Cheryl Martin (Host): Sepsis can be a life-threatening condition. It's connected to common infections like pneumonia. We dive deep into the world of sepsis with Dr. John Baghdadi. He's an Infectious Disease physician and hospital epidemiologist at University of Maryland Medical Center, Midtown Campus. He'll explain how this life-threatening condition develops and the crucial steps you can take to prevent it.

Welcome to the Live Greater podcast series, information for a healthier you, from the University of Maryland Medical System. I'm Cheryl Martin. Dr. Baghdadi, so glad to have you on to talk about this important health risk.

Dr. John Baghdadi: Yeah. Hi, thank you so much for having me.

Host: First, what exactly is sepsis and how does it develop in the body?

Dr. John Baghdadi: Sepsis is a technical term that doctors like me use to describe essentially any bad infection. Infection becomes sepsis when either the infection itself or the body's immune response to the infection cause some organ system in the body such as the liver, kidney, lung, blood vessels, or brain to malfunction. And what this means because sepsis can be really any organ system in the body not working properly is that sepsis can look very different depending on who the person is that's getting sick and what their situation is. An older person with sepsis may come into the hospital with confusion and a low temperature, whereas a young person may come to the hospital with acute onset symptoms and a very high fever.

Host: So, what are the most common causes of sepsis and how do infections like pneumonia, for instance, lead to this condition?

Dr. John Baghdadi: Right. Good question. So, sepsis was first recognized and understood as occurring with bacterial infections. There are also forms of sepsis that can occur with viral or fungal infections. But most of the time, when we're talking about sepsis, we mean a bacterial infection. But then, within that category, really any bacterial infection can progress to sepsis.

The most common ones that get to that level are pneumonia, urinary infections, gut and bowel infections, and skin infections. And that can happen in a variety of different ways. So, patients with pneumonia can develop sepsis because the lungs are a relatively delicate organ. And pneumonia can become sepsis if the lungs collapse or maybe they fill with pus, that's that phlegm that you're coughing up when you're sick with pneumonia, or if inflammation in the body interferes with the lung's core ability to put oxygen into your bloodstream.

Host: So, you've talked about what makes someone at risk. So, in these cases, can sepsis be prevented, especially in individuals at higher risk?

Dr. John Baghdadi: The answer to this is a little bit complicated, so hopefully you'll bear with me. But if you want to prevent sepsis, there's really two ways to do it. You can either prevent an infection from developing in the first place, or you can stop an infection from progressing to that next level of sepsis.

We think about doing those two things with separate actions. Most of the things we recommend for preventing infections will sound a lot like common sense. Everyone should get vaccinated during flu season, and if you're going to a public or crowded event, consider wearing a mask. If you get a cut or a wound, wash it with soap and water and then keep it dry so that it can heal. If you're a person who has a medical device in your body, like a catheter, follow the instructions on how to maintain it. And then, you might also talk with your doctor about modifying chronic risk factors that put you at risk for developing infections, like smoking. Those are the ways to prevent an infection from developing in the first place.

Preventing infections from progressing to the level of sepsis is a little bit trickier, and this is going to be more individualized. So, for instance, if you know that you're a person who is prone to developing urinary infections, you want to make sure to contact your doctor promptly when you develop symptoms. If you get a cold meaning you have a sore throat or runny nose, you do not need antibiotics. But if you're coughing up thick yellow stuff throughout the day or you're having difficulty breathing, that's another reason to contact your doctor. And then, one warning sign that most people should be aware of is if you're sick with an infection and you start to feel woozy or like you're going to pass out, that's a red flag. And I would recommend. You have a family member or someone close to you check your pulse and you probably need to be evaluated.

I do want to reiterate before we move on about what will not prevent sepsis. So if you have a cold or bronchitis, antibiotics do not typically reduce your risk. They do not reduce the risk that that infection will lead to a real pneumonia, but they may cause you to experience toxicity, which is most commonly nausea or diarrhea from people taking unnecessary antibiotics.

Host: Now, you mentioned vaccines. Anything else you want to say about how vaccines can reduce the risk of sepsis, particularly those targeting infections like pneumonia?

Dr. John Baghdadi: Sure. You'll have to forgive me because this is another one that's a little complicated, but the basic point is that vaccines are good for you. Vaccines reduce your risk of getting sick. And then if you're unlucky enough to get sick anyway, the vaccine will prime your immune system so that it can fight off the infection more effectively, and typically more quickly.

So, some vaccines, like the pneumonia vaccine, reduce your risk of getting a bacterial infection. But even vaccines that target viruses, like the flu or COVID vaccine, can reduce your risk of sepsis, because when you have a viral infection, It can lead to a bacterial pneumonia as a secondary complication.

