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Introduction
Sepsis is among the oldest medical conditions described, yet remains a leading cause of death. The Centers for Disease Control and Prevention estimate that 1.5 million people in the United States are affected each year, with a resulting 250,000 American deaths annually. For many, if not most, hospitals, sepsis is the main cause of mortality, and in a 2016 report contributed to $24 billion in annual costs (AHRQ-HC cost and utilization project; June 2016). From a global perspective, sepsis affects over 30 million people each year, with over 5 million deaths. For these reasons, it is imperative that sepsis be recognized early and treated as a medical emergency.
All providers will encounter patients with sepsis, regardless of their practice site or clinical focus; thus it is important for everyone to have an understanding of sepsis. How patients present with sepsis varies depending on age, and for the purposes of this review, pediatric patients will be excluded.
Epidemiology of Sepsis
The incidence of sepsis has increased over the last several decades. This is presumed to be secondary to increased rates of detection and diagnosis, aging populations, high numbers of patients who are immunocompromised, and use of more invasive and foreign medical devices (e.g., cardiovascular implantable electronic devices, ventricular assist devices, vascular catheters, prosthetic heart valves).
Seasonal variation of sepsis has also been described, with increased prevalence in the winter months, presumably due to influenza and other respiratory infections. Respiratory infections are the leading cause of sepsis throughout the year. Gram-positive organisms remain the primary pathogens, but Gram-negative organisms contribute a significant proportion of identified causes of sepsis. Fungi have continued to rise in incidence, possibly related to the increasing numbers of immunocompromised patients. Finally, a significant percentage of sepsis cases—between approximately 25% and 50%—have no pathogen identified and are therefore deemed to be culture-negative sepsis cases.
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