a blood vessel (intravascular), or in the urinary bladder (intravesical)
Heart rate of at least 90 beats per minute (tachycardia)
certain changes in the large blood count: white blood cell count either increased (≥ 12,000 / µL) or decreased (≤ 4,000 / µL) or ≥ ten percent immature neutrophils (subgroup of white blood cells)
Increase in the inflammatory parameters CRP (C-reactive protein) or pro-calcitonin
Defective organ function, for example in the brain (restricted attention, disorientation, restlessness, confusion, delirium, coma, loss of feeling in part of the body, restricted mobility), the liver (increased liver enzymes and bilirubin, changed skin color), kidneys (decreased urine output, Blood pH decreases, creatinine value increases), lungs (decreasing oxygen and increased carbon dioxide content in the blood)
Clotting disorders, decrease in the number of blood platelets (thrombocytes)

As soon as the restriction of an organ function is determined, one speaks of severe sepsis. This also applies if the causes of the sepsis have not yet been clarified. If there is then a critical drop in blood pressure, one speaks of a septic shock.

Blood poisoning: treatment

The prerequisite for successful treatment of sepsis is the treatment of the underlying disease - that is, the infection that led to blood poisoning. It can be done surgically or through medication. So the treatment of blood poisoning always begins with the search for the source of the infection. For example, an inflamed appendix or an infected joint prosthesis can be the trigger. Even seemingly mundane things like a vascular access on the arm or a urinary catheter can cause blood poisoning.

Most often the focus is in the lungs, in the abdomen, the urinary tract, in the skin, on bones and joints, the teeth or in the central nervous system (e.g. meningitis, encephalitis). Foreign material in the body can also be the location of the source of infection, for example screws and plates that are used in bone surgery or the "IUD" (IUD) for contraception.

If possible, this starting point of the sepsis is eliminated as quickly as possible - in technical terminology this procedure is called "remediation". In around 20 percent of sepsis patients, however, the origin of the infection cannot be found.

Treatment of simple sepsis

In the case of simple sepsis, it is usually not necessary to stay in the intensive care unit. In this case, it is sufficient to eliminate the source of the infection and start therapy with antibiotics, as bacteria are usually responsible for blood poisoning. If it is a fungal (Candida sepsis), virus or parasite infection, this must be treated accordingly.

Treatment of severe sepsis

In the case of severe blood poisoning, in addition to eliminating the source of infection and antibiotic therapy, the restricted organ functions must also be taken into account. With this more dangerous course of sepsis, it is always necessary to equip an intensive care unit.

In any case, the pathogen should be precisely named and analyzed in order to be able to select the best therapy. Depending on the pathogen, you can then select, for example, an antibiotic or an antifungal agent (antimycotic).

Additional measures of sepsis treatment in the intensive care unit include:

the replacement of fluids via infusion and possibly nutrient solutions if the patient can no longer eat. The latter can also be done by tube through the nose into the stomach (gastric tube)
if necessary, replacement of blood cells and plasma by transfusion
Supporting the function of affected organs, for example through artificial ventilation in the event of (impending) lung failure or dialysis, which relieves the kidneys of the task of filtering blood.
the administration of painkillers and sedatives
If necessary, blood sugar lowering insulin therapy, as the blood sugar level rises in some patients with sepsis
Prevention of a so-called stress ulcer - an ulcer in the stomach or duodenum that is caused by stress and can cause bleeding. Proton pump inhibitors or histamine-2 receptor blockers are mainly used.
the administration of anticoagulant medication to prevent blood clots (thrombosis), which can form anywhere in the body in the event of severe sepsis

Newer therapies with artificial antibodies (immunoglobulins) can be considered in severe cases. However, there is still a lack of knowledge as to which antibodies are most effective in which form of sepsis. For this reason, this blood poisoning treatment is not yet recommended as a standard.

Treatment of Septic Shock

In addition to the interventions mentioned, there is the additional problem with septic shock that sufficient blood pressure and the pumping function of the heart must be ensured in order to continue to supply all organs with sufficient blood.

So-called vasopressor (vasoconstricting) substances increase blood pressure when it has dropped as a result of septic shock. (see sepsis criteria in the “Symptoms” section).

Attempts are also made to keep the vessels in a full state by supplying high amounts of fluids via infusion, since a lot of blood sinks into the periphery (arms, legs, tissue) as well as in the tissue and does not flow back to the heart quickly enough. Most of the time, the patient must also be artificially ventilated at this point.

Blood poisoning: disease course and prognosis

The course of blood poisoning is usually always the same: Bacteria enter the bloodstream from anywhere in the body and spread through the bloodstream (bacteremia). If the body cannot limit the infection, sepsis occurs. Without treatment, the fight against the pathogens of blood poisoning expands more and more until it finally leads to damage to blood vessels and organs (severe sepsis). The rate at which it progresses depends on the pathogen causing it, the age of the patient and the performance of his immune system.

In the further course of sepsis, cardiovascular failure can occur. Then the blood flow to vital organs is no longer guaranteed, and one speaks of septic shock. The earlier you start treatment, the better the chances of being completely cured. Organ damage often leaves lifelong damage - for example, restricted or failed kidney function, which necessitates lifelong dialysis (blood washing).

In some patients, blood poisoning cannot be successfully treated and sepsis leads to death. Roughly, one can say that the risk of death from sepsis increases by about one percent per hour in which the person concerned is not adequately treated. After a day without treatment, the risk is already 24 percent. In severe sepsis with organ damage, 47 percent of patients do not survive the disease. In the case of septic shock, as many as 60 percent die of circulatory failure due to blood poisoning.

Risk of consequential damage

Even after discharge from the hospital, many patients still suffer from long-term effects of blood poisoning such as nerve damage (polyneuropathies), muscle weakness or post-traumatic stress, as well as depression. (microscopic nerve damage)

The best way to avert the consequences of blood poisoning is to inform the doctor at an early stage of any symptoms. This is especially true for people who are housed in hospitals or care facilities, for immunocompromised and recently operated patients. These patient groups should inform their doctor immediately if they have fever, chills, shortness of breath and / or dizziness.

Prevention is also an important issue in hospitals. Hygiene measures, good wound care and consistent protection of immunocompromised patients can in many cases prevent blood poisoning.

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