Sepsis is a life-threatening complication of an infection. If not treated quickly, sepsis can rapidly lead to multiple organ failure and death. It is also known as blood poisoning or septicaemia.
Sepsis requires immediate medical attention. Time matters.
If you or the person you are caring for has any of the symptoms of sepsis described below, seek immediate medical help. Ask your healthcare provider, 'Could this be sepsis?'
Infections that lead to sepsis can occur at any age, but it is more common in infants, older adults and people who have weakened immune systems.
Sepsis requires immediate medical attention. If not treated quickly, sepsis can rapidly lead to multiple organ failure and death. If you or the person you are caring for is at risk of sepsis and is unwell, get immediate medical help.
Sepsis is your body's response to infection, so by treating any infection seriously, you will reduce your chances of developing sepsis.
Millions of people around the world die of sepsis every year – most of these deaths are preventable. Many people who survive sepsis suffer from consequences of it for the rest of their lives.
What causes sepsis?
Infections are usually confined to one area of your body such as lungs, urinary tract or skin. In most cases, your body’s immune system is able to fight off the infection. However, sometimes the combination of the infecting organism and your immune system's response to it can lead to damage to your body’s organs and tissues.
Sepsis can lead to a drop in blood pressure which leads to your circulatory system being unable to provide enough oxygen and nutrients to the rest of your body. This leads to damage to various organs such as your lungs, heart, kidneys and brain. Multiple organ failure and death can result, especially if sepsis is not diagnosed early and treated quickly. Sepsis is an emergency.
Who is at risk of getting sepsis?
Sepsis can occur at any age, but you are at increased risk if you have a serious infection or a weakened immune system, eg, if you:
are very young or very old
are taking steroids long term or medicines to treat cancer (chemotherapy)
have had an organ transplant and are on anti-rejection medicines
have a long-standing (chronic) disease such as diabetes, chronic obstructive pulmonary disease (COPD) or kidney disease
have severe liver disease
have HIV or leukaemia
have recently had surgery
have wounds or injuries as a result of an accident
have drips or catheters attached to your skin
are pregnant or have just given birth.
Sepsis is a particular risk for people already in hospital because of another serious illness.
Sepsis and cancer
Having cancer and certain treatments for cancer can put you at higher risk of developing an infection and, as a result, sepsis. This is because your body may not be able to fight off infections as it normally would.
Although an infection can happen at any time, your risk of getting an infection is especially increased when you have very low levels of a certain type of white blood cell called neutrophils. This is known as neutropaenia.
Your doctor will routinely test for neutropaenia by checking the level of your white blood cells (neutrophils). Read more about cancer, sepsis and infection
Sepsis and pregnancy (also called maternal sepsis)
If sepsis develops during pregnancy, during or after giving birth, or after an abortion, it is called maternal sepsis. It is one of the main causes of maternal death. If you feel unwell at any time during your pregnancy, consult your healthcare provider.
Prevention is key to reducing your risk of getting sepsis. Make sure you attend recommended antenatal visits, where healthcare providers will:
screen you for common infections
advise you on how to prevent infections
provide information on vaccinations and nutrition
prescribe treatments to prevent or treat bugs that may lead to infection in you or your baby.
The risk of having an infection after a Caesarean section is 4 times higher than by vaginal birth. This is mainly related to the risk of developing an infection at the site of the wound. Seek immediate medical attention if you have any of the following within 14 days after giving birth:
fever
an open wound or pus
painful, red, swollen breasts with fever
bad smelling discharge or pus from your vagina
severe abdominal (tummy) pain
pain when urinating (peeing) plus feeling unwell and having a fever.
Symptoms of worsening infection require immediate medical attention. Time matters. If not treated quickly, sepsis can quickly lead to multiple organ failure and death.
Usually, the first symptoms are those associated with the source of infection, such as a cough due to pneumonia (lung infection) or tummy pain from appendicitis.
Symptoms that indicate an infection is getting worse include:
fever and chills, waves of hot and cold
feeling very unwell
fast breathing
passing less urine (pee) than usual
dizziness, or changes in mental alertness such as confusion, drowsiness or disorientation.
Call Healthline free on 0800 611 116 if you are unsure what to do. Ask 'Could this be sepsis?'
How is sepsis treated?
Treatment of sepsis depends on the site and cause of the infection, the organs affected and the extent of any damage. Treatment involves taking antibiotics (if the infection is detected early enough this may be a course of tablets you can finish taking at home) and often intravenous fluids and sometimes oxygen.
What is septic shock?
When sepsis is severe, you develop septic shock. This is when your blood pressure drops to a dangerously low level. This carries the highest risk of death and complications. Sepsis, especially if severe, needs urgent hospital treatment and may require admission to an intensive care unit (ICU). ICUs are able to support many affected body functions, such as breathing or blood circulation.
