Third most common cause of death in Germany: Sepsis lurks in every infection – which is what makes it so dangerous
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Sepsis is one of the most dangerous forms of infectious diseases and can be fatal if it is not recognized and treated in time. Sepsis specialist Konrad Reinhart explains how sepsis manifests itself, which factors increase the risk and what consequences the disease has.
What is sepsis and how do you recognize the first signs?
Sepsis is the most severe form of infectious disease and can be caused by more than just wound infections. It occurs when the body’s defenses are no longer able to prevent the spread of a local infection and infectious agents penetrate the bloodstream. Bacteria are the most common infectious agents, followed by viral infections such as flu and Covid-19, fungal infections and malaria.
The body reacts to this life-threatening situation by activating all defense systems available to it, especially the immune and coagulation systems. However, this not only damages the pathogens, but also the body’s own organs such as the lungs, heart and kidneys, and due to the clotting of the blood in the small blood capillaries, limbs often die and have to be amputated. If not recognized in time and not treated as an emergency like heart attacks and strokes, multi-organ failure and often fatal septic circulatory failure occurs.
If you have the following symptoms, you should insist on an immediate, emergency medical evaluation to rule out sepsis:
Unprecedented feeling of illness Difficult rapid breathing Extreme pain Change in personality/confusion Increased heart rate & drop in blood pressure
Absence of fever does not rule out sepsis. You can find more information about the symptoms here.
About Konrad Reinhart
Konrad Reinhart is an intensive care physician and anesthesiologist. From 1993 to 2016 he was director of the clinic for anesthesiology and intensive therapy at the University Hospital of the Friedrich Schiller University Jena. He is now BIH Visiting Professor at the Charité Foundation and Senior Professor at the Charité – Universitätsmedizin Berlin. Reinhart is a member of the National Academy of Sciences Leopoldina, founding president of the German Sepsis Society and the Global Sepsis Alliance. He has dedicated his medical career to the study of sepsis. His work has demonstrated the medical and health economic importance of sepsis and led to better drug safety in sepsis therapy.
What risk factors increase the likelihood of developing sepsis?
Sepsis can affect anyone. However, some groups of people are at increased risk. This includes:
People over 60 years of age Newborns/premature babies and children Patients with chronic previous illnesses of the lungs, liver, kidneys, heart or diabetes People with congenital or acquired immune deficiency, e.g. spleenlessness, HIV/AIDS or taking medications that weaken the immune system for treatment from cancer, severe rheumatism or other diseases of the immune system
But people with artificial heart valves, vascular and other plastics implanted in the body such as joint prostheses, those who wear urinary catheters, tracheostomies and corresponding tracheostomy tubes also have an increased risk of infection and therefore sepsis.
Any surgical and other medical measures that involve a violation of the protective function of the skin and mucous membranes pose an increased risk of infection. This applies even to minor injuries such as insect or needle bites.
More information about the risk factors for sepsis can be found here.
How is sepsis diagnosed and what tests are necessary?
The prerequisite for effective therapy is knowledge of the sepsis pathogen and the sepsis focus. Antibiotics only work in cases of infection or sepsis caused by bacteria. The treatment of viral or fungal sepsis requires substances that are effective against these pathogens. Therefore, a blood culture must always be performed before starting therapy.
Unfortunately, a large number of hospitals in Germany do not have their own microbiological laboratories and these are often not staffed 24/7. Germany also lags behind in international comparison in the area of sepsis and blood culture diagnostics. There are now also a number of infection and sepsis markers that help to distinguish whether a viral or bacterial infection or sepsis is present.
In 20-30 percent of sepsis cases, invasive cleaning of the source of infection is necessary in addition to treatment with antibiotics. This is the case, for example, with abscesses, intestinal perforation, pyelonephritis due to kidney stones, inflamed heart valves or foreign bodies such as vascular prostheses or artificial joints.
