Scott Webb (Host): Today, we're going to learn about sepsis and how it's a global issue from Denise Lewis, she's a registered nurse, and the Sepsis Program Coordinator with Eisenhower Health.

 This is Living Well with Eisenhower Health. I'm Scott Webb. Denise, it's so nice to have you here today. I was telling you, I'm going to learn more about sepsis along with listeners and you are the Sepsis Program Coordinator. So, let's start there. What is sepsis?

Denise Lewis: So, what sepsis is, is a life-threatening condition that can happen when the body is fighting an infection. And in the process, it really starts to injure its own tissues. And that can be a spectrum, really, anything from just a single organ, like you might have a little bit of kidney damage, all the way up to full on circulatory collapse, where you're on medications to support your blood pressure and you end up in the ICU. So, it really comes from having an infection. And I use the analogy of those old Western movies where there's a bar fight, and the good guy in the white hat, he's punching the bad guys. And then, in the process, you start punching yourself every now and then, right? And in the process, you maybe start punching yourself a little too much. And that's the best way I can put it to what's happening with sepsis.

Host: Yeah, because I was going to follow up and ask you, you know, how does someone get sepsis? What causes it? And are there risk factors? But it sounds like if you have an infection, especially one that perhaps goes untreated, then you may be at risk for sepsis, right?

Denise Lewis: Right. So, you have to have an infection in order to get sepsis, right? That's sort of our ground zero. And predominantly, the infections are bacterial in nature. Like pneumonia is the number one kind of cause for sepsis. Urinary tract infections and kidney infections, those are like the second most common cause. And then, we have intestinal infections, like postoperative wound infections, skin infections, stuff like that. But you can also have an infection from a viral process, COVID, influenza, something like that. People that are immunocompromised also are more prone to get fungal infections. So, any kind of infection can ultimately cause sepsis.

And, as far as risk factors go, that's really a great question, because age is really the number one of the very old and the very young, like newborns and elderly are at higher risk of getting sepsis. Anybody with a compromised immune system, so whether that is because you have a condition like HIV or you are on immunosuppressing medications from cancer treatments or, you know, all of these new biologic medications that are out that suppress your immune system, those things put you at a higher risk of getting an infection as well as having multiple medical problems.

If you are diabetic or you have chronic obstructive pulmonary disease, any underlying medical conditions. It's sort of cacophony of things that can predispose you. But you can also be a perfectly healthy person with no underlying medical conditions and you get a bladder infection and, the next thing you know, you're in the ICU. So, yes, there are risk factors, but at the same time, it can actually happen to anybody.

Host: Yeah. And I was going to ask you, you mentioned postop there, just wondering, are folks more likely to get sepsis while they're in the hospital?

Denise Lewis: So, actually, no. Most people, about 90% of the people arrive in from the community through our emergency department, and they are already septic when they're presenting to us.

Host: Wondering, of course, then the $64,000 question, how is sepsis treated?

Denise Lewis: So, really, we treat it by, you know, resolving whatever the underlying source of the infection is, right? So, that's why with infections being primarily bacterial, we look to antibiotic infusions and your oral antibiotics. And if you have a viral infection, sometimes there's some antiviral infusions that may or may not be beneficial. Same thing with fungal infections, but it's really treating that underlying source of infection, as well as if you're somebody that ends up like with septic shock in the ICU, we support your system, you support your circulatory system, support your nutritional needs until we can get you over the hump. But really, it's getting to the underlying cause of the infection.

Host: Right. You have to cure the infection first. Is it possible to get sepsis more than once? I'd love to believe we live in a world where if you got it once, then you're good, you're covered. But I'm guessing that's not the case, right?

Denise Lewis: Right. No, there's not a sepsis titer. There's no protection. In fact, once you've had sepsis, there's some schools of thought that you're more likely to get it again.

Host: Well, that's a bummer. That's not the--

Denise Lewis: That's not the answer anybody wants.

Host: No, that's not the one I was looking for. Is sepsis transmittable? In other words, you know, maybe not the underlying cause of the sepsis, but is sepsis itself, is that transmittable? Can you give that to someone else?

Denise Lewis: Oh, that's a great question. No, it is not contagious. Sepsis in and of itself is not contagious. Now, if you have COVID-19 or the flu, that is the cause of why you're septic, that, of course, is transmittable, right? But sepsis itself, it is not a transmittable condition.

Host: All right. So, how long does it take generally to "get over" sepsis?