Can sepsis be prevented?
Sepsis is as a result of an infection, so by treating any infection seriously, you will decrease the chances of developing sepsis. This means seeking early treatment and taking antibiotics when prescribed. You can also prevent infections by:
frequent and thorough hand washing
getting vaccinated for the seasonal flu each year
coughing into your elbow, not your hand (to help prevent spreading infection if you are sick)
maintaining a healthy lifestyle with nutritious food, exercise and plenty of sleep.
Learn more
The following links have more information about sepsis. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Osman David Mansoor, Medical Officer of Health, Hawke’s Bay DHB and Dr Andrew Burns, infectious disease physician, Hawke’s Bay DHB
Last reviewed: 16 Feb 2018
Recovering from sepsis
Most people who survive sepsis recover completely, but for some, full recovery may take a long time. Because you have been seriously ill, your body, mind and spirit need time to recover. As your body heals, you will get your strength back and, for most people, many of the problems described below will go away with time.
The early recovery phase
After you have had sepsis, it’s important to increase your level of activity slowly. Recovery involves rehabilitation to help restore you back to your previous level of health or as close to it as possible. Rehabilitation usually starts in the hospital where staff will assist you to move around and with your personal care such as bathing and dressing.
When you get home
As your body is still recovering, it's not unusual to experience the following symptoms when you get home:
feeling tired which can be general tiredness to extreme weakness and fatigue
general body aches and pains
difficulty moving around
problems sleeping
weight loss, lack of appetite, food not tasting normal
dry and itchy skin that may peel
brittle nails or hair loss.
Having sepsis can be quite traumatic, so it's also not unusual to feel emotionally stretched such as:
feeling unsure of yourself
not caring about your appearance
wanting to be alone, avoiding friends and family
having flashbacks, bad memories
being confused about what is real and what isn’t
feeling anxious, more worried than usual
experiencing poor concentration
having low mood and being depressed, angry or unmotivated
feeling frustrated at not being able to do everyday tasks.
If you find it difficult to cope, talk to your doctor. They know that this can happen after sepsis and they can help you to get through these feelings and frustrations.
How can I help myself recover at home?
Each person will recover at their own pace. Set small, achievable goals for yourself to do each day, such as taking a bath, getting dressed or walking up the stairs. Here are some tips to help you on your road to recovery:
rest and rebuild your strength
eat a balanced diet
exercise as you feel up to it
talk about what you are feeling with family and friends
record your thoughts, struggles and milestones in a journal
learn about sepsis to understand what happened
ask your family to fill in any gaps you may have in your memory about what happened to you
make a list of questions to ask your doctor when you go for a checkup.
Are there any long-term effects of sepsis?
People who survive sepsis usually recover completely and their lives return to normal. However, as with some other illnesses requiring intensive medical care, some patients have long-term effects. These may not become apparent for several weeks after you have had sepsis and may include such consequences as:
sleep problems such as difficulty getting to or staying asleep (insomnia), nightmares or vivid hallucinations
panic attacks
severe muscle and joint pains
decreased mental (cognitive) functioning
loss of self-esteem and self-belief
some people have problems with the functioning of their organs such as kidney failure, lung problems, etc.
in rare cases, loss of hands, arms, legs or feet (limb amputation).
If you feel that you are not getting better or finding it difficult to cope, talk to your doctor.
Sepsis is a condition caused by your body’s immune system responding abnormally to an infection, which can lead to tissue damage, organ failure and death. The infection can start anywhere in your body; it may be only in one part or it may be widespread. Your immune system usually works to fight any germs (bacteria, viruses, fungi) or to prevent infection. However, for reasons we don’t fully understand, sometimes the immune system goes into overdrive and starts to attack our organs and other tissues. Common infections leading to sepsis include the following (we’ve put the words that healthcare professionals use in brackets):
chest infections (pneumonia)
urine infections (urinary tract infection)
leaks from the bowel (intra-abdominal sepsis)
infections of skin (cellulitis), joint (septic arthritis) and bone (osteomyelitis)
infection of the blood (bacteremia) or heart (endocarditis).
What does sepsis feel like and look like?
Sepsis is not a mild illness. People with sepsis usually feel extremely unwell with one or more of the following symptoms:
If someone you care for is sick with an infection and/or fever, ask yourself the following questions:
Are they confused or difficult to wake?
Are they breathing very fast?
Do their hands and feet feel cold or do they have mottled skin?
Have they stopped passing urine (for a day)?
Are they sicker than they’ve ever been before?
If yes, call 111 and tell the operator and ambulance crew that you’re worried about sepsis. In other circumstances it may be appropriate to see your GP or urgent care provider and just ask – could it be sepsis?/he pātai – he sepsis tēnei?
