The article will focus on one of the most dangerous complications of the postoperative period - surgical sepsis. Infection of the blood with a purulent infection occurs due to the ingress of harmful microorganisms into the blood. The likelihood of developing sepsis increases with a significant weakening of the body's defenses.
This disease occurs in the presence of a purulent focus of any localization. Abscesses, phlegmons, boils, mastitis and other pathologies are capable of provoking surgical sepsis. The clinical picture of blood poisoning depends on the form and stage of the disease.
Meaning of term
Until the middle of the last century, the fight against this disease in almost 100% of cases ended in the defeat of medicine. And today, sepsis is understood as a severe general infectious process with a high risk of mortality. When blood is infected with an acute or chronic form, bacterial, viral or fungal flora rapidly spreads in the body.
At the moment, the diagnosis of a common purulent surgical infection (sepsis) is carried out at an early stage.stages, which allows you to start treatment in a timely manner and stop the process of reproduction of opportunistic microorganisms.
Causes and pathogens of sepsis
Anything can cause this disease. Among the bacteria that most often trigger purulent-infectious processes in the body, it is worth noting:
- streptococci;
- staphylococci;
- protea;
- Pseudomonas aeruginosa;
- E. coli;
- enterobacter;
- Klebsiella;
- enterococcus;
- fusobacteria.
Against the background of mycotic infection, surgical sepsis develops much less frequently. But in nine out of ten cases of fungal infection of the blood, the cause is the yeast-like fungus Candida, which causes thrush and is mistakenly considered harmless.
As a rule, viruses are not a direct cause of surgical sepsis. Pathogens of this type are not able to form purulent foci. At the same time, viruses can significantly weaken the immune system, so the protective functions of the body do not work against bacterial infections.
Inflammatory mediators
Without the penetration of pathogens, surgical sepsis does not occur by itself. At the same time, bacterial damage is not the only condition for the onset of the disease. To a greater extent, it is not microbes that provoke severe disorders and lead to irreversible consequences. The reason lies in the self-protective mechanisms of the body, which reacts too strongly to the pathogenic flora. As a result, the reactionis so strong that it damages its own tissues.
And since any infectious process is accompanied by inflammation, it is impossible to avoid the release of special biologically active substances into the blood. They are called mediators of inflammation and interfere with normal blood circulation, damage blood vessels, and cause malfunction of internal organs.
Consequently, the concept of the pathogenesis of surgical sepsis includes not only infection of the body. This disease is an inflammatory reaction of the body itself, which occurs in response to infection with bacteria. In some people, it can be expressed to a weak degree, in others - to a stronger one, which depends on individual characteristics. That is why, when immunity is weakened, the causative agent of surgical sepsis is not only pathogenic microbes, but also opportunistic microorganisms that normally do not cause any harm (for example, thrush), and under the described conditions become an infectious agent.
Types of diseases
There is no single classification of surgical sepsis. In their practice, doctors use the most appropriate, in their opinion, indicator to determine the type of disease. Most often, blood poisoning is distinguished by etiology, that is, by the type of pathogen that happens:
- gram positive or gram negative;
- aerobic or anaerobic;
- mycobacterial or polybacterial.
The classifications of surgical sepsis are divided into separate groups,provoked by representatives of staphylococcal, streptococcal, colibacillary, etc.
Another reason for determining the variety of the disease is the localization of the primary focus, the entry routes of infection. If the cause of blood poisoning was an intervention in purulent tonsillitis, they speak of a tonsillogenic form of sepsis. There are also otogenic, odontogenic, urinogenital and other types of the disease. This method of classification of surgical sepsis allows us to make an assumption about the origin of the disease. If the entry routes of infection are unknown, sepsis is called cryptogenic.
According to the course of the disease, acute, chronic and fulminant are distinguished. If in acute surgical sepsis there is approximately 3-4 days to save the patient, then in the fulminant form - no more than a day. The chronic form of the disease is characterized by relapses and remissions over several months or years.
Forms and stages
Doctors distinguish between several degrees of severity of the disease:
- first – sepsis;
- second - severe sepsis;
- Third is septic shock.
The main difference between ordinary sepsis and severe sepsis is the absence of dysfunction of internal organs. In severe sepsis, symptoms of organ failure appear, which, in the absence of treatment or its ineffectiveness, increase, as a result of which the second degree passes into the third. Septic shock is distinguished from severe sepsis by uncorrectable hypotension and multiple organ dysfunction in the setting of severe widespread vascular and metabolic disease.violations.
