Bacterial sepsis is a life-threatening and a severe condition. The reaction of a body to infection becomes dysregulated. This can lead to organ dysfunction and systemic inflammation. Bacteria or toxins can cause inflammation in the bloodstream. 

Bacterial sepsis is a main and leading cause of mortality and morbidity globally. About 30 million cases of bacterial sepsis occurred globally every year which can lead to millions of deaths. The cases of bacterial sepsis differ across the different areas and healthcare settings.  

This condition is more common in low- and middle-income countries because of the limited access to healthcare, insufficient infection control measures, and a high burden of infectious disease.  

The pathophysiology of bacterial sepsis is complex. It includes a combination of host immune system, endothelial dysfunction, inflammatory mediators, dysfunction of organ, and coagulation abnormalities.  

Early recognition of disease and prompt and immediate administration of proper antibiotic and supportive care are main to improve the result for patients who have bacterial sepsis.  

Bacterial sepsis can affect the different organ system in the body. The etiology of bacterial sepsis may differ based on the specific organ system involved.  

Respiratory System:

• Pneumonia: Bacterial pneumonia, which is caused by pathogens like Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus (methicillin-resistant Staphylococcus aureus [MRSA]), Klebsiella pneumoniae, and Legionella pneumophila may lead to bacterial sepsis.
• Lung abscess: Infections that can cause lung abscesses linked with aspiration can also sometimes lead to bacterial sepsis.

Urinary System:

• Urinary tract infections (UTIs): Bacteria like E. Coli, Enterococcus spp., Klebsiella pneumoniae, and Proteus spp. It can lead to UTIs. If it left as untreated or if the infection spread into the bloodstream, it can develop to bacterial sepsis.

Gastrointestinal System:

• Intra-abdominal infections: Infections like diverticulitis, appendicitis, peritonitis, or perforated bowls can cause bacterial sepsis. The bacteria which can cause this are Escherichia coli, Bacteroides fragilis, Klebsiella pneumoniae, and other enteric bacteria.
• Cholangitis: Bacterial infections in the bile duct is linked with biliary obstruction or gallstones which can lead to bacterial sepsis. Common pathogen includes Klebsiella pneumoniae, E. Coli, and Enterococcus spp.

Skin and Soft Tissues:

• Cellulitis: Bacterial skin infections like cellulitis can develop into bacterial sepsis. Common pathogens include Staphylococcus aureus (MRSA), Streptococcus pyogenes, and Enterococcus spp.
• Necrotizing fasciitis: A rapid and severe progression of soft tissue infection which is caused by bacteria like Staphylococcus aureus, Streptococcus pyogenes and Clostridium spp. can lead to bacterial sepsis.

Central Nervous System:

• Meningitis: Bacterial meningitis, which is caused by pathogens like Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and Listeria monocytogenes can lead to bacterial sepsis.

Cardiovascular System:

• Infective endocarditis: Bacterial infection of heart valves can cause infective endocarditis. If it is not treated, it can cause bacterial sepsis. Common pathogens include Staphylococcus aureus, Streptococcus viridans, and Enterococcus spp.

Age: Older patients are continuously linked with worse results in bacterial sepsis. Older adults have a high rate of mortality rate and have more complications.  

Comorbidities: Pre-existing medical conditions like lung, chronic heart, kidney, or liver disease. Cancer, diabetes, or immunosuppression can have unfavourable effects on the prognosis of bacterial sepsis. This condition can sometimes weaken the ability of body to fight against the infection and elevate the risk of complications.  

Severity of Illness: The severity of bacterial sepsis is determined by scoring systems like Acute Physiology and Chronic Health Evaluation score (APACHE) and Sequential Organ Failure Assessment score (SOFA) may be used as a prognosis indicators. High scores indicate more severe organ dysfunction and are linked with high risk of mortality. 

Organ Dysfunction: The degree and number of organs impacted by bacterial sepsis-association dysfunction are strong prognosis factors. Multiple organ dysfunction syndrome (MODS) significantly enhances the risk of mortality. 

