Introduction

Sepsis is a rare but serious complication of an infection.

Without quick treatment, sepsis can lead to multiple organ failure and death.

Read on or go straight to:

Symptoms in children under five

Symptoms in older children and adults

Tests to diagnose sepsis

Treatments for sepsis

Recovering from sepsis

Who's at risk of sepsis

Different terms

Sepsis symptoms in children under five

Go straight to A&E or call 999 if your child has any of these symptoms:

  • looks mottled, bluish or pale
  • is very lethargic or difficult to wake
  • feels abnormally cold to touch
  • is breathing very fast
  • has a rash that does not fade when you press it
  • has a fit or convulsion

Get medical advice urgently from NHS 111

If your child has any of the symptoms listed below, is getting worse or is sicker than you'd expect (even if their temperature falls), trust your instincts and seek medical advice urgently from NHS 111.

Temperature

  • temperature over 38C in babies under three months
  • temperature over 39C in babies aged three to six months
  • any high temperature in a child who cannot be encouraged to show interest in anything
  • low temperature (below 36C – check three times in a 10-minute period)

Breathing

  • finding it much harder to breathe than normal – looks like hard work
  • making "grunting" noises with every breath
  • can't say more than a few words at once (for older children who normally talk)
  • breathing that obviously "pauses"

Toilet/nappies

  • not had a wee or wet nappy for 12 hours

Eating and drinking

  • new baby under one month old with no interest in feeding
  • not drinking for more than eight hours (when awake)
  • bile-stained (green), bloody or black vomit/sick

Activity and body

  • soft spot on a baby's head is bulging
  • eyes look "sunken"
  • child cannot be encouraged to show interest in anything
  • baby is floppy
  • weak, "whining" or continuous crying in a younger child
  • older child who's confused
  • not responding or very irritable
  • stiff neck, especially when trying to look up and down

If your child has any of these symptoms, is getting worse or is sicker than you'd expect (even if their temperature falls), trust your instincts and seek medical advice urgently from NHS 111. 

Sepsis symptoms in older children and adults

Early symptoms of sepsis may include:

  • a high temperature (fever) or low body temperature
  • chills and shivering
  • a fast heartbeat
  • fast breathing

In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after.

These can include:

  • feeling dizzy or faint
  • a change in mental state – such as confusion or disorientation
  • diarrhoea 
  • nausea and vomiting
  • slurred speech
  • severe muscle pain
  • severe breathlessness
  • less urine production than normal – for example, not urinating for a day
  • cold, clammy and pale or mottled skin
  • loss of consciousness

When to get medical help

Seek medical advice urgently from NHS 111 if you've recently had an infection or injury and you have possible early signs of sepsis.

If sepsis is suspected, you'll usually be referred to hospital for further diagnosis and treatment.

Severe sepsis and septic shock are medical emergencies. If you think you or someone in your care has one of these conditions, go straight to A&E or call 999. 

Tests to diagnose sepsis

Sepsis is often diagnosed based on simple measurements such as your temperature, heart rate and breathing rate. You may need to give a blood test.

Other tests can help determine the type of infection, where it's located and which body functions have been affected. These include:

  • urine or stool samples
  • a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing
  • respiratory secretion testing – taking a sample of saliva, phlegm or mucus
  • blood pressure tests
  • imaging studies – such as an X-rayultrasound scan orcomputerised tomography (CT) scan

Treatments for sepsis

If sepsis is detected early and hasn't affected vital organs yet, it may be possible to treat the infection at home with antibiotics. Most people who have sepsis detected at this stage make a full recovery.

Almost all people with severe sepsis and septic shock require admission to hospital. Some people may require admission to an intensive care unit (ICU).

Because of problems with vital organs, people with severe sepsis are likely to be very ill and the condition can be fatal.

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

Read more about treating sepsis.

Recovering from sepsis

Some people make a full recovery fairly quickly. The amount of time it takes to fully recover from sepsis varies, depending on:

  • the severity of the sepsis
  • the person's overall health
  • how much time was spent in hospital
  • whether treatment was needed in an ICU

Some people experience long-term physical and/or psychological problems during their recovery period, such as:

  • feeling lethargic or excessively tired
  • muscle weakness
  • swollen limbs or joint pain
  • chest pain or breathlessness

These long-term problems are known as post-sepsis syndrome. Not everyone experiences these problems.

Read more about recovering from sepsis on the UK Sepsis Trust website.

Who's at risk?

There are around 123,000 cases of sepsis a year in England. Around 37,000 people die every year as a result of the condition.

Anyone can develop sepsis after an injury or minor infection, although some people are more vulnerable.

People most at risk of sepsis include those:

  • with a medical condition or receiving medical treatment that weakens their immune system
  • who are already in hospital with a serious illness
  • who are very young or very old
  • who have just had surgery or who have wounds or injuries as a result of an accident

Read more about the causes of sepsis.

Sepsis, septicaemia and blood poisoning

Although sepsis is often referred to as either blood poisoning or septicaemia, these terms refer to the invasion of bacteria into the bloodstream.

Sepsis can affect multiple organs or the entire body, even without blood poisoning or septicaemia.

Sepsis can also be caused by viral or fungal infections, although bacterial infections are by far the most common cause.