At the initial stage of blood infection, which doctors call purulent-resorptive fever, there are extensive purulent foci and body temperature above 38 ° C for seven days after opening the abscess. In this case, the results of a blood test may be within the normal range. If medical assistance is not provided at this stage, the disease will move to the next stage - septicotoxemia. In this case, blood culture will show the first changes. It takes about two weeks to successfully treat septicotoxemia. Control blood tests are done to confirm cure.
The transition of this stage to the next, into septicemia, is evidenced by a stable fever and positive results of blood cultures. Unlike septicopyemia, another form of the disease, there are no metastatic ulcers.
Separately distinguish chronic sepsis, in which blood cultures can remain non-sterile for a long time. The patient has a history of purulent foci. The chronic form of blood infection proceeds less aggressively, periodically marked by fever, deterioration of he alth, and sometimes the appearance of new metastatic ulcers.
Sepsis as a complication of diseases
Blood poisoning can occur against the background of almost any infectious and inflammatory disease. A feature of the surgical form of the disease is that it develops as a result of invasive intervention. The most common reasons for surgerysepsis:
- diseases of the genitourinary system;
- wounds and purulent lesions on the skin, burns;
- osteomyelitis (bone damage);
- severe forms of tonsillitis, otitis media, sinusitis;
- infection during surgery, childbirth;
- end-stage cancer;
- AIDS;
- infectious and inflammatory processes of the abdominal cavity, peritonitis;
- autoimmune diseases;
- pneumonia, congestion in the lungs.
Discovering the original disease that led to blood poisoning is a great success. Depending on the cause, certain principles of treatment of surgical sepsis are applied. The clinic of the disease also plays a role in the diagnosis of sepsis. If no pathogens are found in the patient's body during a laboratory test, a diagnosis of "cryptogenic sepsis" is made.
Is it possible to get infected from a patient
Patients with sepsis are not contagious and do not pose a danger to others, unlike people with a septic form of a severe infection (eg, salmonellosis, meningitis, scarlet fever). In this case, the risk of infection through contact with the patient is much higher. But in the septic form, doctors do not diagnose sepsis, even if the symptoms of the disease are similar to those of blood poisoning.
In some patients, the causative agent of this disease may be their own intestinal bacteria. They inhabit the intestinal walls of every he althy person, so this type of sepsis is not infectious. Moreover, getting infectedkind of disease from another person is impossible.
Typical symptoms
The clinic of surgical sepsis can be recognized not only by the severity of symptoms, but also by the rate of progression of the disease. The disease can develop at lightning speed, within 1-2 days, while at the very peak of the disease there may not be a high temperature at all: this is due to the variability of infectious agents or prolonged use of antibiotics. The course of surgical sepsis largely depends on the primary focus and the type of pathogen, but it is still worth noting the symptoms characteristic of any type of blood poisoning:
- great chills;
- permanent increase in body temperature, which has a wave-like character, which is associated with the spread of infection in the blood;
- strong sweating (the patient has to change several sets of underwear during the day).
In addition to the main symptoms of sepsis, which are considered the most constant signs of the disease, there may also be:
- herpetiform rashes on the lips and mucous membranes;
- bleeding of superficial wounds;
- breathing disorders;
- drop in blood pressure;
- presence of seals or pustules on the skin;
- dysuria;
- pale skin and mucous membranes.
Patient feels tired even after rest. In his gaze, there is indifference, apathy, indifference to everything around him. Mental disorders can also occur, when causeless euphoria is suddenly replaced by stupor. In patients withsepsis often present with hemorrhages on the skin of the limbs, resembling stripes or spots.
Sepsis in children
Most often, newborns and babies of the first year of life suffer from sepsis. According to unofficial data, from 1 to 8 cases of blood poisoning are diagnosed for every thousand babies. Over the past decades, doctors have managed to reduce infant mortality rates, but so far they remain high: 13-40% of infants die due to sepsis. At the slightest suspicion of this disease, it is necessary to urgently diagnose and, if confirmed, begin treatment.
Surgical sepsis in children of the first year of life can develop not only as a complication of surgery. At risk - babies with local suppuration in the navel, deep phlegmon and abscesses of different localization. There is also an increased risk of the disease in premature babies. Moreover, in children born prematurely, sepsis develops at lightning speed due to a completely immature immune system. You can suspect blood poisoning in a child by the following signs:
- vomiting and diarrhea;
- lack of appetite;
- weight loss;
- dehydration;
- earthy complexion, dry skin.
