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2 - Sepsis, severe sepsis, and septic shock
- from Part I - Clinical syndromes: general
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- By Joseph Adrian L. Buensalido, Wayne State University School of Medicine, Rodger D. MacArthur, Newland Immunology Center of Excellence
- Edited by David Schlossberg, Temple University, Philadelphia
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 April 2015
- Print publication:
- 23 April 2015, pp 13-23
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Summary
DEFINITIONS
Sepsis is a complex syndrome that results from a host's response to infection. Simply put, it is the systemic inflammatory response syndrome (SIRS) arising because of documented or suspected infection. Clinically, SIRS is identified by the presence of at least two of the following: fever or hypothermia, tachycardia, tachypnea, and leukocytosis or leukopenia. Severe sepsis is sepsis with organ dysfunction or tissue hypoperfusion from the infection. Septic shock is severe sepsis plus hypotension that is not corrected by fluid resuscitation. Since 1991, the definitions and diagnostic criteria have expanded with inflammatory, hemodynamic, organ dysfunction, and tissue perfusion variables, but general definitions are the same. Sepsis-related terminology and definitions are in Table 2.1. Diagnostic criteria for sepsis are in Table 2.2. The document by a consensus committee of international experts called “Surviving Sepsis Campaign” has become one of the most comprehensive guidelines for clinicians as to best practice (though not yet standard of care) in the care of patients with severe sepsis and septic shock.
EPIDEMIOLOGY
The incidence of sepsis, severe sepsis, and septic shock are probably underestimated since most estimates are based on hospital databases that rely on the International Classification of Diseases, and so are biased toward a more severely ill population. The global incidence of sepsis is reported as from 22 to 240 cases/100 000 persons; severe sepsis from 13 to 300 cases/100 000 persons; and for septic shock, 11 cases/100 000 persons (based on a 2012 study). Case-fatality rates are as high as 30% for sepsis, 50% for severe sepsis, and 80% for septic shock. In the United States, the incidence of severe sepsis had been rising but in-hospital mortality was decreasing and not significantly different from Europe.
2 - Sepsis and Septic Shock
- from Part I - Clinical Syndromes – General
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- By Carmen E. DeMarco, Wayne State University School of Medicine, Rodger D. MacArthur, Wayne State University School of Medicine
- Edited by David Schlossberg
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- Book:
- Clinical Infectious Disease
- Published online:
- 05 March 2013
- Print publication:
- 12 May 2008, pp 9-20
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- Chapter
- Export citation
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Summary
DEFINITIONS
Sepsis is a complex syndrome comprising a constellation of systemic symptoms and signs in response to infection, including inflammatory, pro-coagulant, and immunosuppressive events. Septic shock occurs when there is significant hypotension in the presence of sepsis. The definitions and diagnostic criteria for sepsis and related conditions were developed in 1991 at a consensus conference sponsored jointly by the American College of Chest Physicians and the Society for Critical Care Medicine and reviewed by the 2001 International Sepsis Definitions Conference (sponsored by the Society of Critical Care Medicine, European Society of Critical Care Medicine, American College of Chest Physicians, American Thoracic Society, and the Surgical Infections Society). Apart from expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience, the definitions remained unchanged. The sepsis-related terminology and definitions are presented in Table 2.1; the diagnostic criteria for sepsis presented in Table 2.2 have been updated by the Conference to include a variety of signs of systemic inflammation in response to infection. This international group proposed a classification scheme for sepsis that stratifies patients based on their predisposing conditions, the nature and extent of the insult (infection), the host response, and the degree of concomitant organ dysfunction (acronym PIRO). This concept will have to be further tested and refined before it can be routinely applied in clinical practice.