Host: That's good to know. Very good information. You have talked about some of the signs of sepsis. Just go deeper on that. Are there other early signs and symptoms of sepsis that people should be aware of?

Dr. John Baghdadi: So, unfortunately, I think this is an unanswerable question. The early signs of sepsis are just the early signs of any infection. So maybe I'm going to sidestep or dodge, and instead of directly answering this question, I want to emphasize that the listeners of this podcast do not need to be afraid of sepsis.

In the last decade, sepsis awareness campaigns have probably gone a little too far, so that now even people with mild illnesses may be labeled when they come into the hospital as having sepsis. For most people who might be worried about sepsis, Infectious Disease doctors like me are just going to emphasize the basics. Wash your hands if you touch something gross. Don't put anything in your body that you know will cause it harm. And in the case that you do get sick, it's helpful to know in advance who you can call or talk to for help.

Host: So, once you're in the hospital, how is sepsis diagnosed and then treated in that setting? And then, what are the challenges in managing it?

Dr. John Baghdadi: When we take care of a person with sepsis in the hospital, we focus on understanding what caused their illness controlling the source of infection, and then making sure they get on appropriate antibiotics as quickly as possible. Sepsis can be challenging both for diagnosis and treatment. The issue with diagnosis is that sepsis does not have clearly defined symptoms, so it can be tricky to recognize. The issue with treatment is that sepsis antibiotics should be given directly into the bloodstream through an IV. So, if you're the type of person where getting an IV into your vein is difficult, it can cause a delay. But once again, honestly, because of the success of community and hospital-based programs to improve the quality of our sepsis care. Doctors have gotten really good at recognizing and treating sepsis early.

At my hospital, University of Maryland Medical Center Midtown Campus, we have a multidisciplinary team of doctors, nurses, and pharmacists who review cases every month where we evaluate for weak points in the chain and we make improvements. And so, we've gotten really timely at recognizing and delivering high quality sepsis care.

Host: Great. So, if someone has sepsis, what are the long-term effects and how can they be managed?

Dr. John Baghdadi: People who develop sepsis and need to go to the intensive care unit can have a difficult recovery. Being laid up in bed with a serious illness just takes a toll on the body. And afterwards a person who had sepsis may feel weaker than they did before, their muscles may not work as well, they may feel depressed, and some patients come out of the hospital with PTSD. The treatments for this need to be individualized. But generally, physical therapy can help. And many medical centers have clinics set up to help patients with recovery from a severe illness that required intensive care.

Host: And are you talking about them, let's say, if they were working, being off work for weeks or months, or they may never be able to go back?

Dr. John Baghdadi: Oh, no. These changes tend to be reversible with time. And it really depends on how long you're in the hospital for and how intense your treatments were. Some people come into the hospital with a mild case of sepsis, they never end up in the intensive care unit, and they leave feeling just as great as they did before. But if you're in the hospital for a week, and you were in bed for most of that time, you may be surprised at how different you feel.

Host: Talk about whether or not there are any recent advancements in sepsis research or treatments that offer hope for even better outcomes for patients.

Dr. John Baghdadi: Yeah. So for me, the most exciting breakthroughs in sepsis research are the things that doctors have been doing forever that we are starting to discover are potentially not necessary. So for instance, for nearly 20 years, it's been accepted as a point of basic fact that for all patients with sepsis, the sooner we get an antibiotic into your blood stream, the better you do.

But in the last few years, there's now solid evidence that's starting to emerge that that way of thinking is wrong. And for patients who come to the hospital with shock, meaning an infection caused their blood pressure to drop, absolutely, IV antibiotics need to be in that person's bloodstream as quickly as possible, and they can be life-saving. But for everyone else, doctors have a little bit more time to collect labs, be thoughtful about doing a workup, and figuring out really what best treatment is going to be to address the cause of illness.

Host: What would you like to be the key takeaways for our listeners?

Dr. John Baghdadi: Well, I hope this comment doesn't undermine the premise of the podcast, but I really want to emphasize that most folks out in the community do not need to worry about getting sepsis. Because of people like me, doctors in practice are very, very ready to diagnose sepsis. And that means we tend to set a lower lower bar for which infections end up getting called sepsis than we did 20 years ago. As a result, on average, people diagnosed with sepsis have gotten less sick over time, and it's just not the killer that it used to be.

Host: And that's great news, Dr. John Baghdadi. Thanks so much for coming on and educating us about sepsis. Very informative. Thank you.

Dr. John Baghdadi: Thank you so much for having me.

Host: You can find more shows just like this one at umms.org/podcast and on YouTube. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this episode on your social media.