Talk:Sepsis

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Contents 1 Septic 2 Post-sepsis 3 Abdomenal GSWs and sepsis 4 Septicemia 5 Question 6 Clear definition? 7 Necessary additions 8 Sepsis in long-term renal transplant patients as a result of improperly targeted primary infection 9 Septicemia

[edit] Septic

Is there a reason why Septic is a redirect to Sepsis? I don't quite understand it from the article text. --Timc 03:22, 6 Jun 2004 (UTC)

I believe septic is a term used to describe someone or something with sepsis. Vansice 23:15, 2 June 2006 (UTC)

[edit] Post-sepsis

I can't find anything related to what happens to babies born with sepsis, I was born with sepsis, and I turned out to be a very withdrawn child who was very afraid of people. --86.18.156.77 16:28, 25 December 2006 (UTC)

[edit] Abdomenal GSWs and sepsis

I think the article should mention the high incidence of sepsis following gunshot wounds to the abdomen. My understanding is that this is caused by wholesale leaking of GI material from punctured (or eviscerated) bowel and colon into the abdominal cavity, and that left unchecked death from massive sepsis can occur with 24-36 hours. This article discusses GSWs in Lagos (where prompt surgery and antibiotics clearly aren't always available). Also, I understand a large number of battlefield deaths in WW1 (particularly at the beginning, before they figured out surgical methods for treating abdominal injuries) were due to gunshot-related sepsis. -- Finlay McWalter | Talk 00:53, 19 Aug 2004 (UTC)

[edit] Septicemia

Could someone who knows about septicemia please make a separate article instead of a redirect?

Please sign your name. Septicicaemia is a form of sepsis, and creating a seperate page would lead to Balkanisation of the relevant information. Just keep it here. JFW | T@lk 07:08, 15 Jun 2005 (UTC)

[edit] Question

My 2 month pregnant, 26 year old friend died last week. It started 3 weeks ago with up and down fever and head pain.After one week in the hospital she could not speak any more and a week later she died. The death certificate announce: SEPTICEMIA, UTI, MAJOR DEPRESSIVE MOOD WITH PHYCITOSIS. Can a young person like her die that fast from it? Tom Philippines April.06

Toxic shock syndrome which is a very aggressive condition, can be fatal within 24 hours. Although I don't know what you friend had (it sounds like the infection started as a urinary tract infection) any person with a severe infection can die. I have seen enough examples of that. Nomen Nescio 06:37, 6 April 2006 (UTC)

Sorry to hear about your friend. The description you give sounds like it was a very tragic case. Any case, to answer the question-- septicemia can cause death and it can be quite quick, even in the young. Dying from sepsis is rarer in the young but does happen. A typical scenario would be-- a person with a bad burn--getting a bad infection and then sepsis. As for the other things-- (depression and psychosis) --they probably made the situation more difficult and possibly were the bit that tipped them over the edge. The urinary tract infection (UTI) -- is possibly where it all started... that is somewhat speculative. Nephron  T|C 20:35, 15 April 2006 (UTC)

[edit] Clear definition?

It seems to me that the article is lacking a clear definition of what sepsis "is" (as opposed to what it does, or how it is diagnosed.) As far as I know, sepsis is when the perfectly clean, antiseptic state of the inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct? Either way, the page needs a better definition than the non-definition of "sepsis is a serious medical condition caused by a severe infection." I mean, I reread the article and there is literally no section describing what it is the article is talking about! I would fix this myself, but I only have the shaky definition I wrote above. 65.94.230.83 17:48, 15 April 2006 (UTC)

Quote: ...inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct?

The definition is quite clear-- it is in the Definition of sepsis section. Sepsis is sort of a catch all things-- and can be caused by a lot of different things. Sometimes the cause is not known and doctors just know that things are NOT right and there is an infection. As for ...food actually entering the bloodstream... that seems rather unlikely to me. What can enter the bloodstream is a bacteria and that may come indirectly from food that is ingested and ends-up going through a hole in the stomach or the duodenum. Any time the gastrointestinal tract is perforated there is a high risk of infection (which can lead to sepsis). Nephron  T|C 20:24, 15 April 2006 (UTC)

If such is the case, I suggest mentioning in the article that sepsis is a catch-all term. Currently the definition section starts with "Sepsis can be diagnosed if" followed by a list of conditions. If there is no one definition of sepsis, perhaps this should be noted at the beginning, and the "Definition of Sepsis" section renamed to "Diagnosis of Sepsis". Unless medical conditions are always defined by their method of diagnosis? In which case, is there not some way of describing sepsis in layman terms? MrHumperdink 17:06, 29 April 2006 (UTC)

It is not "a catch-all term," since it only means that when infection (what kind can't be defined since all infections, if severe, potentially have this effect) is so severe that if the used criteria apply, we call it sepsis. Beyond that, we have septic shock. Nomen Nescio 17:34, 29 April 2006 (UTC)

Nescio is right --it isn't a catch-all. If you re-read what I wrote you'll notice I used the weasel words sort of before catch-all. Any case, I'll try and answer your questions.