Source of Infection: The specific source or site of infection can affect the prognosis. Specific conditions like intra-abdominal infections, pneumonia, and bloodstream infections can be linked with a high rate of risk of complications or treatment difficulties. 

Delayed Initiation of Treatment: Inadequate or delayed initiation of proper antibiotic treatment and supportive acre may negatively impact on the result in bacterial sepsis. Timely recognition and proper treatment are necessary to improve the prognosis. 

Microbial Factors: The prognosis can be affected by resistance or virulence of invading microorganism. Infections which are caused by drug resistant bacteria, like multidrug-resistant Gram-negative bacteria, or methicillin-resistant Staphylococcus aureus (MRSA) can be linked with worse result.  

Biomarkers: Certain specific biomarkers like lactate levels, procalcitonin (PCT), C-reactive protein (CRP), or biomarkers of coagulation abnormalities (disseminated intravascular coagulation [DIC]) may give more prognosis information in bacterial sepsis.  

Immune Response: Individuals differences in genetic factor and immune response may affect the prognosis of bacterial sepsis. Genetic polymorphisms which are linked to inflammatory and immune responses have been linked to the differences in bacterial results.  

Non-specific signs & symptoms 

Fever with or without chills 

Impaired mental condition 

Increased breathing 

Warm/cold skin 

Hypotension 

Systemic signs & symptoms  

Respiratory infection 

Gastrointestinal infection 

Genitourinary infection 

Surgical wound infection 

Age Group:   

Neonates 

Infants 

Children 

Adolescents 

Adult 

Elderly 

During the physical examination if a patient is found having bacterial sepsis, healthcare providers will check for signs and symptoms which can indicate the presence of sepsis and infection. The examination will check the vital signs, general appearance, and specific physical findings in the patient.  

• Vital Signs: The vital signs of patient will be closely monitored. This includes heart rate, temperature, blood pressure, respiratory rate, and oxygen saturation. 
• General Appearance: The overall appearance of the patient is observed by signs of distress like agitation, restlessness, or lethargy.  
• Skin Examination: The skin is observed for signs of perfusion and infection. Any signs of warmth, swelling, redness, or purulent discharge can indicate a localized infection. 
• Respiratory Examination: The respiratory system will be assessed for the symptoms of respiratory distress, like increased rate of respiration, use of accessory muscles, or labored breathing. Lung auscultation can give abnormal breath sounds like crackles and decrease breath sounds, which indicate possible pneumonia or acute respiratory distress syndrome (ARDS). 
• Cardiovascular Examination: The cardiovascular system will be assessed for symptoms of circulatory complications. The heart rhythm and rate will be evaluated, specifically tachycardia. Blood pressure can be low, and orthostatic hypotension can be noticed. The peripheral pulses and capillary refill time will be checked to evaluate peripheral perfusion. 
• Abdominal Examination: The abdomen will be checked for distension, tenderness, or symptoms of peritonitis. These can suggest any intra-abdominal infection as a prognosis of bacterial sepsis. The enlarged liver or spleen can indicate the systemic involvement.  
• Neurological Examination: The neurological examination will be assessed which include cranial nerve function, motor strength, sensory examination, and reflexes. Any changes in the neurological function, like delirium, confusion, or focal neurological deficits, can indicate severe bacterial sepsis, which can affect the central nervous system. 
• Other System-Specific Examination: Other additional system specific examination can be performed based on the symptoms and suspected source of infection on the patient. An examination of musculoskeletal system, genitourinary system, or central venous access sites can be assessed if there are any indication of infection. 

• Immunosuppression 
• Diabetes 
• Chronic kidney failure 
• Chronic lung disease 
• Liver disease 
• Cardiovascular disease 
• Surgical procedures 
• Substance abuse 
• Advanced or old age 

Bacterial sepsis can occur sudden and acute onset in some cases. The condition of the patient may get worse rapidly within hours or minutes. The common severe infections are like pneumonia or meningococcal sepsis. The patient can have a sudden fever, chills, altered mental health, hypotension, signs of organ dysfunction, and rapid breathing. This requires an immediate medical attention. 

