World Sepsis Day - -
Sepsis is common and often deadly. It remains the primary cause of death from infection, despite advances in modern medicine like vaccines, antibiotics, and intensive care.
What is Sepsis? Sepsis is a global healthcare problem. It is more common than heart attack, and claims more lives than any cancer, yet even in the most developed countries fewer than half of the adult population have heard of it. In the least developed countries, sepsis remains a leading cause of death.
Colloquially known as “blood poisoning”, sepsis is a life threatening medical condition that arises when the body’s attempt to fight an infection results in the immune system damaging tissues and organs. This chaotic response, designed to protect us, causes widespread inflam- mation, leaky blood vessels, and abnormal blood clotting resulting in organ damage. In severe cases, blood pressure drops, multiple organ failures ensue, and the patient can die rapidly from septic shock. Patients vary in their response; the severity of their sepsis and the speed with which it progresses is affected by their genetic characteristics and the presence of coexisting illnesses, as well as the numbers and virulence of the infecting micro-organism. Some pa- tients seem not to deteriorate until late in their illness, in others sepsis progresses rapidly and can be fatal within a few hours.
What can be done about Sepsis?Cost-effective basic interventions save lives. The best centres, mainly in industrialized countries, have doubled patients’ chances of survival, simply by recognising the condition and responding rapidly. However, only 10-30% of patients with sepsis receive excellent care.
Saving lives depends not just on treatments specific to a particular infection, but rather a focus on early recognition and awareness of sepsis, rapid antimicrobial therapy and resuscitation, and vital organ support. In short, sepsis is a medical emergency and each hour matters. A better understanding of sepsis as the final common pathway of illness due to infection is essential to drive improvement. This applies to the medical profession, governments and the general public.
Furthermore, some infections that could lead to sepsis can be prevented through vaccination for diseases like influenza, pneumococcus and meningitis and also strategies to prevent healthcare-associated infections are effective to reduce the burden of sepsis.
What causes Sepsis?
Sepsis is always triggered by an infection. Sepsis occurs as a result of infections acquired both in the community and in hospitals and other health care facilities. The majority of cases are caused by infections we all know about: pneumonia, urinary tract infections, skin infections like cellulitis and infections in the abdomen (such as appendicitis). Invasive medical procedures like the insertion of a catheter into a blood vessel can also introduce bacteria into the blood and trigger sepsis.
Normally, when we suffer a minor cut, the area around the injury swells and becomes hot and red. This is the immune system in action. To fight any infection and to form a blood clot to stop bleeding, the body must get white blood cells and platelets into the tissues surrounding the cut. The body does this through inflammation, which is managed by the immune system. The blood vessels swell to allow more blood to flow, become leaky so that the infection-fighting cells and clotting factors can get out of the blood vessels and into the tissues where they’re needed, and we see the typical hot, red swelling.
Sepsis is best thought of as this process in overdrive: inflammation is no longer localized to the “cut”, but is now widespread affecting all of the body’s organs and tissues. The body ́s defense and immune system go into overdrive, leading to widespread inflammation, poor perfusion, organ failure and septic shock. Most types of microbes can cause sepsis, including bacteria, fungi, viruses and parasites such as those causing malaria. Bacteria are by far the most common culprit, but it is important to understand that viral infections with seasonal influenza viruses, the Dengue and Ebola viruses may also progress to acute organ dysfunction and result in death from multiple organ failure and septic shock.
Sepsis is the final common pathway in the vast majority of deaths from infection worldwide.
Who gets Sepsis?
Sepsis does not discriminate. It affects all age groups and is not respectful of lifestyle choices. Vulnerable groups such as new born babies, small children and the elderly are most at risk, as are those with chronic disease and weakened immune systems. It is not a disease confined to healthcare settings, though most patients with established sepsis will be cared for in hospital. Age, sex, and race or ethnic group can all influence the incidence of severe sepsis, which is higher in infants and elderly persons than in other age groups, higher in males than in females, and higher in blacks than in whites . People with chronic illnesses, such as diabetes, cancer, AIDS, kidney or liver disease, are also at increased risk, as are pregnant women and those who have experienced a severe burn or physical injury.
How many people get Sepsis?
Sepsis is a global health problem that carries a high risk of death. A recent global assessment of the mortality rate of patients with sepsis treated in an intensive care unit found that over one third of these patients died without leaving hospital . Sepsis remains the primary cause of death from infection despite advances in modern medicine, such as vaccines, antibiotics and acute care. In the developing world sepsis accounts for 60-80% of lost lives per year, affecting more than 6 million newborns and children annually and over 100,000 women contract sepsis in the course of pregnancy and childbirth . In all countries where data on hospitalisations for sepsis are available the number of cases has increased steadily [12-15]. The US Center for Disease Control’s National Center for Health Statistics estimates that, based upon information collected for billing purposes, the number of times people were in the hospital with sepsis increased from 621,000 in the year 2000 to 1,141,000 in 2008 . The number of hospital admissions for sepsis following healthcare-associated as well as community-acquired infections increased up to three-fold over the last decade. In comparison hospital admissions for stroke and myocardial infarction remained stable over the same period .
The number of deaths from sepsis in the U.S increased from 154,159 in 2000 to 207,427 in 2007  and the numbers of hospitalizations with sepsis have overtaken those for myocardial infarction  In the U.S., sepsis accounts for far more deaths than the number of deaths from prostate cancer, breast cancer and AIDS combined.
The number of hospital-treated sepsis cases in resource rich countries may be up to 7-fold higher because it relies on use of administrative data to identify sepsis patients which likely underestimates the true incidence rate based on clinical assessment or chart review [18-20]. The reason for the rise in sepsis cases is likely due to a combination of factors, including poor socioeconomic conditions, increased awareness and tracking of the condition, an aging population, with more chronic diseases, an upsurge in major surgical interventions and invasive procedures, broader use of immunosuppressive and chemotherapeutic agents as well as the spread of antibiotic-resistant organisms.
What is the economic cost of Sepsis?
Early identification and treatment of sepsis will have tremendous economic benefits, totally apart from saving lives and reducing the negative impacts of sepsis. Treatment for sepsis often involves a prolonged stay in the intensive care unit and complex therapies, which incur high costs. The Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 2011 increasing on average annually by 11.9% .
It has been estimated that if the U.S. as a whole achieved earlier sepsis identification and evidenced based treatment, there would be 92,000 fewer deaths annually, 1.25 million fewer hospital days annually, and reductions in hospital expenditures of over $1.5 billion .
The costs related to long-term impacts of sepsis have not been quantified but are likely very substantial, including subsequent medical care: the true fiscal burden, considering delayed return to work, the need for families to adjust lifestyles to support, and rehabilitation cost is likely to be huge.
Download ... 2015_WSD_FactSheet_long_English.pdf
References: Please download the WSD_FactSheet_long_English.pdf for detailed references.
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