In sepsis – colloquially called blood poisoning – (synonyms: Bacterial toxemia; Biliary sepsis; Friedländer sepsis; Gangrenous sepsis; Generalized pus absorption; Generalized infection n.d. ; Cryptogenetic sepsis; Postoperative sepsis; Pyaemia; Sepsis with multiorgan failure; Septicaemia; Septicopyemia; Septic intoxication; Septic shock; Septic fever; Septic multiorgan failure; Septic toxicosis; Septic poisoning; Septic toxic shock; Septic toxic multiorgan failure; Suppurative sepsis; Toxemia; Toxicemia; Urosepsis; ICD-10 A40. -/A41.-: Streptococcal sepsis/other sepsis) is a severe systemic (affecting the entire organism) inflammatory response (inflammatory reaction) of the body to infection. The infection can be caused by bacteria – Staphylococcus aureus, Escherichia coli, bacteria of the genus Klebsiella, Enterobacter, Serratia as well as Pseudomonia species and Streptococcus viridans, S. faecalis and S. pneumoniae – or their toxins (poisons) or also mycoses (fungi). Since the 2016 Society of Critical Care Medicine Annual Meeting in Orlando, the above definition of sepsis has been replaced as “life-threatening organ dysfunction due to a dysregulated body response to infection.” In the current S3 guideline “Sepsis – Prevention, Diagnosis, Therapy and Follow-up” defined as follows: “Sepsis is a life-threatening organ dysfunction triggered by an infection, which is associated with a dysregulation of the host”. Septic shock has since been defined as a subset of sepsis: the circulatory response and cellular and metabolic changes are so profoundly altered that the mortality risk (risk of death) is significantly increased. The most common forms of sepsis are:
- Catheter-associated sepsis – sepsis caused by catheters or other foreign bodies inserted into the body.
- Ventilator-associated pneumonia – pneumonia associated with artificial ventilation.
Sex ratio: men are affected slightly more often than women. About 150,000 people develop sepsis annually (in Germany).Worldwide, 60-70% of all sepsis cases are community-acquired.Sepsis is responsible for 1 in 5 deaths worldwide; in Germany, sepsis is the third leading cause of death. The incidence (frequency of new cases) is 335 cases per 100,000 inhabitants per year (in Germany)In the USA, the incidence is approximately 377 cases per 100,000 inhabitants per year (2008). Sepsis is thus significantly more frequent in the USA than myocardial infarction (heart attack), breast or colon cancer (breast or colon cancer). Course and prognosis: Sepsis and septic shock are medical emergencies! Course and prognosis depend on the form of sepsis and how early therapy was started. In the course of sepsis, life-threatening disturbances of vital functions may occur. Failure of one or more organs (multiorgan failure) is also not uncommon. Intensive medical monitoring is usually required. Fulminant courses are:
- Meningococcal sepsis – sepsis caused by the bacterium Neisseria meningitidis.
- OPSI-syndrome (overwhelming post splenectomy infection syndrome) – sepsis after splenectomy (splenectomy).
- Toxic shock syndromes (toxic shock syndrome, TSS; synonym: tampon disease) – severe circulatory and organ failure due to bacterial toxins (usually enterotoxin of the bacterium Staphylococcus aureus, more rarely streptococci, then called streptococcal-induced toxic shock syndrome).
The lethality (mortality relative to the total number of people suffering from the disease) is about 55% in hospital despite therapy. The mortality rate is 43.6% for severe sepsis and 58.8% for septic shock.The lethality rates vary depending on the origin of infection. For example, lethality rates of 20-40% are reported for severe urosepsis.A monocenter registry study with 4 years of follow-up showed an overall mortality of 59% 6 months after diagnosis and a mortality rate at 4 years of nearly 75%. Vaccination: The Standing Commission on Vaccination (STIKO) at the Robert Koch Institute indicates that vaccination against influenza and pneumococci, as well as vaccination against meningococci and Haemophilus influenzae B, can help reduce the incidence (frequency of new cases) of sepsis.