Subacute Presentation: 

Bacterial sepsis can have a subacute presentation. The symptoms may develop over days. The patient can initially experience non-specific symptoms like fever, generalized weakness, malaise, and fatigue. They may develop some specific symptoms of sepsis like increased heart rate, respiratory distress as the infection progresses. The subacute presentation cab ne seen in intra-abdominal or UTI that significantly get worsen. 

• Early Recognition and Diagnosis: Early recognition of bacterial sepsis is necessary. Healthcare providers must be vigilant for the symptoms like fever, increased respiratory rate, increased heart rate, altered mental status, and any signs of organ dysfunction. 
• Stabilization and Supportive Care: Immediate resuscitation includes provide intravenous fluid and oxygen to maintain adequate tissue perfusion. 
• Source Control: Identify and control the source of infection are essential. This may include surgical procedures to remove abscesses, infected tissues, or devices. 
• Empirical Antibiotic Therapy: Broad-spectrum antibiotics are started as soon as the bacterial sepsis is suspected. The choice of antibiotics is dependent on the source of infection and local antibiotic resistance patterns.  
• Monitoring: Continuous monitoring of laboratory values, vital signs, and organ function is necessary to check he response of patient to treatment and guide for further treatment. 
• Prevention and Surveillance: Infection control measures must be places to prevent the healthcare associated infections. 

Critical Care/Intensive Care

Infectious Disease

Pulmonary Medicine

• Infection Control Measures: Apply strict infection control measures to stop the transmission of bacteria. This involves proper hand hygiene practices for healthcare provider and visitor, personal protective equipment like gowns, gloves, and masks, and adherence to isolation precautions.   
• Keep Isolation Rooms: Patients who have bacterial sepsis keep them in an isolated room, specifically with multidrug-resistant organisms or continuous infections. Isolation rooms help to limit the exposure to susceptible individuals and reduce the risk of infection. 
• Cleanliness and Disinfection: Maintain a clean environment by regular cleaning and disinfecting the surfaces, equipment, and patient care areas. Use proper disinfectants which are effective against the concern pathogens. 
• Ventilation: Make sure adequate ventilation is here in patient care areas to improve the air circulation and reduce the contamination of airborne pathogens. Proper ventilation system reduces the risk of airborne transmission of bacteria.  
• Hand Hygiene Facilities: Provide accessible hygiene facility by the healthcare facility which include sinks with soap and water or alcohol-based hand sanitizers. Promote and educate healthcare workers, patients, and visitor about the necessity of proper hand hygiene. 
• Avoidance of Crowding: Restrict the number of visitor and ensure proper spacing between patient to prevent overcrowding. This can help to reduce the transmission of pathogen and promotes a more controlled and safer environment.  
• Prevention of Healthcare-Associated Infections: Appl strategies to prevent healthcare associated infections like catheter associated urinary tract infection (CAUTI) or ventilator associated pneumonia (VAP). This can include proper insertion and maintenance of invasive devices, regular monitoring, and stick to evidence-based guidelines.  
• Adequate Staffing: Make sure adequate staffing is providing proper care, monitor the patient closely, and prompt concerns related to infection control. Staffing help to maintain a clean and safe environment and can make timely intervention and surveillance.  
• Education and Training: Provide education and training to healthcare providers about infection control practices, early recognition of bacterial sepsis, and proper management strategy. This can help to make sure a consistent and knowledge approach to prevent and manage bacterial sepsis.  
• Antimicrobial Stewardship: Implement antimicrobial stewardship programs to promote the judicious use of antibiotics, prevent any emergence of antimicrobial resistance, and optimization of patient results. This includes the proper antibiotics selection, dose optimization and duration of treatment.  

