Causes and risk factors
Gram negative bacteria causing sepsis include Bortadella, E. coli, Enterobacter, Chlamydia, Helicobacter, Klebsiella, Neisseria, Pseudomonas, Salmonella, Shigella, Vibrio, Yersinia. Invasion of organism does not cause sepsis in itself; it is caused as a result of body’s response to the infection caused by bacteria or other harmful organism in the form of release of chemicals or endotoxins in the blood stream. Sepsis can arise due to infection beginning from any body part. However, the common infections leading to sepsis include pneumonia, kidney infections, abdominal infections, and bacteremia. Some individuals are at a higher risk of developing sepsis compared to others – such as infection with antibiotic resistant bacteria, very young and elderly people, people suffering from an immune-compromised condition such as HIV or AIDS, people who have recently had any major surgery or are in the intensive care unit due to any cause; people with burns, wounds or other injuries; people with long-term invasive devices such as IV lines, catheters, breathing tubes, etc. Broad spectrum antibiotic therapy, immunosuppressant treatments [chemotherapy], invasive procedures, prosthetic devices, penetrating wounds, anatomic obstructions, contaminated IV fluid administration can lead to the condition.
Clinical presentation
Patients in sepsis present with reduced mental alertness, confusion, lethargy, and agitation. High fever above 101 °F or hypothermia is observed. Chills may be present. There is rapid breathing, respiratory rate higher than 20 per minute, tachycardia. Patient has reduced or no urine output and pain in abdomen. Patient ends up in septic shock characterized by symptoms of sepsis plus extremely low blood pressure that does not respond to simple fluid replacement. Eventually, sepsis leads to organ failure like liver or kidney failure or even multiorgan failure. Complications like ARDS, disseminated intravascular coagulation [DIC] may occur.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Complete blood count and certain blood tests are done. Arterial blood gas is advised. There are specific blood markers for septicaemia. Serum electrolyte levels, blood clotting tests are done. Urine examination and culture is recommended. Imaging studies such as x-rays, ultrasound, CT scan or MRI is useful for further evaluation. Kidney function tests, liver function tests to detect any damage that might have occurred to these organs.
Treatment
Sepsis is a medical emergency and must be treated promptly by hospitalization. Antibiotics are given either orally or intravenously. IV fluids are administered. Oxygen support is given in case of severe breathing difficulty. Other measures such as dialysis are taken. Medications like anti-clotting drugs, etc., are prescribed if necessary. Abscesses if present are surgically drained. Amputation of extremities is required in some cases to avoid further spread of sepsis.
Other Modes of treatment
The other modes of treatment can also be effective in treating gram-negative sepsis. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating gram-negative sepsis.