Denise Lewis: Oh my gosh, that's another $64,000 question. I mean, it's variable based on underlying medical conditions, what was your baseline health before you got sick, right? It can take quite a while to get over the effects of having sepsis, you know, people even after they get home might feel weak or have trouble sleeping, itchy skin. There's a whole growing body of research that, you know, much like a post-COVID syndrome that we're hearing a lot about, that there's a post-sepsis syndrome, especially for patients that have been in the ICU, that really there's a mental fog that people can have, some depression, some crazy vivid dreams. And that's not to say everybody's going to have that, or that it's going to really take a long time to get over. But we are learning more about this as we're having more research done with our sepsis survivors. Definitely, physical therapy is needed a lot of the time. People are really surprised by how terrible they feel afterwards. You know, a lot of people have said, I feel like I've been ran over.

Host: Sure.

Denise Lewis: It's exhausting. It really affects your whole body.

Host: Mentally, physically, and otherwise, right?

Denise Lewis: Yep. And that's why once people go home, even after you're discharged from the hospital, it's so important to follow up with your doctor and follow up with physical therapy if that's been ordered for you and complete the antibiotics that you're sent home with to really stay on top of getting well.

Host: Yeah. Because we've heard of the COVID long-haulers, if you will, and I don't know that they're calling it sepsis long-haulers, but it does sound like there are some lasting effects. So finishing your meds, staying connected with your medical team, all of that sounds prudent. And I was going to ask you if you could prevent sepsis, but I think you're going to say, "Well, yeah, don't have any of the underlying causes," right? Don't be at risk for sepsis, but that's probably easier said than done, right?

Denise Lewis: You know, really, the best defense against sepsis is a strong offense. If you notice that you have an infection, if you're concerned that you have a bladder infection, if you're concerned that you have pneumonia, and you have these risk factors, that you initiate contact with your provider or get into urgent care sooner rather than later, right? So, if you come in when you just have a, I call it a light infection, right? If you come in the early stages of when you just have an infection, we want to prevent you from having that dysregulated response, trying to fight it off, right? So again, the best defense is an early offensive treatment and getting examined, getting looked at.

Host: Yeah. And you mentioned, we were talking there about sort of the lasting effects, if you will. So, we can't really put a timeline on getting over sepsis. But are you finding, is the research showing that even after, you know, many months or years later, that folks still suffer effects from sepsis?

Denise Lewis: There are some that do report that. I mean, typically, it's a couple of weeks to a month. And it tends to be, again, like I said, maybe the people that have been in the ICU and more acutely sick, but that's not necessarily the case. I mean, every person is unique and has a recovery experience. So, yeah, there's a lot of research going into this. This is really kind of a new area.

The Sepsis Alliance is a resource I refer people to. They have a great website. They have a lot of videos of sepsis survivors with their stories and what they've gone through from recovery. One of the things that I find so fascinating about sepsis is the individual response to how they fight the infection and how it affects them and then also the recovery.

Host: Yeah. It does seem very much individualized, right? It's unique to the patient and their experience and their team and all of that. This has been really educational today. But in case we didn't answer all the questions folks have and they want to learn more, you mentioned that one website there. Where can folks go to learn more about sepsis?

Denise Lewis: I would absolutely recommend that they go to the Sepsis Alliance website. They can just type in Sepsis Alliance, they can go to sepsis.org. That's the Sepsis Alliance website. It's a fantastic resource. It's available in English and in Spanish. You can change the language. There's a lot of really great resources and information there.

Host: Well, I really appreciate your expertise today. I told you before we got rolling that I was really looking forward to this and you seem surprised, you know, that someone would want to learn more about sepsis. But I really do. It's one of those interesting topics that, you know, we hear the word a lot, but what does it really mean? And now, I have a much better sense. So, thank you so much.

Denise Lewis: Well, yeah, and thank you so much, because this is really actually what I don't think people understand is sepsis is the number one cause of inpatient hospital deaths in the country. It is one of the most expensive conditions that we call it a healthcare cost burden, like the treatment. It's a huge problem worldwide as far as length of stay for hospitals. There's so many people that are going to have a loved one that is going to experience something like this, and we don't have the big awareness campaigns like the Heart Association with heart attacks and strokes does. And so, I think that that's starting to change and it's exciting to be part of getting the information out there, because it does affect so many people.

Host: Yeah. And it seems to me with these types of topics that, you know, education is key. So hopefully we've, you know, furthered that goal today, educated some folks, encouraged them, speak with their own providers. So, again, thank you so much.

Denise Lewis: Thank you so much. I really appreciate it.

Host: And for more information, go to eisenhowerhealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. I'm Scott Webb. And this has been Living Well with Eisenhower Health. Thanks for listening.