[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Sepsis and septic shock [Conditions](https://durgical.com/en/conditions/) · [Systemic conditions](https://durgical.com/en/conditions/) # Sepsis and septic shock Sepsis is a life-threatening reaction to an infection that damages the body's own organs; septic shock is its most severe form, with failing circulation. Updated 2026-10-30 ## Structures involved Tap one to see what it is and open it in 3D. - [Right lower lobe](https://durgical.com/en/anatomy/inferior-lobe-of-right-lung/) - [Kidneys](https://durgical.com/en/anatomy/kidney/) - [Peritoneum](https://durgical.com/en/anatomy/peritoneum/) - [Left lower lobe](https://durgical.com/en/anatomy/inferior-lobe-of-left-lung/) - [Liver](https://durgical.com/en/anatomy/liver/) - [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) - [Appendix](https://durgical.com/en/anatomy/vermiform-appendix/) - [Gallbladder](https://durgical.com/en/anatomy/gallbladder/) - [Spleen](https://durgical.com/en/anatomy/spleen/) ## In biochemistry - [Lactate](https://durgical.com/en/biochemistry/molecules/lactate/) - [Cori cycle](https://durgical.com/en/biochemistry/topics/cori-cycle/) - [Cardiac troponin as a lab test](https://durgical.com/en/biochemistry/topics/cardiac-troponin-as-a-lab-test/) - [C-reactive protein (CRP) as a lab test](https://durgical.com/en/biochemistry/topics/c-reactive-protein-as-a-lab-test/) - [Energy requirements and basal metabolic rate (BMR)](https://durgical.com/en/biochemistry/topics/energy-requirements-and-basal-metabolic-rate/) - [Nitrogen balance](https://durgical.com/en/biochemistry/topics/nitrogen-balance/) - [Nitric oxide synthase (NOS)](https://durgical.com/en/biochemistry/enzymes/nitric-oxide-synthase/) - [Nitric oxide (NO)](https://durgical.com/en/biochemistry/molecules/nitric-oxide/) - [Norepinephrine (noradrenaline)](https://durgical.com/en/biochemistry/molecules/norepinephrine/) ## Microorganisms that cause it - [Bacteroides fragilis](https://durgical.com/en/microbiology/bacteroides-fragilis/) - [Burkholderia cepacia complex and Burkholderia pseudomallei](https://durgical.com/en/microbiology/burkholderia-cepacia-complex-and-burkholderia-pseudomallei/) - [Vibrio vulnificus and Vibrio parahaemolyticus](https://durgical.com/en/microbiology/vibrio-vulnificus-and-vibrio-parahaemolyticus/) - [Enterobacter, Serratia and Citrobacter](https://durgical.com/en/microbiology/enterobacter-serratia-and-citrobacter/) - [Neisseria meningitidis](https://durgical.com/en/microbiology/neisseria-meningitidis/) - [Non-typhoidal Salmonella](https://durgical.com/en/microbiology/non-typhoidal-salmonella/) - [Klebsiella pneumoniae](https://durgical.com/en/microbiology/klebsiella-pneumoniae/) - [Pseudomonas aeruginosa](https://durgical.com/en/microbiology/pseudomonas-aeruginosa/) - [Acinetobacter baumannii](https://durgical.com/en/microbiology/acinetobacter-baumannii/) - [Strongyloides stercoralis](https://durgical.com/en/microbiology/strongyloides-stercoralis/) - [Plasmodium falciparum](https://durgical.com/en/microbiology/plasmodium-falciparum/) ## In immunology - [Neutrophil](https://durgical.com/en/immunology/neutrophil/) - [Immunity to microbes: which arm defends against what](https://durgical.com/en/immunology/immunity-to-microbes-which-arm-defends-against-what/) - [Secondary immunodeficiency: HIV, malnutrition, drugs, asplenia](https://durgical.com/en/immunology/secondary-immunodeficiency-hiv-malnutrition-drugs-asplenia/) - [The neutropenic and immunosuppressed patient (nursing)](https://durgical.com/en/immunology/the-neutropenic-and-immunosuppressed-patient/) - [Innate immunity (overview, barriers)](https://durgical.com/en/immunology/innate-immunity/) - [Pattern recognition: PAMPs, DAMPs, Toll-like receptors](https://durgical.com/en/immunology/pattern-recognition-pamps-damps-toll-like-receptors/) - [Acute-phase response and fever (CRP, ESR, procalcitonin)](https://durgical.com/en/immunology/acute-phase-response-and-fever/) - [Cytokines: