SIRS may indicate infection but is not specific; potentially being present in inflammation, ischaemia or trauma and so should be interpreted in the clinical context. CRP may be elevated in infection [and in other conditions] but cannot be used to judge severity of infection. CRP may also remain elevated even when infection is resolving and must not be used in isolation to assess the severity of infection [including the need for IV therapy].
N.B. Signs of sepsis [or SIRS] may be masked in: immunosuppression, the elderly and in the presence of anti-inflammatory drugs or beta-blockers.
Figure 1 – qSOFA scoring tool
A score of ≥2 of:
- Confusion [94% or 88%-92% in people at risk of hypercapnic respiratory failure]
- Measure lactate
- Start intravenous fluid resuscitation
- Monitor hourly urine output
- the sepsis is severe
- you develop septic shock – when your blood pressure drops to a dangerously low level
Review empirical [best guess] antimicrobial therapy no later than 48 hours after initiation. Simplify and switch to narrow spectrum therapy when microbiology results become available.
If you have the early signs of sepsis, you'll usually be referred to hospital. You'll then be given a diagnosis and treatment.
Emergency treatment
You'll need emergency treatment, or treatment in an intensive care unit [ICU], if:
ICUs can support body functions like breathing that are affected by sepsis. This allows the medical staff to focus on treating the infection.
Sepsis is treatable if it's identified and treated quickly. In most cases it leads to full recovery with no lasting problems.
Antibiotics
The main treatment for sepsis, severe sepsis or septic shock is antibiotics. These will be given directly into a vein [intravenously].
Ideally, antibiotic treatment should start within an hour of diagnosis.
Intravenous antibiotics are usually replaced by tablets after 2 to 4 days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition.
Types of antibiotics
If sepsis is suspected, broad-spectrum antibiotics are given first. This is because there won't be time to wait until a specific type of infection has been identified.
Broad-spectrum antibiotics work against a wide range of known infectious bacteria. They usually cure most common infections.
Once a specific bacterium has been identified, a more focused antibiotic can be used.
Viral infections
If the sepsis is caused by a virus, antibiotics won't work. However, it would be too dangerous to delay treatment to find out the specific cause. This means antibiotics are usually given anyway.
With a viral infection, you'll need to wait until your immune system starts to tackle it. However, antiviral medication may be given in some cases.
Intravenous fluids
If you have sepsis, your body needs more fluid to prevent dehydration and kidney failure.
If you have severe sepsis or septic shock, you'll usually be given fluids intravenously for the first 24 to 48 hours.
It's important that the doctors know how much urine your kidneys are making when you have sepsis. This helps them spot signs of kidney failure.
If you're admitted with severe sepsis or septic shock, you'll usually be given a catheter. This is inserted into your bladder to monitor your urine output.
Oxygen
Your body's oxygen demand goes up if you have sepsis.
If you're admitted to hospital with sepsis and the level of oxygen in your blood is low, you'll usually be given oxygen. This is given through a mask or tubes in your nostrils.
Treating the source of infection
If a source of the infection can be identified, like an abscess or infected wound, this will also need to be treated.
For example, any pus may need to be drained away. In more serious cases, surgery may be needed to remove the infected tissue and repair any damage.
Increasing blood pressure
Medications called vasopressors are used if you have low blood pressure caused by sepsis.
Vasopressors are normally given intravenously while you're in an ICU. Extra fluids may also be given intravenously to help increase blood pressure.