Surviving Sepsis: A Q&A with Mitchell Levy, MD

Posted Friday, November 30, 2012

Mitchell Levy, MD

Rhode Island Hospital physician and researcher Mitchell Levy, MD, chief of the division of pulmonary, critical care and sleep medicine, and other investigators from the Surviving Sepsis Campaign, studied records of more than 25,000 patients with severe sepsis or septic shock in the U.S. and Europe. They found a 12 percent increase in the number deaths from sepsis-related causes in European hospitals than in the U.S. Their findings were recently published in The Lancet Infectious Diseases.

Severe sepsis is a life-threatening illness caused by the immune system over-reacting to an infection, and it may develop into septic shock if allowed to progress, interfering with the function of the body’s vital organs and causing a dangerous drop in blood pressure. Approximately 30 percent to 50 percent of people who acquire severe sepsis die as a result of the condition.

Levy offers additional insight on the article, “Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: A prospective cohort study.”

What is sepsis and septic shock, and how does a person get it?

Levy: Sepsis is the body’s reaction to infection, and it’s much more common than is generally understood. Any common infection, such as pneumonia, bladder infections, skin infections, gall bladder infections and so on can lead to severe sepsis and septic shock.

As part of the natural defense against common infections, the white blood cells in the blood produce chemicals that attack the bacteria and other causes of infection such as viruses. Sometimes this reaction becomes so strong that these chemicals begin to damage the body, causing low blood pressure and failure of important organs such as the kidney, heart, and lungs. This is sepsis.

The symptoms of sepsis are seen frequently in common infections and include fever, rapid heart rate, rapid breathing rate, mild confusion and elevated white blood cell count. Because these symptoms are common, the diagnosis of severe sepsis can be difficult until people become quite ill.

Typical treatment for sepsis includes early antibiotics, replacement of fluids because people with sepsis are usually dehydrated, and medication for low blood pressure when sepsis progresses to shock. The prognosis for sepsis varies depending on how sick people are when they received medical attention, but early intervention with antibiotics and fluids is the key to a good recovery.

How does the treatment of sepsis differ between the U.S. and Europe?

Levy: The ratio of ICU beds to hospital beds varies widely within Europe. However, there are several European countries that have only half the ICU-bed-to-hospital-bed ratio seen in the U.S. It remains unclear whether more ICU beds is wasteful, or if this translates into better care. But it is clear that many patients in the ICU in the U.S. are less sick that those found in Europe, and that the death rate of ICU patients is higher in Europe than in the U.S.

What does this mean for patients?

Levy: People should be aware that, when simple infections such as bronchitis, bladder infections or skin infections do not improve over several days, they should seek medical attention to be certain they are receiving appropriate antibiotics and the infection is getting better. Persistent or very high fever, shaking, chills, confusion, shortness of breath, markedly decreased urine output may all be signs and symptoms of worsening infection.

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