What is the treatment for sepsis?

Sepsis needs urgent treatment in hospital. People who are seriously unwell with sepsis may need treatment in the intensive care unit (ICU).

Sepsis treatment includes:

• Antibiotics given intravenously - through a drip - as soon as possible.

• Fluids given intravenously.

• Oxygen, if blood oxygen levels are low.

• If possible, removing the source of the infection - for example, draining collections of pus.

• Monitoring and re-assessment, to check if someone is improving with treatment or not.

• If necessary, treatment in an ICU, such as:

  • Medications for increasing blood pressure.

  • Breathing support with a ventilator.

  • Dialysis - filtering of the blood - for severe kidney failure.

Most people make a full recovery from sepsis, but it's a serious illness, and it can take some time.

In this series of articles centred around sepsis, you can read about the warning signs of sepsis, sepsis treatment, and the causes of sepsis- all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the treatment of sepsis, as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

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Sepsis

Sepsis treatment

Sepsis treatment needs to be given as soon as possible in hospital. The sooner it's given, the better the prognosis - which is why it's important to recognise the symptoms of sepsis. See the warning signs of sepsis leaflet for more information about how clinicians diagnose sepsis.

Sepsis treatment includes:

Intravenous antibiotics

Intravenous broad-spectrum antibiotics - antibiotics that work on a variety of bugs all at one -should be given as soon as possible, and within an hour of diagnosing or suspecting sepsis.

Sepsis is caused by an infection, so treating that infection as quickly as possible can help stop sepsis from progressing.

Viral infections can lead to sepsis. Antibiotics don't work against viral infections. However, they might still be given if there is a possibility of a bacterial infection - if someone is seriously ill, it's usually better to treat with antibiotics without waiting for other results to come back.

Broad-spectrum means antibiotics that work against a large range of different bacteria. They are given intravenously so that they start working as soon as possible. The exact antibiotic used depends on the type of infection. After a few days, if the exact bacteria causing the infection is known, and the person is improving, antibiotic treatment is usually changed to a narrower spectrum drug - one that only works against that bacteria and a few others - to reduce the risk of antibiotic resistance and side-effects.

Intravenous fluids

In sepsis, the immune system's response leads to leaky blood vessels that lose fluid from the bloodstream. This reduces blood pressure and blood flow to tissues, causing organ damage.

Intravenous fluids can help to treat this by replacing fluid in the bloodstream.

There's a limit to how much intravenous fluid can be given. If this is reached, and blood pressure is still low, further treatment in intensive care may be needed (see below).

Oxygen

Sepsis can cause blood oxygen levels to drop. This means the body's tissues don't get enough oxygen to survive. Oxygen is given if blood oxygen levels are too low. It can be given by tubes that sit outside the nose or with a mask. People with sepsis who have serious lung problems may also need breathing support in intensive care (see below).

Treating the source of the infection

Sometimes, if there's a source of infection inside the body, antibiotics might not be enough to kill the bacteria.

If so, a procedure to treat the source may be necessary - called source control. Examples include:

• Changing a long-term urinary catheter, if it's the source of a urinary tract infection.

• Removing a long-term intravenous line, if it's become infected.

• Doing an operation to drain a collection of pus, or remove infected tissue.

Monitoring and re-assessment

People with sepsis should be monitored and re-assessed after starting treatment, to check that they are responding.

Monitoring is likely to include:

• Re-checking vital signs - heart rate, blood pressure, breathing rate, oxygen levels, and temperature - regularly.

• Monitoring how much urine is being produced. The rate at which urine is being produced is a good way of measuring how well the kidneys are working. Sometimes, a urinary catheter is inserted to measure this accurately.

• Repeating blood tests.

  • A chemical called lactate is usually measured as part of the initial tests for sepsis. High lactate suggests that the body's tissues are not getting enough blood flow. It might be checked again after initial treatment, to check that the levels are coming down.

  • Blood tests for inflammation might be monitored over the next few days, to check that they are improving.

Treatment in intensive care

People who are seriously unwell with sepsis may need to be admitted to an ICU for enhanced monitoring and special treatments that can only be given there.

ICU treatments include:

• Medications for increasing blood pressure. These can be used for treating sepsis when it has caused septic shock - a dangerously low blood pressure that doesn't improve with intravenous fluids. They include medicines that make the heart beat stronger, and medicines that cause blood vessels to narrow. They require close monitoring in ICU.

• Breathing support. Sepsis can cause the lungs to fill with fluid, making breathing very difficult. Breathing support might be needed. This can sometimes be given through a special mask, but may need to be given through a breathing tube whilst unconscious.

• Dialysis. Sepsis can cause kidney failure. In severe cases, people may require dialysis which is done in ICU in an emergency.

Recovering from sepsis

Most people make a full recovery from sepsis. It's a major illness, though, and recovery can take some time.

The long-term effects of sepsis, and how long it takes to fully recover, depend in part on how severe the initial episode of sepsis was.

Post-sepsis syndrome

Some people develop physical, emotional, and psychological problems after surviving sepsis. These can last months to years. Symptoms differ from person to person, but can include:

• Tiredness, fatigue, and exhaustion.

• Feeling generally weak.

• Difficulty sleeping.

• Breathlessness.

• Hair loss.

• Low mood, anxiety, and depression.

• Flashbacks.

• Poor concentration.

• Symptoms of post-traumatic stress disorder.

Post-sepsis syndrome is complex and there are likely to be many different reasons for it. Tissue damaged during sepsis may take a long time to recover, and may not recover fully at all, leading to symptoms due to organ damage. The psychological trauma of being seriously ill can also have profound effects on people's mental health.

Most people with post-sepsis syndrome get better with time. Support from friends, family, and loved ones can help, as can professional help. For example, occupational therapists and physiotherapists can aid physical recovery and rehabilitation, and psychological support can be good for mental health.

How long does it take to recover from sepsis?

People who have mild sepsis and respond well to treatment are likely to be in hospital for a few days to a week. It's likely to take at least a few weeks at home to recover.

People who have severe sepsis, especially if they need intensive care treatment, may be in hospital for weeks or months. After going home, full recovery often takes more time. Some people need up to 18 months before they feel normal or near-normal again.

Sepsis complications

Sepsis can cause many complications. They include:

• Organ failure, such as:

  • Heart failure.

  • Respiratory (lung) failure.

  • Liver damage.

  • Kidney failure.

• Another (secondary) infection, due to the immune system becoming under-active after the initial phase of sepsis.

• Blood clotting problems. Sepsis can cause blood clots to form throughout the body, preventing blood flow to tissues. If lots and lots of blood clots form at once, this can use up the clotting proteins in the blood, leading to severe bleeding elsewhere.

• Amputations. Severe sepsis and septic shock can reduce blood flow to the arms and legs, causing tissue there to die (gangrene). In the most severe cases, amputation of an affected limb might be required to stop it spreading.

• Long-term physical, psychological, and emotional problems, as described above.

• Death. Sepsis is a life-threatening condition. Around one in five people with sepsis die from it.