Andalucía registers around 8,500 cases of sepsis a year, of which 3,000 are serious or fatal

The 'sepsis code', enabling the faster diagnosis and treatment of this largely unknown condition, has helped reduce the number of deaths but experts are calling for this protocol to be more widely implemented in the region's health centres

Iván Gelibter

Malaga

Friday, 13 September 2024, 16:12 | Updated 16:25h.

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Andalucía is registering around 8,500 cases of sepsis (or septicaemia) every year, of which almost 3,000 are serious or even fatal. This figure is 13 times higher than the number of deaths due to road traffic accidents. On this World Sepsis Day (13 September), experts remind us that detecting cases at an early stage is crucial in order to avoid further, or lasting, complications.

Sepsis is one of the most prevalent fatal clinical complications, "but sometimes misdiagnosed", as the Andalusian society of intensive care medicine and coronary units (Samiuc) pointed out. Specifically, it is a serious medical condition caused by the body's extreme immune response to an infection, which is usually bacterial, but can be viral or via parasites or fungi. Chemicals released into the blood to fight the infection trigger widespread inflammation, which in the most serious cases can lead to the failure of one or more organs (multi-organ failure). In the worst cases, blood pressure drops and the heart weakens, leading to septic shock and even death.

As Samiuc reminds us, sepsis is the leading cause of hospital deaths and the leading cause of hospital readmissions. Moreover, half the survivors of sepsis suffer physical or psychological sequelae (lasting health issues as a consequence of sepsis).

Despite its extraordinary seriousness (a death from sepsis occurs every 2.8 seconds somewhere in the world), experts consider that sepsis is still largely unknown in society. In Spain it affects more than 50,000 people a year, 17,000 of whom may die from various complications. "Early identification of the septic patient through a coordinated, multidisciplinary approach and ensuring immediate implementation of all measures for resuscitation, diagnosis and treatment have been shown to reduce sepsis mortality. Patients treated appropriately in the first hour survive in 80% of cases, reducing to 15-20% after the first 12 hours," said Dr Carmen de la Fuente, president of Samiuc. It is the members of her society who are the leading healthcare professionals in intensive care units (ICUs) where patients are managed in critical situations such as sepsis.

De la Fuente recalls that, thanks to the establishment of the 'sepsis code' in hospitals, (a multidisciplinary action, rapid response protocol that allows health professionals to recognise a situation of serious infection in a patient and quickly implement all available resuscitation, diagnosis and treatment measures with immediate referral to the intensive care unit ICU), such measures have been shown to reduce morbidity (prolonged illness) and mortality. "But these protocols are not as widespread as we would like," she states.

Despite the "rapid and favourable response" offered by the ICUs to patients affected by sepsis, the number of cases of this condition is increasing every year in correlation with the longer life expectancy of the population. With older patients there is a greater number of diseases and treatments that can facilitate the appearance of sepsis, hence the need to "continue to raise awareness" among all the bodies involved with the global objective of reducing the incidence of sepsis by 2025, "improving awareness and knowledge about this disease, promoting access to appropriate rehabilitation services and reducing complications in the medium and long term," she adds.

Malaga and, more specifically, the city's teaching hospital the Clínico is one of those centres where a "multicentre" register of septic shock cases has been started. "The aim is to know the incidence of the problem for the Andalusian people, as well as the when and how our patients are first managed in order to establish points for improvement," explained Dr María Antonia Estecha, vice-president of Samiuc and head of the ICU department at this hospital that treats over 200 patients presenting with sepsis every year.

The aim of this project, which is already being implemented in most ICUs in Andalucía's hospitals, is to analyse the results and make proposals for improvement to reduce sepsis mortality in all units. To compile this registry, samples are being collected from patients over 14 years of age in each hospital, in order to achieve a minimum of 500 patients. Samiuc hopes that, after completing this exercise, the mortality rate for sepsis can be reduced by at least 30% in the centres where these interventions are carried out.

How does a case of sepsis occur?

The most common infections that cause sepsis are those affecting the urinary and respiratory system (for instance, pneumonia), those of abdominal origin, skin infections and meningitis, among others. Common symptoms of sepsis are fever, chills, rapid breathing and heart rate, muscle pain, skin rashes, confusion and/or disorientation. "Many of these symptoms are also common in other conditions, making sepsis difficult to diagnose, particularly in its early stages," say the experts.

People with a weakened immune system are at increased risk of sepsis. This is especially true for adults over 60 years of age, children under 12 months, those with chronic lung, liver or heart disease, diabetes, HIV or those who have had their spleen removed, the immunocompromised, and more.

Even so, they point out that sepsis can be prevented and is, in fact, one of the "most preventable" causes of death in the world. To this end, it is essential to prevent any type of infection (80% of cases originate outside the hospital setting) through ways such as maintaining basic hygiene or vaccination. Early recognition of infection or sepsis, if any, is essential to save lives. Many people who survive severe sepsis make a full recovery and return to normal, "but other patients may suffer permanent organ damage," state the experts.

There is also evidence that severe sepsis alters people's immune systems and makes them more vulnerable to future infections. Some studies have even shown that people who have had sepsis have an increased risk of developing a number of medical conditions.

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