Who is most at risk of sepsis?
Sepsis can affect anyone, but some people are more at risk than others:
very young and very old people
people with diabetes
people with weak immune systems (due to chemotherapy or taking drugs like prednisone)
people who have had an organ transplant
people with long-term medical conditions like liver, heart or kidney disease
people who are pregnant or who have just given birth.
In New Zealand, sepsis (and the infections that lead to sepsis) are more common among Māori and Pasifika people than non-Maori, non-Pasifika people.
What happens to people who survive sepsis?
Many people who get over the initial infection still need a lot of help with:
regaining physical and mental strength
completing a course of antibiotic treatment
assessing the reason that the infection happened in the first place, ie, its underlying cause
making sure that the home environment is safe for people leaving hospital with new physical disability.
This process of recovery and rehabilitation often requires an average length of stay in hospital of 7 days. People who leave hospital after sepsis often struggle to return to their previous level of function. The main problems directly related to sepsis are physical, cognitive (relating to brain function) and psychological.
There is no easy way to deal with these problems and nobody is the same – in some cases people barely notice any change, in others the effects of sepsis can be devastating, costing people their independence and/or livelihoods.
On a positive note, symptoms usually improve over time and can respond to therapy. Speak with your healthcare professional about recovery from a severe illness, and ask for extra help if you need it. It may also help you to:
speak with friends and relatives about what you’re feeling and going through
keep a diary during your recovery, so that you can see where things have improved
get in touch with your GP once you’ve left hospital and explain how things have been at home
speak with your employer about a graduated return to work if that is available to you – remember, sepsis is a severe illness like a heart attack or stroke and many people with these conditions can’t go straight back to work.
Can I get sepsis more than once?
There has been some research into sepsis survivors which found that, over the following year at least, some survivors are more prone to contracting another infection. As with any infection, there is a risk of sepsis. But most people who’ve had sepsis before seek help early on and are treated promptly.
If you (or your loved one) have an infection, then you should keep a close eye for any signs of sepsis and seek help urgently if worried.
What does a doctor or nurse find when they see someone with sepsis?
A healthcare worker will see signs of an infection and one or more of the following symptoms:
very low blood pressure
very fast heart rate
rapid breathing (25 breaths per minute or more)
low levels of oxygen in the blood
reduced level of consciousness (somebody responding only to voice or pain)
high levels of lactic acid in the blood (indicating the body isn’t getting enough oxygen).
How is sepsis treated?
It is very important to give treatment for sepsis as early as possible. This is why recognising the symptoms of sepsis and calling for help is so important.
After sepsis has been recognised there are 6 things that have to be done within 1 hour – this is called the 'Sepsis Six' bundle. In healthcare, a bundle is a group of interventions that reduce harm (or improve outcomes) when given together as a package. If everything in the Sepsis Six bundle is done within an hour (compared with no treatment), the chance of death from sepsis is roughly halved.
The Sepsis Six bundle steps are to:
give antibiotics
give fluids
give oxygen (if required)
take blood cultures (to try and grow the bug causing sepsis)
take a blood lactic acid level (a ‘lactate’)
take measurements of urine output (to make sure enough blood is flowing to the kidneys).
Content courtesy of Sepsis Trust NZ. The mission of the New Zealand Sepsis Trust is to ensure that there are no preventable sepsis deaths in New Zealand.
Information for health professionals
This page will be of most interest to clinicians (nurses, doctors, pharmacists, specialists etc.) or those seeking more detail.
Sepsis is one of the most serious conditions we can see as health professionals and with a mortality rate of 10–20%, we need to recognise it immediately and act fast.
Because it doesn't fall neatly into one specialty, the extent of the problem hasn't been profiled as clearly as other serious conditions, yet each year it kills more people than lung, breast and bowel cancer combined.
To address this gap, a group of clinicians at Waikato Hospital have set up Sepsis Trust NZ and adapted the NICE guidelines for New Zealand. This page highlights some of the key messages from these documents and viewers should read the full versions for more detail.
Just ask, could it be sepsis?
Given the delays often experienced diagnosing sepsis, a new approach is recommended to continually ask yourself or each other, "Could this be sepsis?"
Every 4 seconds someone in the world dies of sepsis.
In New Zealand sepsis kills more people than lung, breast, and bowel cancer combined.
It can occur in any clinical setting and is the leading cause of in-hospital death.
In the Waikato region, up to 1 in 1000 people are admitted to hospital with sepsis every year, and 20% of those people will die.
In the following video, Dr Erik McClain from Waikato Hospital explains how sepsis is caused, signs to watch for and the serious effects, which can include death.
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