Unless medical conditions are always defined by their method of diagnosis?

Medical conditions are always defined by some set of criteria and always relative to what is considered normal/healthy (based on age and sex). Most medical conditions have several criteria and are typically defined by signs and symptoms. Sometimes the criteria for a condition are exclusionary (i.e. social phobia can not be diagnosed if the patient has body dismorphic disorder).

In which case, is there not some way of describing sepsis in layman terms?

I don't think there is a good way to describe it in layman terms-- but I'll give it a try:

A person has sepsis when doctors can prove that the person has an infection with a disease causing organism (e.g. a bacterium that normally isn't found in a healthy person) and some of the person's vital signs and blood levels are abnormal.

A person with sepsis is very sick. 00:42, 30 April 2006 (UTC)

Under the "Symptoms" heading, the definition appears more to be "signs" than actual symptoms. Symptoms should be what the patient experiences or can report about his/her condition, signs would be what the doctor can conclude from tests or observation. I would like to see more discussion of what symptoms patients normally experience, such as the ones discussed on this page, like high fever, pain, difficulty breathing, etc., under the "Symptoms" heading. And then perhaps the heading should read "Signs and Symptoms," instead. My mother just died of sepsis due ultimately to multiple myeloma, and we thought she had bronchitis, the symptoms were similar. Kelelain 16:23, 25 January 2007 (UTC)Kelelain, 25 January 2007

[edit] Necessary additions

This article needs a timeline or something like that, to tell how long a person with sepsis has to live. Sepsis is also very common from gunshot wounds, which is not present in the article.

There's no way to make such predictions, so there's no way to make such a timeline. People with sepsis survive diferrent lengths of time - or recover - based on many, many variables relating to their age, their state of health, the nature of the sepsis, and treatment, as well as other factors. - Nunh-huh 06:19, 17 April 2006 (UTC)

I think the question is a fair one and despite what is above I think the outcome can be predicted to some degree. APACHE II is one way of predicting outcome-- yet not specific to sepsis per se. Survival depends on many factors-- age, co-morbidity (i.e. other health problems), pregnant/non-pregnant, type of infection et cetera.

I don't think sepsis from gunshot wounds it that common. Sepsis in GSW is seen approx. in 4-5% of patients. That said, it is lethal in approx. 50% of cases. Briusov PG, Frantsuzov VN, Novozhilov AA. [Modern aspects of wound sepsis in war surgical trauma] Khirurgiia (Mosk). 1999;(10):35-8. PMID 10540551, Nechaev EA, Revskoi AK. [Gunshot wound sepsis] Khirurgiia (Mosk). 1993 Mar;(3):27-32. PMID 8089965.,

Overall death due to sepsis seems to be quite low-- vascular injuries are much more lethal. Feliciano DV, Burch JM, Spjut-Patrinely V, Mattox KL, Jordan GL Jr. Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients. Ann Surg. 1988 Sep;208(3):362-70. PMID 3421760. Nephron  T|C 22:11, 17 April 2006 (UTC)

If you'll read what I wrote, I think you'll find I had the APACHE variables in mind, but an APACHE score indicates relative risk, not time till death, which is what the questioner was asking for. And even if the APACHE score permitted such a calculation, the fact that there are so many variables would still make a timeline of no use. - Nunh-huh 00:21, 18 April 2006 (UTC)

You wrote: If you'll read what I wrote, I think you'll find I had the APACHE variables in mind, but an APACHE score indicates relative risk, not time till death... - survival is very much figuring-out 'til time of death i.e. die in the next week or die in twenty years from now. Doctors very often speak of time 'til death (even when it is based on estimates of a relative risk comparing survival at a point in time) doctors say to a patient with Gioblastoma multiforme you have about one year to live with best treatment (as that is the mean survival) as opposed to 3 months if one doesn't treat it.

You wrote: ... the fact that there are so many variables would still make a timeline of no use. A precise prediction cannot be made, but there is a critical period (a few days to a week) after which one can say the person will most certainly live. Hospital discharge data and length of stay... go some distance in that way. Age, severity of injury etc. can be accounted for. Lazarus HM, Fox J, Burke JP, Lloyd JF, Snow GL, Mehta RR, Evans RS, Abouzelof R, Taylor C, Stevens MH. Trauma patient hospital-associated infections: risks and outcomes. J Trauma. 2005 Jul;59(1):188-94. PMID 16096562. While variable, AFIAK, the time 'til resolution of sepsis is relatively short --when compared to something like Guillain-Barre syndrome which typically has a course of several weeks 'til resolution. Nephron  T|C 02:13, 18 April 2006 (UTC)

APACHE scores were developed to predict the likelihood of leaaving the ICU and being discharged alive, and not to predict the time frame within which that would occur or not occur. If you feel you can make a meaningful "time line for survival with sepsis", go ahead and make it. I think you'll quickly find it a waste of time. - Nunh-huh 03:57, 18 April 2006 (UTC)

