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Sepsis and Septic Shock: Surviving Sepsis Campaign

Time-critical syndrome of organ dysfunction from dysregulated host response to infection.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Sepsis and Septic Shock: Surviving Sepsis Campaign?

Sepsis (Sepsis-3 definition) is life-threatening organ dysfunction caused by a dysregulated host response to infection, identified by an acute increase in SOFA score 2 or more points. Septic shock is a subset with persisting hypotension requiring vasopressors to maintain MAP 65 mmHg or higher and lactate greater than 2 mmol/L despite adequate fluid resuscitation. In-hospital mortality is 10-20% for sepsis and 30-40% for septic shock.

qSOFA (respiratory rate 22+, altered mentation, systolic BP 100 or less) is a bedside screen, but lacks sensitivity for early detection. Modern emphasis is on prompt clinical suspicion combined with lactate, organ-dysfunction markers, and infection assessment. Sources include lung (most common), abdomen, urinary tract, skin/soft tissue, and bloodstream/catheter infections.

The Surviving Sepsis Campaign 2021 bundles consolidate the evidence-based approach: measure lactate, obtain blood cultures before antibiotics, administer broad-spectrum antibiotics within 1 hour for septic shock and within 3 hours for sepsis, give 30 mL/kg crystalloid for hypotension or lactate greater than 4, start vasopressors (norepinephrine first-line) for persistent hypotension, and pursue source control. Hour-1 bundle implementation reduces mortality.

Symptoms

Fever or hypothermia
Tachycardia, tachypnea
Altered mental status, confusion
Hypotension (systolic less than 100 mmHg)
Cool peripheries, mottled skin
Reduced urine output less than 0.5 mL/kg/hour
Capillary refill time greater than 2 seconds
Petechiae or purpura (DIC, meningococcal)
Productive cough, dyspnea (pulmonary)
Abdominal pain, peritonitis (intra-abdominal)
Dysuria, flank pain (urinary)
Skin erythema, fluctuance, eschar
Catheter site cellulitis or pus
Hyperglycemia, lactic acidosis
Coagulopathy with bleeding

Risk Factors

Older age (more than 65)
Immunocompromise (chemotherapy, transplant, HIV, asplenia)
Diabetes mellitus
Chronic liver, kidney, heart, or lung disease
Recent surgery or invasive procedure
Indwelling devices (catheter, central line, tube)
Prior antibiotic use and resistance risk
ICU stay
Pregnancy and postpartum
Malnutrition
Substance use (IV drug use)
Burns and trauma

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Suspected infection with confusion or altered mental status
  • Fever with rigors and tachycardia
  • Hypotension or fainting with infection
  • Reduced urine output and signs of dehydration
  • Mottled or cool extremities
  • Petechiae, hemorrhagic rash
  • Persistent vomiting and inability to take fluids
  • Severe abdominal pain with fever
  • Suspected catheter or surgical wound infection with systemic symptoms

Treatment Methods

01
Rapid recognition: qSOFA screen plus clinical assessment, lactate, organ-dysfunction markers
02
Hour-1 bundle: lactate, blood cultures (before antibiotics if no delay), broad-spectrum antibiotics, IV crystalloid 30 mL/kg if hypotension or lactate greater than 4, vasopressor for persistent hypotension
03
Empiric antibiotics within 1 hour for shock, within 3 hours for sepsis without shock
04
Antibiotic choice based on suspected source and local resistance: piperacillin-tazobactam, cefepime, meropenem; add vancomycin for MRSA risk; add antifungal in immunocompromised
05
Source control: drain abscesses, remove infected devices, debride necrotizing fasciitis, surgical control of perforation
06
Fluid resuscitation: crystalloid (Ringer's lactate or balanced solutions preferred over normal saline)
07
Reassess fluid response with dynamic measures (passive leg raise, IVC variation, stroke volume variation)
08
Vasopressors: norepinephrine first-line, target MAP 65 mmHg or higher
09
Add vasopressin (0.03 U/min) for refractory shock; epinephrine if needed
10
Inotropes (dobutamine) for cardiac dysfunction
11
Hydrocortisone 200 mg/day for septic shock requiring high-dose vasopressors
12
Glucose target 6.1-10 mmol/L (110-180 mg/dL)
13
Lung-protective ventilation in ARDS (Vt 4-8 mL/kg ideal weight, plateau less than 30 cmH2O)
14
Renal replacement therapy as indicated
15
VTE prophylaxis with LMWH
16
Stress ulcer prophylaxis in high-risk patients
17
Early enteral nutrition in stable patients
18
Daily reassessment of antibiotic indication, de-escalation
19
Procalcitonin to guide duration in selected scenarios
20
Family communication and goals of care discussion in severe disease
21
Post-sepsis follow-up for cognitive, physical, and psychological sequelae

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.