Originally published by our sister publication Specialty Pharmacy Continuum
By Heidi Splete
Sepsis remains a concern for people on immunoglobulin (Ig) therapy, especially those receiving infusions at home, but identification of risk factors and patient education can prevent or catch sepsis early, said Ying-Tang Casapao, PharmD, MBA, BCPPS, in a presentation at the IgNS 2024 National Conference, in Washington, D.C.
Early on, sepsis presents as an infection plus at least two of three symptoms: fever, mental decline or feeling extremely ill, said Dr. Casapao, a clinical pharmacist educator in Jacksonville, Fla. Severe sepsis involves organ damage, and septic shock-the most severe form-will require treatment in the ICU, she said.
Recent data from the National Kidney Foundation show that more than 1.7 million cases of sepsis occur in the United States each year, and approximately 350,000 are fatal; approximately 1 in 3 patient deaths in hospitals are caused by sepsis, Dr. Casapao said.
Although sepsis remains a leading cause of in-hospital deaths, a majority of cases originate at home; therefore, early detection and treatment of high-risk patients is vital, she noted.
However, a 2023 survey published in the Journal of Advanced Nursing showed that approximately half of respondents agreed or strongly agreed that they were competent in clinical assessment of suspected sepsis or confident in identifying symptoms (J Adv Nurs 2023;79[2]:616-629).
“Patients on total parenteral nutrition [TPN], corticosteroids, [or have] chronic vascular catheters or neutropenia are at significant risk,” Dr. Casapao said in her presentation. Other population groups with increased risk include adults aged 65 years and older, those with preexisting medical conditions including use of a central line or other catheter, those who are immunocompromised, and children younger than 1 year.
Risk factors for sepsis include invasive devices, but not only central vascular access devices and peripheral intravenous catheters, Dr. Casapao said. Urinary catheters, nephrostomy tubes, gastrostomy tubes and endotracheal tubes can be sources of sepsis, she said.
Use of medications including corticosteroids, monoclonal antibodies and other cancer medications also can increase sepsis risk. Potentially less obvious risk factors include infection, surgery, skin trauma, pregnancy and the postpartum period, chronic conditions, and immobility, Dr. Casapao added.
Red Flags
Early signs of sepsis include a fever of 100.4° F or higher, as well as chills, complaints of feeling cold, hypothermia, and clammy skin, Dr. Casapao said. Racing heart rate, weak pulse and shortness of breath can indicate sepsis, as can confusion and disorientation, extreme pain, and general discomfort.
Signs of progression to advanced sepsis may include cold, clammy skin that is pale or mottled; a pinprick skin rash; or limbs cool to the touch or warm and sweaty, she added. Advanced sepsis patients also may experience breathing problems and profound lethargy. Other indicators of advanced illness include nausea and vomiting, photophobia, severe headache, decreased urine, loss of appetite, dizziness, or loss of consciousness, she noted.
Dr. Casapao stressed that clinicians should always consider sepsis in patients at risk, and rule out or confirm via physical evaluation, vital signs and laboratory data.
The prevention of sepsis calls for collaboration across the healthcare team, Dr. Casapao said. Other strategies include educating patients about potential symptoms, and reinforcing effective management of chronic illnesses, especially infection prevention measures such as practicing hand hygiene and staying current with recommended vaccinations, she said.
The CDC offers a graphic on four ways to stay ahead of sepsis that can be shared with patients who are managing conditions at home (www.cdc.gov/sepsis), Dr. Casapao noted.
Dr. Casapao reported no relevant financial disclosures.