SEPSIS · Risk Factors for Septic Shock Acronym

Septic shock is a severe form of sepsis characterized by dangerously low blood pressure despite adequate fluid resuscitation. Sepsis is a life-threatening condition that occurs when the body's response to an infection causes widespread inflammation throughout the body, resulting in tissue damage and organ dysfunction. The infection leading to sepsis can be bacterial, viral, or fungal, and may originate from any tissue, initiating a complex interplay between infectious virulence factors and host defense mechanisms.  

Signs and symptoms of sepsis include tachycardia or high heart rate; weak pulse; fever or shivering; confusion; and clammy or sweaty skin. Additionally, individuals with septic shock may be hemodynamically unstable and present with extremely low blood pressures (i.e., <90/60 mmHg) and reduced blood flow to vital organs, which may lead to multi-system organ failure. Once sepsis or septic shock is identified, treatment must begin immediately, preferably within the first hour of recognition. Mortality in sepsis and septic shock increases with each hour delay in treatment, which is why starting antibiotic therapy as soon as possible is extremely important.  

Treatment of sepsis focuses on addressing the source of infection with broad-spectrum antibiotics in bacterial infections, antivirals in viral infections, and antifungals in fungal infections. Additionally, septic shock often requires aggressive fluid resuscitation and vasopressor medications, such as norepinephrine or dopamine, if blood pressure remains low despite IV fluid resuscitation. Vasopressors cause vasoconstriction of peripheral blood vessels, which increases blood pressure and blood flow to vital organs. Management of septic shock is typically carried out in intensive care units (ICUs) due to the need for continuous monitoring. 

The “E” in SEPSIS refers to extreme ages, specifically infants and individuals with advanced age. Because their immune system is still developing, infants rely primarily on antibodies passed down by the pregnant individual during pregnancy and breastfeeding. Antibodies from the pregnant individual gradually decline within the first few months of life, leaving infants more susceptible to infections. Young infants are also at risk of severe infections because they have not had time to complete their immunization schedule. 

On the other hand, as people get older, their immune system undergoes a process called immunosenescence, where it becomes less efficient at fighting off infections. This decline in immune function, coupled with other factors such as underlying health conditions and malnutrition, can leave older adults more susceptible to sepsis and septic shock. 

The second “S” in SEPSIS refers to surgical procedures. Surgical incisions create an entry point for bacteria and other microorganisms to enter the body, increasing the risk of surgical site infections. Additionally, during surgery, there can be breaks in sterile technique, such as touching non-sterile instruments or failing to maintain a sterile field around the surgical site. Finally, some procedures involve prosthetic devices or artificial joints, which provide an ideal surface for bacteria attachment. 

The likelihood of infection during surgery changes dramatically depending on certain factors such as location, trauma history, or breaks in sterile technique. For example, wounds in colonized areas like the mouth, gastrointestinal, or urinary tract are at an increased risk for infection development, as are open traumatic wounds. 

The SEPSIS acronym is a helpful mnemonic to remember the most important risk factors for developing septic shock. Septic shock is a type of circulatory failure resulting from a widespread and exaggerated immune response against an infection. The main risk factors for septic shock include suppressed immune system, extreme age, procured organs, surgical procedures, indwelling devices, and sickness. Without timely treatment, septic shock can rapidly lead to tissue damage, organ failure, and death, which is why early diagnosis and treatment are essential to improving clinical outcomes.