Critical Care/Intensive Care

Infectious Disease

Pulmonary Medicine

• Antibiotics are administrated as soon as the bacterial sepsis is suspected. It is used to cover a wide range of pathogens. These antibiotics are selected on the basis of source of infection and local antibiotic resistance patterns.   
• Imipenem: Imipenem is a broad-spectrum carbapenem antibiotic. It is effective against a wide range of bacteria, including many gram-positive and gram-negative pathogens. It is often used empirically in sepsis treatment when the organism is unknown.  
• Clindamycin: Clindamycin is an antibiotics which covers the gram-positive bacteria like staphylococci, streptococci, and anaerobic pathogens. It is often used to treat skin infection and soft tissue infection linked with bacterial sepsis or to cover the anaerobic organisms. 
• Metronidazole: Metronidazole is an antibiotic which covers anaerobic bacteria and protozoa. It is used to manage the intra-abdominal and pelvic infections like intra-abdominal abscesses.  
• Cefepime: Cefepime is a broad-spectrum cephalosporin antibiotic. It is effective against the gram-negative and gram-positive bacteria. It is used for wide range of infections like sepsis specifically critically ill patients.  
• Levofloxacin: Levofloxacin is a fluoroquinolone antibiotic which covers gram-negative and some gram-positive bacteria. It is used to treat the bacterial sepsis specifically in cases were respiratory infection or UTIs are found.  
• Vancomycin: Vancomycin is a glycopeptide antibiotic. It is effective against gram-positive bacteria like MRSA. It is used in the suspected cases of gram-positive bacterial infection like skin and soft tissue infection, sepsis, or pneumonia.  

Critical Care/Intensive Care

Infectious Disease

• Source Control Procedures: Source control are procedures which aims to remove or control the source of infection. These procedures may include: 
• Surgical Drainage: Surgical drainage can be performed in localized infections like infected fluid or abscesses collections. This includes an incision to access the infected area, remove pus and infected material, and establish proper drainage. This procedure can be guided by imaging techniques like computed tomography (CT) or ultrasound for accurate location of the source of infection. 
• Debridement: Necrotizing soft tissues infections, debridement can be necessary. This includes surgically removing dead or infected tissue to prevent spread of infection and promote healing.  
• Source Control in Specific Infections: Specific procedures can be necessary to address the source of infection. Removal or drainage of infected prosthetic devices like joint prostheses or infected intravenous catheters can be necessary. 
• Vascular Access Procedures: In patients who have severe sepsis or septic shock, vascular access procedures can be performed to facilitate fluid resuscitation and administration of medications. 
• Central Venous Catheter Placement: Central venous catheters, like central venous lines or peripherally inserted central catheters (PICC), can be inserted to provide central access to administer intravenous fluids, medications, and monitoring. 
• Arterial Catheter Placement: Arterial catheters can be inserted to continuously monitor blood pressure and facilitate frequent arterial blood gas sampling to assess oxygenation and acid-base status. 
• Hemodynamic Monitoring Procedures: Continuous hemodynamic monitoring can be necessary to guide fluid resuscitation and optimize patient management. 

Critical Care/Intensive Care

Infectious Disease

• Recognition and Early Intervention: This phase starts with the recognition of sepsis. This includes the identification of symptoms like elevated heart rate, fever, increased respiratory rate, and altered mental status. 
• Stabilization and Support: After the initial resuscitation, the focus will be to stabilize the vital signs of patient and to address any organ dysfunction. Source control measures like surgical drainage of abscesses or removal of infected devices are started.  
• Antibiotic Therapy: Broad-spectrum antibiotics are administered to target the likely causative pathogens. 
• Hemodynamic Support: Patients who have sepsis often develop low blood pressure and require vasopressor medications to maintain adequate perfusion to vital organs. 
• Supportive Care Phase: Patients may need mechanical ventilation for respiratory support. Renal replacement therapy (dialysis) can be necessary for patients who have kidney dysfunction. 
• Monitoring Assessment: Continuous monitoring of vital signs, laboratory values, and organ function is necessary to assess the response of patient to treatment and guide further interventions. The Sequential Organ Failure Assessment (SOFA) score and other tools are used to assess organ dysfunction and predict patient results. 
• Rehabilitation and Recovery Phase: After the acute phase of sepsis, patients often require rehabilitation to address physical and functional impairments that result from the illness. Rehabilitation can include physical therapy, occupational therapy, and psychological support. 
• Prevention and Surveillance: Infection control measures are necessary to prevent healthcare-associated infections during the patient’s stay in the hospital. Regular surveillance and audits can help to identify and address issues that contribute to sepsis.