Mortality among children in the first year of life is indeed high, but the percentage of children who, having recovered, face serious consequences of sepsis, is even higher. Some of them remain disabled until the end of their days, others lose their resistance to respiratorydiseases, acquire dangerous pulmonary and cardiac pathologies, lag behind their peers in physical and mental development. Whatever the complications of sepsis, it is important to remember that without timely treatment with antibiotics and immunomodulators, the child will not be able to survive.
Diagnostic measures
When examining a patient with suspected surgical sepsis, first of all, the clinical picture and the location of pyemic foci are taken into account. If external signs indicate blood poisoning, a microbiological study is carried out to clarify the qualitative and quantitative indicators. The laboratory also studies the composition of discharge from wounds, fistulas, and other biological fluids (urine, sputum, spinal cord, pleural or abdominal exudates).
Diagnosis of surgical sepsis and further treatment of the disease should be carried out by surgeons and resuscitators in an intensive care unit.
How to deal with the disease
The first stage is the surgical treatment of sepsis, which involves primary or secondary treatment of a wound, a purulent focus, timely amputation of the affected limbs, etc. Only after wound decontamination measures, the doctor makes a choice of an antibacterial drug. In sepsis, doctors most often opt for III-generation cephalosporins, inhibitor-protected penicillins, and II-III generation aminoglycosides. As a rule, a course of antibiotics for suspected blood poisoning is prescribedurgently, without waiting for the results of microbiological studies. When choosing a drug, the doctor should build on the following factors:
- severity of the patient's condition;
- localization of the infectious-inflammatory process;
- functionality of the immune system;
- prone to allergic reactions;
- kidney condition.
If within 2-3 days there is a positive trend, antibacterial drugs do not change. In the absence of a clinical effect during this time, the doctor must make adjustments to the treatment program, taking into account the results of microbiological tests. If it is not possible to conduct a study, then other drugs are prescribed based on the resistance of potential pathogens.
In surgical sepsis, antibiotics are administered intravenously at a maximum dose corresponding to the age and weight of the patient. The dosage regimen depends on the level of creatinine clearance. As soon as this indicator reaches normal values, the patient is transferred to intramuscular and oral antibiotics. A contraindication to the use of drugs inside is the impossibility of full absorption in the gastrointestinal tract and impaired blood and lymph circulation in the muscles.
The duration of antibiotic therapy is determined by a specialist. After recovery, the doctor will give the patient basic clinical recommendations. Surgical sepsis is a complex and life-threatening disease, in which it is important to achieve a confident regression of inflammatory changes and exclude the possibility of recurrent bacteremia, newinfectious-purulent foci, block inflammatory mediators.
Even if the patient is recovering quickly, the course of therapy for blood poisoning should not be less than two weeks. Longer antibacterial treatment is required for staphylococcal form, accompanied by bacteremia, with localization of septic foci in bone tissues, lungs and endocardium. Patients with congenital or acquired immunodeficiency are prescribed antibiotics for a longer period than patients with normal immune status. Antibiotics can be canceled 5-7 days after the stabilization of the temperature regime and the elimination of the source of purulent infection.
Features of treatment
In old age, sepsis is especially dangerous. When choosing antibiotics, the doctor should take into account the degree of functionality of the patient's kidneys. Drugs in this group can lead to a decrease in the productivity of the excretory system, so the dose of the drug is reduced.
When sepsis occurs in a pregnant woman, all therapeutic measures should be aimed at saving her life, therefore, in this case, all restrictions on the use of antimicrobial drugs are removed. The patient is prescribed drugs from the same groups as the rest of the patients. In pregnant women, sepsis is more likely to be a complication of a urinary tract infection.
The selection of drugs for children depends on age-related contraindications and the type of blood poisoning. For example, in newborns, group B streptococci and Escherichia coli provoke the disease. Surgical sepsisagainst the background of a staphylococcal infection develops when using invasive devices.
And although doctors have managed to make a breakthrough in the treatment of such a complex disease, the problem of high mortality does not lose its relevance. It is important to pay special attention to the trend towards an increase in the number of patients with purulent-septic form in all civilized states. The growth in the number of patients with diabetes mellitus, oncological and autoimmune diseases plays a negative role in this issue.
