Sepsis explained

There are a lot of health promotion days and here at the Network, we often have to choose between good causes and excellent ones. Today is World Sepsis Day and it occurred to us we should tell you a bit more about it.

The Public Relations team spoke with Professor Alison Kesson, who heads up The Children’s Hospital at Westmead's Department of Infectious Diseases and Microbiology and who knows her bacteria and other invading pathogens inside-out.

PR: Can you explain what sepsis is?

AK: Sepsis is a term for a syndrome involving bacteria replicating in the blood stream and associated with organ damage, especially the lungs or kidneys. It often occurs when children have serious underlying infections such as pneumonia, meningitis or kidney disease. Young children are more susceptible to sepsis than adults because their protective immune systems are developing and unready to fight foreign invading bacteria.

Sepsis can occur with conditions like septic arthritis or osteomyelitis which are more common in infants and children than in adults, because their bones and joints have a higher blood supply as part of normal growth. These infections are serious and can damage the bone or joint if not treated.

Sepsis always comes with fever, though there is a rare response in very small babies that involves hypothermia, or the decrease in normal body temperature.

There is also something called ‘Septic Shock’ which is a severe sepsis reaction that can cause low blood pressure and organ failure. Thankfully, it’s quite rare.

PR: Why is sepsis a continuing issue?

AK: Sepsis has historically been a major cause of child mortality as a result of diseases such as pneumonia. With immunisation, antibiotics, and advanced diagnostic techniques more children survive childhood infections than ever before.

In hospital, we tend to see more serious systemic illnesses, some in children that have compromised immune conditions. In these children infections can be difficult to treat and sometimes means the child continues to be vulnerable to infections afterwards.

In children, serious infection can occur from colonising bacteria, like those normally found in our nose or throat or on our skin. You can see this with septic arthritis and osteomyelitis—the bacteria which live on the body surfaces are not causing a problem  but if they  enter the bloodstream an infection can result.

It’s also important to differentiate between hospital-acquired infections, which we define as ‘acquired 48 hours after being admitted to hospital’. Again, children with immune deficiencies are the most vulnerable and strict adherence to infection control practices, like hand-washing are really important in reducing these risks.

Another factor that can contribute to sepsis in hospitals are invasive devices such as central venous lines. Invasive devices themselves don’t cause infections, but they can provide an entry point for bacteria and in some cases fungi to enter the body. Poor infection control practices can lead to sepsis which is why consistent hygiene is so important to maintain in hospitals.

PR: What factors make sepsis management a challenge in a paediatric situation?

AK: Well, in addition to managing the complex conditions we just talked about, young infants and newborns have immature immune systems and are therefore more vulnerable to serious infections.

In a paediatric situation, where babies and very young children can’t verbally explain what’s wrong, we rely on parents and carers to report symptoms and behaviours before a diagnosis can be made.

This kind of report or interpretation—while given with the best intentions—isn’t always accurate and is influenced by levels of health literacy and clinical knowledge. So sometimes presentation to the hospital is delayed simply because no one knew what was going on or until more serious symptoms appeared at which time organ or joint damage may already be underway.

PR: How can we better protect children most at risk?

AK: Patients who have a greater risk of contracting sepsis include unvaccinated children or patients with chronic diseases or  immune-deficiency conditions.

The best way to protect patients from sepsis is to increase education and awareness of the causes and risks, which why World Sepsis Day exists. We can’t underestimate the importance of providing basic protection—consistent hand-hygiene practices to reduce the spread of bacteria, viruses and fungi, and adhering to the current immunisation schedule provided by the NSW Government will continue to reduce the incidence of sepsis in infants and newborns.

PR: Thanks for your time Alison.

Like more information about sepsis?

Watch this video