Experts and the Sepsis Foundation are therefore demanding that all acute hospitals that treat sepsis be able to offer the appropriate diagnostic and therapeutic options and the necessary technical expertise around the clock, as has been standard for decades in other emergencies such as heart attacks and strokes .
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What treatment options are there for sepsis and how effective are they?
Another central component in the treatment of sepsis in the acute phase is supportive intensive care treatment to stabilize the circulatory system and to bridge the disorders associated with sepsis or the failure of the body’s own organs. This affects organ systems such as: lungs, kidneys, heart, liver, gastrointestinal tract, brain, nervous system. Serious disorders of the coagulation system and metabolism must also be treated in intensive care.
The central, often life-saving intensive care measures to bridge the disturbed or failed organ systems include:
Support of the cardiovascular system through the intravenous administration of fluids to replenish the circulatory system and medication to strengthen the heart function Administration of oxygen and mechanical ventilation and in extreme cases the use of heart lung machines (ECMO) Blood washing (dialysis) via kidney replacement procedures Artificial nutrition Replacement of coagulation factors
As part of studies on the treatment of virus-related sepsis in the context of the Covid-19 pandemic, it was shown that medicinal dampening of the excessive immune reaction with immune-modulatory antibodies improves the chances of survival and reduces long-term consequences. Some of these substances have also led to emergency approvals by US and European regulatory authorities.
How can you reduce the risk of sepsis and what preventative measures are there?
You cannot protect yourself from sepsis directly, but you can protect yourself from infections that can lead to sepsis. The following measures can help prevent infections by strengthening the immune system – and thus also reduce the risk of sepsis:
Vaccinations in accordance with the vaccination recommendations of the Standing Vaccination Commission at the Robert Koch Institute (STIKO). It was also shown in the Covid-19 pandemic that vaccinations against the Sars-Cov-2 virus improved the chances of survival and reduced long-term consequences. There is clear evidence that regular physical activities such as walking, cycling and gymnastics exercises significantly reduce the risk of developing infections and dying from sepsis. Healthy lifestyle, balanced diet, avoidance of alcohol and drug abuse, adherence to safe hygiene measures, consistent treatment of infections and infectious diseases by correctly taking antibiotics or other anti-infectives prescribed by a doctor to prevent them from developing into sepsis. Consistent treatment of chronic diseases (e.g. lungs, liver or diabetes) because this reduces the risk of developing an infection or an infection To develop sepsis Careful observation, handling and care of wounds and infected insect bites
What are the long-term effects of sepsis and how to manage them?
Every year around 360,000 people in Germany survive sepsis. Around 75 percent of them suffer from sequelae, sometimes for the rest of their lives, often even if the sepsis was not treated in the intensive care unit. A distinction is made between consequences for the brain, physical and psychological sequelae.
These diseases often occur together. They lead to a new need for care in almost a third of all those affected and often have far-reaching social consequences. The secondary diseases are referred to as post-sepsis syndrome. The consequences of Long Covid and sepsis are largely identical! They only differ in degree.
Physical consequences
Disturbances in the function of the heart, kidneys and liver Chronic tiredness/fatigue Breathing problems Muscle weakness Vision and speech problems Chronic pain Amputations
Consequences for the brain
Memory problems, difficulty concentrating, balance problems and dizziness, memory problems
Psychological consequences
Depression Anxiety Sleep disorders Nightmares Hallucinations Post-traumatic stress disorder (PTSD)
Social consequences: Can arise due to the duration of the illness (e.g. incapacity to work). Lack of understanding of the consequences of sepsis can lead to stress in your personal environment. The consequences of sepsis are often not defined in the service catalogs of health insurance companies and pension insurance companies. You can also find more information about this via the Sepsis Foundation.
This text comes from an expert from the FOCUS online EXPERTS Circle. Our experts have a high level of specialist knowledge in their subject area and are not part of the editorial team. Learn more.