the table to know](https://durgical.com/en/immunology/cytokines-the-table-to-know/) - [Interleukin-1](https://durgical.com/en/immunology/interleukin-1/) - [TNF-α](https://durgical.com/en/immunology/tnf/) ## In the clinical exam - [Shock: the clinical signs and the types](https://durgical.com/en/clinical-exam/shock-the-clinical-signs-and-the-types/) - [Vital signs: what they are and how to record them](https://durgical.com/en/clinical-exam/vital-signs-what-they-are-and-how-to-record-them/) - [Body temperature and fever patterns](https://durgical.com/en/clinical-exam/body-temperature-and-fever-patterns/) - [Capillary refill time](https://durgical.com/en/clinical-exam/capillary-refill-time/) - [Early warning scores: NEWS2 and qSOFA](https://durgical.com/en/clinical-exam/early-warning-scores-news2-and-qsofa/) - [Fever, infection and sepsis: the bedside signs](https://durgical.com/en/clinical-exam/fever-infection-and-sepsis-the-bedside-signs/) ## In physiology - [White blood cells: types and functions](https://durgical.com/en/physiology/white-blood-cells-types-and-functions/) - [The physiology of inflammation](https://durgical.com/en/physiology/the-physiology-of-inflammation/) - [Thrombosis and bleeding: Virchow's triad and hemostatic defects](https://durgical.com/en/physiology/thrombosis-and-bleeding-virchow-s-triad-and-hemostatic-defects/) - [Cardiac output and what sets it](https://durgical.com/en/physiology/cardiac-output-and-what-sets-it/) - [How edema forms](https://durgical.com/en/physiology/how-edema-forms/) - [Shock physiology](https://durgical.com/en/physiology/shock-physiology/) - [Local and humoral control of blood flow](https://durgical.com/en/physiology/local-and-humoral-control-of-blood-flow/) - [Skin blood flow](https://durgical.com/en/physiology/skin-blood-flow/) - [The endocrine stress response](https://durgical.com/en/physiology/the-endocrine-stress-response/) - [Physiology of the vital signs (including blood pressure measurement)](https://durgical.com/en/physiology/physiology-of-the-vital-signs/) - [Fever](https://durgical.com/en/physiology/fever/) - [Mixed acid–base disorders](https://durgical.com/en/physiology/mixed-acid-base-disorders/) - [Physiology of pulmonary edema](https://durgical.com/en/physiology/physiology-of-pulmonary-edema/) - [Oxygen content, delivery and extraction](https://durgical.com/en/physiology/oxygen-content-delivery-and-extraction/) ## Why it happens - [How septic shock develops](https://durgical.com/en/general-pathology/how-septic-shock-develops/) - [Systemic effects of inflammation: fever, acute-phase proteins, leukocytosis, sepsis](https://durgical.com/en/general-pathology/systemic-effects-of-inflammation-fever-acute-phase-proteins-leukocytosis-sepsis/) - [Other forms of cell death: necroptosis, pyroptosis, ferroptosis](https://durgical.com/en/general-pathology/other-forms-of-cell-death-necroptosis-pyroptosis-ferroptosis/) - [Disseminated intravascular coagulation: how consumption causes both clots and bleeding](https://durgical.com/en/general-pathology/disseminated-intravascular-coagulation-how-consumption-causes-both-clots-and-ble/) - [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/) - [Mediators of inflammation: the table to know](https://durgical.com/en/general-pathology/mediators-of-inflammation-the-table-to-know/) ## Show 3 more - [Histamine, serotonin, bradykinin and the plasma protein cascades](https://durgical.com/en/general-pathology/histamine-serotonin-bradykinin-and-the-plasma-protein-cascades/) - [Inflammation: the cardinal signs and its five steps](https://durgical.com/en/general-pathology/inflammation-the-cardinal-signs-and-its-five-steps/) - [The autopsy: clinical and medicolegal](https://durgical.com/en/general-pathology/the-autopsy-clinical-and-medicolegal/) ## What it is Life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the subset with circulatory and cellular failure severe