Sepsis is a generalized infection caused by bacteria. It causes significant inflammation. The disease has been known for a long time, since the term sepsis was coined in 1837 by a French physician, Pierre Piorry. Currently infectiologists tend to replace the term sepsis by that of “bacteremia associated with sepsis” (bacteremia meaning “circulation of bacteria in the blood” and sepsis “generalized inflammatory response, following a serious infection.” The word sepsis still remains. widely used by the general public and doctors.  

• Bacteremia is defined by the presence of bacteria in the bloodstream. When their number is low, they are eliminated thanks to the body’s defenses, which is the most frequent situation. In this case, the person has no symptoms, but may sometimes experience a slight fever (fever) or slight transient fatigue. When bacteria are too numerous or the person’s immune defenses are reduced (by treatment, disease, infection against HIV, for example or congenital immune deficiency), or overwhelmed by their number, the organism does not is more able to eliminate them which can lead to sepsis.
• Sepsis is the excessive generalized inflammatory reaction in response to severe infection.  
• Septic shock (which can also occur with sepsis) is linked to the release into the blood of toxins secreted by certain bacteria. 

The release of bacteria in the blood can be linked to sometimes trivial situations, such as brushing teeth, dental care or more rare situations such as cleaning a wound, changing a probe, surgery or even a pulmonary, urinary, osteo-articular, digestive infection (in particular in the bile ducts), skin (infected wounds, abscesses or bedsores) or endocarditis (infection of a pathological heart valve), etc.

The risk of sepsis is increased by the presence of a “foreign body” in the body, such as a bone or joint prosthesis, a prosthetic heart valve, a vascular catheter, a urinary or digestive catheter, a tracheal intubation catheter ( probe allowing air to enter the bronchi).

Bacteria that accumulate in this foreign material or in an infectious focus are released episodically into the bloodstream. 

All bacteria can be involved, including those that are not pathogenic (that is to say, which usually do not cause infection) and which the body usually carries in the skin, pathways. respiratory tract or digestive tract, for example.  

Mushrooms, like candida can, but rarely, cause sepsis called fungi mostly in people with compromised immune systems 

People at risk

People with weakened immune systems are particularly at risk:

• women who have just given birth (sepsis is called puerperal fever) and newborns. Sepsis is a major cause of death at birth in emerging countries.
• seniors.
• people with diseases that decrease immunity such as diabetes, cirrhosis, certain cancers or hemopathies (blood cancers), HIV-AIDS, congenital immune deficiencies. 
• drugs or treatments likely to weaken immunity such as corticosteroids, certain chemotherapy or biotherapy.
• hospitalized people are exposed to the risk of sepsis with nosocomial germs, often resistant to antibiotics

Risk factors

• drug injections with contaminated equipment or without skin disinfection
• the wearing of osteo-articular prostheses, urinary and digestive probes, intubation, drains, catheters.  
• valve disease (heart valve diseases) or valve prostheses (heart valve prostheses).  
• skin infections boils, bedsores, burns, wounds.
• dental, sinus, biliary infectious foci, etc.  
• surgical interventions. 

Sepsis results in a generalized infection, responsible for a high fever but sometimes, on the contrary, a drop in body temperature (hypothermia), major fatigue, often associated with an acceleration of the heart and respiratory rhythms. It is accompanied by chills, sweating, abdominal pain, vomiting, diarrhea, and even mental confusion in older and younger people. Fever, chills, and sweating often come on in flare-ups.

Other signs vary depending on the site of the initial infection and complications. Sepsis can be complicated by “septic shock”, with a drop in blood pressure and impaired function of various organs due to a lack of blood supply. When the blood supply of oxygen is insufficient, the skin becomes cold, mottled, cyanotic (bluish in tone) especially at the extremities. 

During a blood test:

• on the blood count, the level of white blood cells is generally very high or on the contrary markedly lowered.
• CRP (C Reactive Protein) and procalcitonin in the blood are evidence of inflammation, but their elevation is not specific to infection. However, low levels make it unlikely that sepsis exists.
• Bacteremia is observed on a blood sample showing the presence of a bacterium in the blood, a bacterium sometimes visible on direct examination under a microscope. The blood sample is cultured (hence the termblood culture, “Blood culture”) in order to identify the responsible bacteria (s) and to determine their sensitivity to various antibiotics. The blood culture should ideally be done as soon as a bacteremia is suspected, before taking any antibiotics that could affect the results. This is not always done and it complicates the interpretation of the results. Other samples are taken from potential entry points for infection (sputum, urine, catheter, probe, wounds) to identify the bacteria and place it in culture.

            Other radiological, biological or cardiological examinations are required to search for the initial site of infection, the secondary infectious locations and to assess the severity of the infection and of the shock and their repercussions on the cardiovascular and respiratory systems in particular.

Sepsis is a particularly serious disease, with a risk of death, especially in the event of septic shock, complications from initial or secondary infections and damage to “noble” organs which can leave sequelae after the infection has healed.

The risk of complications depends on the fragility of the person, the speed of the initiation of treatment, the existence of antibiotic resistance.        

It is necessary to consult urgently when the signs of infection persist despite the antibiotic treatment, especially since it is a vulnerable person, suffering from valve disease or carrying foreign material.  

Prevention of sepsis                       

People at risk due to deficient immunity or the wearing of a joint or valve prosthesis should benefit from preventive antibiotic treatment before certain dental or medical / surgical treatments.

To ensure the total cure of an infectious focus and avoid the development of bacteria resistant to antibiotics, it is essential to respect the doses and duration of treatment and to take antibiotics only if they are absolutely necessary and to take them then. really over the duration recommended by the doctor.

Treatments for sepsis

Treatment is performed in the hospital, usually in intensive care units or in intensive care.

The treatment of the infection is based on intravenous antibiotics, initiated as soon as possible after blood cultures but without waiting for their result. Usually 2 or 3 antibiotics are combined, the choice being based on the supposed origin of the initial infection, the condition of the subject and the existence of other pathologies. The results of blood cultures are obtained in 1 to 3 days depending on the germ and allow the antibiotics to be adapted. The duration of antibiotic therapy is 7 to 14 days or more, depending on the negativation of the blood cultures, the clinical condition, the fever, the germ, the initial and secondary locations.  

 The material on which the bacteria may have been deposited, such as a catheter, must be removed, open wounds thoroughly cleaned, and abscesses drained.      

Treatment of vital functions

The management and monitoring of the cardiovascular, respiratory and renal systems generally involves infusing intravenous fluids to fight against shock and restore normal arterial pressure and provide oxygen. In severe cases, good ventilation should be ensured by intubation or even by a machine to assist breathing.   

Injectable corticosteroids are prescribed in some cases when blood pressure remains low despite treatment.

Dr Maia Bovard-Gouffrant, doctor and journalist:

“The number of septicemias is increasing, because we are living older, and longer with pathologies such as diabetes, cancer, HIV-AIDS, etc. Sepsis is a serious pathology. Its management has improved thanks to progress in resuscitation and antibiotics, but we now encounter, after years of carelessness, bacteria that have become increasingly resistant to antibiotics while there is a lack of new antibiotics. . We all have a role to play, individually and collectively, in the fight against antibiotic resistance by restricting their use to well-established indications, and by scrupulously following the doses and duration of treatment ”