Septicemia

Answer 1

Definition

Septicemia is the presence of bacteria in the blood (bacteremia) and is often associated with severe infections.

Alternative Names

Blood poisoning; Bacteremia with sepsis; Systemic infammatory response syndrome (SIRS)

Causes, incidence, and risk factors

Septicemia is a serious, life-threatening infection that gets worse very quickly. It can arise from infections throughout the body, including infections in the lungs, abdomen, and urinary tract. It may come before or at the same time as infections of the bone (osteomyelitis), central nervous system (meningitis), heart (endocarditis), or other tissues.

Symptoms

Septicemia can begin with spiking fevers, chills, rapid breathing, and rapid heart rate. The person looks very ill.

The symptoms rapidly progress to shock with fever or decreased body temperature (hypothermia), falling blood pressure, confusion or other changes in mental status, and blood clotting problems that lead to a specific type of red spots on the skin (petechiae and ecchymosis).

There may be decreased or no urine output.

Signs and tests

A physical examination may show:

• Low blood pressure
• Low body temperature or fever
• Signs of associated disease (such as meningitis, epiglottitis, pneumonia, or cellulitis)

Tests that can confirm infection include:

• Blood culture
• Blood gases
• CBC
• Clotting studies
  • PT
  • PTT
  • Fibrinogenlevels
• CSF culture
• Culture of any suspect skin lesion
• Platelet count
• Urine culture

Treatment

Septicemia is a serious condition that requires a hospital stay. You may be admitted to an intensive care unit (ICU).

Fluids and medicines are given by an IV to maintain the blood pressure.

Oxygen will be given. Antibiotics are used to treat the infection.

Plasma or other blood products may be given to correct any clotting abnormalities.

Expectations (prognosis)

What to expect depends on the organism involved and how quickly the patient is hospitalized and treatment begins. The Death Rate is high -- more than 50% for some organisms.

Complications

Septicemia can rapidly lead to adult respiratory distress syndrome (ARDS), septic shock, and death.

Septicemia associated with meningococci can lead to shock or adrenal collapse ( Waterhouse-Friderichsen syndrome).

Calling your health care provider

Septicemia is not common but is devastating. Early recognition may prevent progression to shock.

Seek immediate care if:

• A person has a fever, shaking chills, and looks very ill
• Any person who has been ill has changes in mental status
• There are signs of bleeding into the skin

Call your health care provider if your child's vaccinations are not up-to-date.

Prevention

Appropriate treatment of localized infections can prevent septicemia. The Haemophilus influenza B (HIB) vaccine and S. pneumoniae vaccine have already reduced the number of cases of septicemia in children. Both are recommended childhood immunizations.

In certain cases, people who are in close contact with someone with septicemia may be prescribed preventative antibiotics.

References

Enrione MA, Powell KR. Sepsis, septic shock, and systemic inflammatory response syndrome. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 176.

Munford RS. Sepsis, severe sepsis, and septic shock. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 67.

Shapiro NI, Zimmer GD, Barkin AZ. Sepsis syndromes. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 136.

Answer 2

Definition

Septicemia is bacteria in the blood (bacteremia) that often occurs with severe infections.

Alternative Names

Blood poisoning; Bacteremia with sepsis

Causes, incidence, and risk factors

Septicemia is a serious, life-threatening infection that gets worse very quickly. It can arise from infections throughout the body, including infections in the lungs, abdomen, and urinary tract. It may come before or at the same time as infections of the:

• Bone (osteomyelitis)
• Central nervous system (meningitis)
• Heart (endocarditis)
• Other tissues

Symptoms

Septicemia can begin with:

• Chills
• High fever
• Rapid breathing
• Rapid heart rate

The person looks very ill.

The symptoms quickly progress to:

• Confusion or other changes in mental status
• Red spots on the skin (petechiae and ecchymosis)
• Shock

There may be decreased or no urine output.

Signs and tests

A physical examination may show:

• Low blood pressure
• Low body temperature or fever
• Signs of related disease (such as meningitis, epiglottitis, pneumonia, or cellulitis)

Tests that can confirm infection include:

• Blood culture
• Blood gases
• CBC
• Clotting studies
  • PT
  • PTT
  • Fibrinogenlevels
• CSF culture
• Culture of skin sore
• Platelet count
• Urine culture

Treatment

Septicemia is a serious condition that requires a hospital stay. You may be admitted to an intensive care unit (ICU).

You may be given:

• Antibiotics to treat the infection
• Fluids and medicines by IV to maintain the blood pressure
• Oxygen
• Plasma or other blood products to correct any clotting problems

Expectations (prognosis)

The outlook depends on the bacteria involved and how quickly the patient is hospitalized and treatment begins. The death rate is high -- more than 50% for some infections.

Complications

Septicemia can quickly lead to:

• Adult respiratory distress syndrome (ARDS)
• Septic shock
• Death

Septicemia due to meningococci can lead to shock or adrenal collapse (Waterhouse-Friderichsen syndrome).

Calling your health care provider

Septicemia is not common but it is very serious. Diagnosing it early may prevent septicemia from worsening to shock.

Seek immediate care if:

• A person has a fever, shaking chills, and looks very ill
• Any person who has been ill has changes in mental status
• There are signs of bleeding into the skin

Call your health care provider if your child's vaccinations are not up-to-date.

Prevention

Getting treated for infections can prevent septicemia. The Haemophilus influenza B (HIB) vaccine and S. pneumoniae vaccine have already reduced the number of septicemia cases in children. Both are recommended childhood immunizations.

In rare cases, people who are in close contact with someone who has septicemia may be prescribed preventive antibiotics.

References

Munford RS, Suffredini AF. Sepsis, severe sepsis, and septic shock. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 70.

Shapiro NI, Zimmer GD, Barkin AZ. Sepsis syndromes. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 136.

Orenstein WA, Pickering LK. Immunization practices. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 165.

Reviewed By

Review Date: 08/24/2011

Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.