enough to markedly raise mortality. ## Who gets it A leading cause of death in hospitals worldwide, including Latin America; most cases start in the community. Among 2,510 adults with severe sepsis or septic shock in emergency departments of three hospitals in Medellín, Colombia, urinary (27.8%) and lung (27.5%) infections were the commonest sources and in-hospital mortality was 11.5%. ## Causes - Pneumonia, the most common source - Intra-abdominal infection (peritonitis, cholangitis, appendicitis, abscess) - Urinary tract infection and pyelonephritis - [Skin](https://durgical.com/en/anatomy/skin/) and soft tissue infection; infected catheters and devices - Bacteria (gram-negative and gram-positive) most often; also fungi and viruses ## Risk factors - Extremes of age (infants and older adults) - Immunosuppression: cancer, chemotherapy, HIV, steroids, transplant - Diabetes, chronic [kidney](https://durgical.com/en/anatomy/kidney/) or [liver](https://durgical.com/en/anatomy/liver/) disease, alcohol use disorder - Recent surgery, invasive devices or hospital stay - Pregnancy and the postpartum period ## Pathophysiology Microbial products trigger an excessive inflammatory and clotting response together with immune suppression. Vasodilation, capillary leak and microvascular thrombosis reduce tissue perfusion and oxygen use, causing lactate rise and dysfunction of the lungs, kidneys, liver, brain, heart and coagulation system. ## Classification - Sepsis (Sepsis-3): infection plus an acute increase of 2 or more points in the SOFA score - Septic shock: sepsis needing vasopressors to keep mean arterial pressure at or above 65 mmHg, with lactate above 2 mmol/L despite adequate fluids - By source: respiratory, abdominal, urinary, skin, device-related or unknown ## Symptoms and signs - Fever or hypothermia, chills - Fast heart rate and fast breathing - Low blood pressure, cold mottled skin and slow capillary refill - Confusion, agitation or drowsiness - Reduced urine output - Symptoms of the source: cough, abdominal pain, painful urination, a red hot skin area ## Red flags - Hypotension that does not respond to fluids - New confusion or reduced consciousness - Respiratory rate of 22 or more, or falling oxygen saturation - Very little or no urine - Mottled skin, rising lactate or a non-blanching rash ## Diagnosis **Clinical** Suspected infection plus signs of organ dysfunction. qSOFA (respiratory rate ≥22, altered mentation, systolic pressure ≤100 mmHg) is a bedside prompt for risk, not a diagnostic test; SOFA scores dysfunction of six organ systems. Early warning scores are also used. **Tests** Blood cultures (ideally before antibiotics) and cultures from the suspected source, lactate, full blood count, creatinine, bilirubin, coagulation tests, blood gas and glucose; procalcitonin in some settings. **Imaging** [Chest](https://durgical.com/en/anatomy/region/chest/) X-ray for pneumonia; ultrasound or CT of the [abdomen](https://durgical.com/en/anatomy/region/abdomen/) to find a source needing drainage; bedside ultrasound to assess the heart and fluid status. ## Differential diagnosis - Hypovolaemic shock (bleeding, dehydration) - Cardiogenic shock (myocardial infarction, myocarditis) - Anaphylaxis - Pulmonary embolism - Acute pancreatitis or other non-infectious systemic inflammation - Severe dengue or other tropical infections ## Goal of treatment Recognise sepsis early, restore tissue perfusion, start effective antimicrobials quickly and control the source of infection, while supporting failing organs. ## Treatment **Acute** Early broad-spectrum antibiotics, ideally within the first hour when shock or sepsis is likely, after taking cultures without delaying treatment; later narrowed to the organism found. **Acute** Intravenous crystalloid fluids for hypoperfusion, guided by repeated assessment of response; vasopressors (noradrenaline first-line) if hypotension persists. **Procedure** Source control: drainage