Blood poisoning - Treating sepsis

Treatment of sepsis varies depending on the site and cause of the initial infection, the organs affected and the extent of any damage.

If your sepsis is detected early enough and has not yet affected vital organs, it may be possible to treat the condition at home with antibiotic tablets. Most people who have sepsis detected at this stage will make a full recovery.

If the sepsis is severe or you develop septic shock (when your blood pressure drops to a dangerously low level), you will need emergency hospital treatment and may require admission to an intensive care unit (ICU). ICUs are able to support any affected body functions, such as breathing or blood circulation, while the medical staff focus on treating the infection.

As a result of problems with vital organs, people with severe sepsis are likely to be very ill and up to four in every 10 people with the condition will die. Septic shock is even more serious, with an estimated six in every 10 cases proving fatal.

However, if identified and treated quickly, sepsis is treatable and in most cases leads to full recovery with no lasting problems.

Antibiotics

The main treatment for sepsis, severe sepsis or septic shock is antibiotics.

If you have severe sepsis and septic shock, antibiotics will be given directly into a vein (intravenously). There will not usually be time to wait until a specific type of infection has been identified, so 'broad-spectrum' antibiotics will initially be given. Broad-spectrum antibiotics are designed to work against a wide range of known infectious bacteria and will usually cure most common infections.

Ideally, antibiotic treatment should start within an hour of diagnosis to reduce the risk of serious complications or death.

Once a specific bacterium has been identified, a more 'focused' antibiotic can be used. This has the advantage of reducing the chance of the bacteria becoming resistant to antibiotics.

How long you will need intravenous antibiotics depends on your individual circumstances, such as the severity of the sepsis. Typically, intravenous antibiotics are changed to tablets in two to four days but on occasions they may have to be given for up to seven to 10 days or longer.

If the sepsis is caused by a virus, antibiotics will not work. However, it is likely that antibiotics will be started anyway because it would be too dangerous to delay antibiotic treatment until tests are able to confirm the specific cause of the infection. You will then need to wait until your immune system starts to tackle the infection, although antiviral medication may be given in some cases.

Intravenous fluids

If you have sepsis, your body requires increased amounts of fluid to prevent dehydration and kidney failure. Therefore, you will usually be given fluids intravenously during the first 24 to 48 hours after admission if you have severe sepsis or septic shock.

It is important that the doctors know how much urine your kidneys are making when you have sepsis, so they can spot signs of kidney failure. Therefore, if you are admitted with severe sepsis or septic shock, usually you will have a catheter inserted into your bladder to monitor your urine output.

Oxygen

Your body’s oxygen demand will go up if you have sepsis, so you will usually be given oxygen through a mask or tubes in your nostrils when admitted to hospital with sepsis if the level of oxygen in your blood is low.

People with chronic lung conditions, such as chronic obstructive pulmonary disease (COPD), or with pneumonia are particularly vulnerable to this problem.

Treating the source of the infection

If a source of the infection can be identified, such as an abscess (collection of pus) or infected wound, this will also need to be treated.

For example, any pus may need to be drained away, or in more serious cases, surgery may be needed to remove the infected tissue and repair any damage.

Increasing blood pressure

Medications called vasopressors are used if you have low blood pressure caused by sepsis. The two types of vasopressors used in the treatment of sepsis are dobutamine and noradrenaline.

These medications can help to increase blood pressure by stimulating the muscles involved in pumping blood around the body and constricting (narrowing) the blood vessels.

Vasopressors are normally given intravenously while you are in an ICU. Extra fluids may also be given intravenously to help increase blood pressure.

Other treatments

Depending on your condition and the effect sepsis has had on your body, you may also require additional treatments such as:

• corticosteroids or insulin medication
• a blood transfusion
• mechanical ventilation (where a machine is used to help you breathe)
• dialysis (where a machine filters your blood to replicate the function of your kidneys)