Causes

Sepsis can be triggered by an infection in any part of the body. The most common sites of infection leading to sepsis are the lungs, urinary tract, tummy (abdomen) and pelvis.

Sepsis may develop when you're already in hospital. For example, you're more likely to develop sepsis if:

  • you've recently had surgery
  • you've had a urinary catheter fitted
  • you have to stay in hospital for a long time

Sources of infection

Types of infection associated with sepsis include:

  • lung infection (pneumonia)
  • appendicitis
  • an infection of the thin layer of tissue that lines the inside of the abdomen (peritonitis)
  • an infection of the bladder, urethra or kidneys (urinary tract infection)
  • an infection of the gallbladder (cholecystitis) or bile ducts (cholangitis)
  • skin infections, such as cellulitis – this can be caused by an intravenous catheter that's been inserted through the skin to give fluids or medication
  • infections after surgery
  • infections of the brain and nervous system – such as meningitis or encephalitis
  • flu (in some cases)
  • bone infection (osteomyelitis)
  • heart infection (endocarditis)

Sometimes the specific infection and source of sepsis can't be identified.

What causes the symptoms of sepsis?

Usually, your immune system keeps an infection limited to one place. This is known as a localised infection.

Your body produces white blood cells, which travel to the site of the infection to destroy the germs causing infection.

A series of biological processes occur, such as tissue swelling, which helps fight the infection and prevents it spreading. This process is known as inflammation.

If your immune system is weak or an infection is particularly severe, it can quickly spread through the blood into other parts of the body. This causes the immune system to go into overdrive, and the inflammation affects the entire body.

This can cause more problems than the initial infection, as widespread inflammation damages tissue and interferes with blood flow.

The interruption in blood flow leads to a dangerous drop in blood pressure, which stops oxygen reaching your organs and tissues.

People at risk

Everybody is potentially at risk of developing sepsis from minor infections. However, some people are more vulnerable, including people who:

  • have a medical condition that weakens their immune system – such as HIV or leukaemia
  • are receiving medical treatment that weakens their immune system – such as chemotherapy or long-term steroids
  • are very young or very old
  • are pregnant
  • have a long-term health condition – such as diabetes
  • have just had surgery, or have wounds or injuries as a result of an accident
  • are on mechanical ventilation – where a machine is used to help you breathe
  • have drips or catheters attached to their skin
  • are genetically prone to infections

Sepsis is a particular risk for people already in hospital because of another serious illness.

Bacterial infections that can be caught in hospital, such as MRSA, tend to be more serious, as these bacteria have often developed a resistance to many commonly used antibiotics.

Treatment

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

You'll usually be referred to hospital for diagnosis and treatment if you have possible early signs of sepsis. Severe sepsis and septic shock are medical emergencies.

Management of sepsis after admission to hospital usually involves three treatments and three tests, known as the "sepsis six". These should be initiated by the medical team within an hour of diagnosis.

Treatment involves:

  • giving antibiotics – if the sepsis is detected early enough, this may be a course of tablets you can finish taking at home
  • giving fluids intravenously
  • giving oxygen if levels are low

These treatments are described in more detail below.

Tests will include:

  • taking blood cultures – to identify the type of bacteria causing sepsis
  • taking a blood sample – to assess the severity of sepsis
  • monitoring your urine output – to assess severity and kidney function

Emergency treatment

You'll need emergency hospital treatment and may require admission to an intensive care unit (ICU) if:

  • the sepsis is severe
  • you develop septic shock – when your blood pressure drops to a dangerously low level

ICUs are able to support any affected body functions, such as breathing or blood circulation, while the medical staff focus on treating the infection.

Because of problems with vital organs, people with severe sepsis are likely to be very ill. Up to 4 in every 10 people with the condition will die.

Septic shock is even more serious, with an estimated 6 in every 10 cases proving fatal.

However, sepsis is treatable if it is identified and treated quickly, 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). 

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

Intravenous antibiotics are usually replaced by tablets after two to four days. You may have to take them for 7 to 10 days or longer, depending on the severity of your condition.

Types of antibiotics

There won't usually be time to wait until a specific type of infection has been identified, so broad-spectrum antibiotics are given first. 

These are designed to work against a wide range of known infectious bacteria and usually cure most common infections.

Once a specific bacterium has been identified, a more focused antibiotic can be used.

Viral infections

If the sepsis is caused by a virus, antibiotics won't work. Antibiotics are usually given anyway because it would be too dangerous to delay treatment until tests confirm the specific cause.

With a viral infection, you'll 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 needs increased amounts of fluid to prevent dehydration and kidney failure.

You'll usually be given fluids intravenously during the first 24 to 48 hours after admission if you have severe sepsis or septic shock.

It's important that the doctors know how much urine your kidneys are making when you have sepsis so they can spot signs of kidney failure.

If you're admitted with severe sepsis or septic shock, you'll usually have a catheter inserted into your bladder to monitor your urine output.

Oxygen

Your body's oxygen demand goes up if you have sepsis.

If you're admitted to hospital with sepsis and the level of oxygen in your blood is low, you'll usually be given oxygen. This is either given through a mask or tubes in your nostrils.

Treating the source of infection

If a source of the infection can be identified, such as an abscess 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.

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

Other treatments

You may also require additional treatments, such as:

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

These treatments are mostly used in ICUs.

Also on NHS inform

Other health sites