of abscesses or empyema, removal of infected devices, surgery for peritonitis or necrotising infection, relief of obstructed bile or urine. **Follow-up** Intensive care monitoring of blood pressure, urine output, lactate and organ function; oxygen, ventilation, dialysis or corticosteroids in refractory shock as needed. ## Drugs for this condition - [Ampicillin](https://durgical.com/en/pharmacology/ampicillin/) - [Ceftazidime](https://durgical.com/en/pharmacology/ceftazidime/) - [Cefotaxime](https://durgical.com/en/pharmacology/cefotaxime/) - [Vancomycin](https://durgical.com/en/pharmacology/vancomycin/) - [Gentamicin](https://durgical.com/en/pharmacology/gentamicin/) - [Tobramycin](https://durgical.com/en/pharmacology/tobramycin/) - [Aztreonam](https://durgical.com/en/pharmacology/aztreonam/) - [Polymyxin B](https://durgical.com/en/pharmacology/polymyxin-b/) - [Dopamine](https://durgical.com/en/pharmacology/dopamine/) - [Epinephrine](https://durgical.com/en/pharmacology/epinephrine/) - [Norepinephrine](https://durgical.com/en/pharmacology/norepinephrine/) - [Vasopressin](https://durgical.com/en/pharmacology/vasopressin/) - [Meningococcal vaccine](https://durgical.com/en/pharmacology/meningococcal-vaccine/) ## Complications - Acute respiratory distress syndrome (ARDS) - Acute kidney injury - Disseminated intravascular coagulation - Septic cardiomyopathy and arrhythmias - Liver dysfunction and delirium - Multiple organ failure and death - Long-term weakness, cognitive problems and post-intensive care syndrome ## Prognosis Mortality rises with the number of failing organs and is highest in septic shock. Early recognition and prompt antibiotics, fluids and source control improve survival. Survivors often have lasting physical, cognitive or psychological effects. ## Prevention - Vaccination (influenza, pneumococcus and others) - Hand hygiene and infection control in hospitals - Prompt treatment of common infections and careful care of catheters and devices ## Test yourself Think of the answer, then tap the question to see it. ## How does the Sepsis-3 consensus define sepsis? Life-threatening organ dysfunction caused by a dysregulated host response to infection, shown by an acute rise of 2 or more points in the SOFA score. ## What are the three qSOFA criteria? Respiratory rate of 22 or more, altered mentation and systolic blood pressure of 100 mmHg or less. ## How is septic shock defined? Sepsis needing vasopressors to keep mean arterial pressure at or above 65 mmHg, with lactate above 2 mmol/L despite adequate fluid resuscitation. ## What are the key principles of early sepsis management? Cultures, early broad-spectrum antibiotics, intravenous fluids for hypoperfusion, vasopressors if needed, lactate measurement and source control. ## What is the most common source of sepsis? Pneumonia, followed by abdominal and urinary tract infections. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/sepsis-and-septic-shock/) ## Related conditions - [Dengue](https://durgical.com/en/conditions/dengue/) - [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/) - [Anaphylaxis](https://durgical.com/en/conditions/anaphylaxis/) - [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/) - [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/) - [Acute pyelonephritis](https://durgical.com/en/conditions/acute-pyelonephritis/) - [Splenic injury](https://durgical.com/en/conditions/splenic-injury/) - [Peritonitis](https://durgical.com/en/conditions/peritonitis/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Bacterial Sepsis](https://www.ncbi.nlm.nih.gov/books/NBK537054/) (StatPearls (NCBI Bookshelf), 2023); [Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia](https://europepmc.org/article/PMC/PMC6443304) (Revista Brasileira de terapia intensiva, 2019) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/sepsis-and-septic-shock/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/sepsis-and-septic-shock/