APACHE scores were developed to predict the likelihood of leaaving the ICU and being discharged alive, and not to predict the time frame within which that would occur or not occur. Sure-- but the variables are probably important in time course. Any case, they are are still working on this.[1] Time of stay is a cost predictor--and it is important. Someone knows how long an average sepsis admission is... and my point is that the problems are related. I'll go back to what you said... There's no way to make such predictions, so there's no way to make such a timeline. -- I don't think that's right. The information just isn't talked about much. Any case, the following reference suggests the time course is two weeks or less[2] and possibly could be predicted by cytokine levels. Nephron  T|C 06:11, 18 April 2006 (UTC)

That's just it: talking about an "average" sepsis admission is meaningless when applied to a specific sepsis admission. When the range is wide, an average is not particularly informative. But as you feel you can produce an informative or useful timeline, we await it. - Nunh-huh 06:33, 18 April 2006 (UTC)

[edit] Sepsis in long-term renal transplant patients as a result of improperly targeted primary infection

Pt History: ESRF 1961-1977: Renal transplant 10.3.1977. Perfect renal function. Due to immunosuppressant therapy I am of course at higher risk of opportunistic infections. UTIs are common (transplant isolated from native renal system via renal urostomy). In April-June 2002, severe recurrent e.coli infections were treated with Keflex and Augmentin Duo-Forte with limited success (multiple hospital admissions). Ciprofloxacin intervention as last resort (hospital was worried about its cost) cleared infection up, but during maintenance course symptoms worsened unexpectedly with elevated bilirubin. Higher level blood tests showed sepsis had developed. Hospital misdiagnosed it as e.coli and was pressued to do blood cultures. From these, it was established that bacteremia (MSSA/methycillin sensitive staphyloccocus aureus) present, with secondary minor tricuspic endocarditis proven by TOE. Treatment with Flucloxacillin over 10 weeks (2 weeks in situ hospital and 8 weeks hospital-in-the-home) via PICC line to vena carva. Recovery full and uneventful and renal transplant unaffected by it.

The BIG question: Where did it come from? A battery of radiological (isotope) investigations proved all of inconclusive. Bone scans and radiography failed to find any entry point ie. through sores or skin lesions. Possible exposure to animals carrying infection (?). Specialists considered it unusual the source could not be identified. Another possibility was a systemic complication from earlier and recurring infections.

Long after recovery, in June 2003, my 13-year old dog developed a severe illness. Ill for a long time with periodontitis and associated complications, he did not respond well to antibiotics and his condition rapidly worsened. Taken to the vet, blood tests revealed poor liver function and he died shortly after from cardiac arrest. Pathological tests revealed he had p. aeruginosa and a more severe sepsis of golden staph, both of which had taken over his liver and contributed to heart failure.

I informed my treating Specialists of this discovery, which raised a a flurry of questions regarding my exposure to animals, as they had earlier speculated. It is known for certain that animals do carry some infections on their coats, particularly p. aeruginosa, e.coli et al, all of which are a recognised risk of bacterial sepsis to immunocompromised patients.

[edit] Septicemia

I had a baby 14 months ago and due to neglegence of the hospital I ended up with septicemia. Had 4 ops in two weeks including debridements and a historectomy. Nowhere in this talk does it say anything about what sepsis does afterwards. During my septic period i had considerable pain in my right hip and leg. As soon as the white blood cell count came down the pain would go away, when the count picked up it would be back. After the historectomy the count came down to almost normal and I was sent home. I still today have lots and lots of problems with my hip and my leg, can't sit crossed legged, can't sit stand or lie down for long periods without moving. No site that I have visited actually gives you information on what happens after this illness. Maybe you can look at doing something like this. —The preceding unsigned comment was added by 168.209.98.68 (talk • contribs) 2006-07-25t11:02:37z.

-- Jeandré, 2006-08-08t21:50z

Sounds like the past while has been very difficult, perhaps even the worst you've experienced ever. To me, it sounds like you might have had some endometritis, something that happens approximately 2% of the time after a vaginal delivery and at much higher rates after a C-section;[3] I'm guessing this by the fact that you had a baby and eventually required a hysterectomy-- but this is merely speculative.

I revised the related conditions/complications section of the article and tried to simplify the language a bit. AFAIK, the outcome of sepsis can be everything from dead to perfectly healthy after-- so what is “typical” is hard to say. Sounds like you may have had a septic hip (that is septic arthritis) as a complication. I'm not a doctor and I don't think any one can diagnose that over the internet... so take what I say with a good dose of salt. I suggest you talk with your doctor about what it is that happened to you. Any case, I hope your baby is alright. Also, I hope that you're now better since the hospitalization. Feel free to tweak the article if you feel there is something that's missing or unclear--this is the encyclopedia that any one can edit. Nephron  T|C 03:47, 9 August 2006 (UTC)