Hopp til hovedinnhold

Sepsis

Sist revidert:
Sist revidert av:


Definisjon: 
En tilstand hvor en infeksjon har utløst en selvopprettholdende og ukontrollerbar organdysfunksjon
Forekomst:
Spesielt hyppig i definerte risikogrupper, men også i befolkningen for øvrig
Symptomer:
Lokalisert eller systemisk infeksjon med blant annet feber eller hypotermi, rask puls og pust, endret mental status mfl.
Funn: 
Feber, hypotermi, takykardi, takypne, endret mental status, hypotensjon, hypoperfusjon, redusert diurese
Diagnostikk: 
Lokalisert eller systemisk infeksjon, samt systemiske tegn til organinvolvering
Behandling: 
Oksygentilskudd, intravenøs væsketerapi og intravenøs antibiotika
  • Nasjonal kompetansetjeneste for antibiotikabruk i spesialisthelsetjenesten - nettside 
  1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definition for sepsis and septic shock (Sepsis-3). JAMA 2016; 315: 801-10. doi: 10.1001/jama.2016.0287 DOI  
  2. Knoop ST, Skrede S, Langeland N, Flaatten HK. Epidemiology and impact on all-cause mortality of sepsis in Norwegian hospitals: A national retrospective study. PLoS One. 2017 Nov 17;12(11):e0187990. PMID: 29149187 PubMed  
  3. Markwart R, Saito H, Harder T, et al. Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis. Intensive Care Med. 2020;46(8):1536-1551. PubMed  
  4. Schroder K, Tschopp J. The Inflammasomes. Cell 2010; 140: 821. pmid:20303873 PubMed  
  5. Angus DC, van der Poll T. Severe Sepsis and Septic Shock. New Engl J Med 2013; 369: 840. pmid:24256390 PubMed  
  6. van der Poll T, Opal SM. Host-pathogen interactions in sepsis. Lancet Infect Dis 2008; 8: 32. pmid:18063412 PubMed  
  7. Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017; 317: 301. doi:10.1001/jama.2016.20329 DOI  
  8. Fernando SM, Tran A, Taljaard M, et al. Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis. Ann Intern Med 2018; 168: 266-75. pmid:29404582 PubMed  
  9. Dellinger RP, Levy MM, Rhodes A. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Int Care Med 2013; 39: 165. pmid:23361625 PubMed  
  10. Vesteinsdottir E, Karason S, Sigurdsson SE et al. Severe sepsis and septic shock: a prospective population-based study in Icelandic intensive care units. Acta Anaesthesiol Scand 2011; 55:722-31. PubMed  
  11. Nygård ST, Langeland N, Flaatten HK. Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital. BMC Infect Dis 2014; 14: 121. pmid:24588984 PubMed  
  12. Helsedirektoratet. Nasjonal faglig retningslinje for antibiotika i primærhelsetjenesten nettdokument. Oslo: Helsedirektoratet. Sist faglig oppdatert: 16. november 2021.
  13. Helsedirektoratet. Sepsis. Nasjonale retningslinjer om antibiotika i sykehus. Sist faglig oppdatert 20. desember 2022. www.helsedirektoratet.no  
  14. Velissaris D, Zareifopoulos N, Lagadinou M, et al. Procalcitonin and sepsis in the Emergency Department: an update. Eur Rev Med Pharmacol Sci. 2021;25(1):466-479. PubMed  
  15. Mouncey PR, Osborn TM, Power GS. Trial of Early, Goal-Directed Resuscitation for Septic Shock. New Engl J Med 2015; 372: 1301. pmid:25776532 PubMed  
  16. Peake SL, Delaney A, Bailey M. Goal-directed resuscitation for patients with early septic shock. New Engl J Med 2014; 371: 1496. pmid:25272316 PubMed  
  17. Yealy DM, Kellum JA, Huang DT. A Randomized Trial of Protocol-Based Care for Early Septic Shock. New Engl J Med 2014; 370: 1683. pmid:24635773 PubMed  
  18. Patel A, Laffan MA, Waheed U, Brett SJ. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality . BMJ 2014; 349: g4561. BMJ (DOI)  
  19. Sprung CL, Annane D, Keh D et al. Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008; 358: 111-24. New England Journal of Medicine  
  20. Lamontagne F, Rochwerg B, Lytvyn L, et al. Corticosteroid therapy for sepsis: a clinical practice guideline . BMJ 2018; 362: k3284. doi:10.1136/bmj.k3284 DOI  
  21. Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis in children and adults. Cochrane Database Syst Rev. 2019;12:CD002243. doi: 10.1002/14651858 DOI  
  22. Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock The VITAMINS Randomized Clinical Trial. JAMA 2020. pmid:31950979 PubMed  
  23. Sevransky JE, Rothman RE, Hager DN, et al. Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis The VICTAS Randomized Clinical Trial. JAMA 2021; 325: 742-50. pmid:33620405 PubMed  
  24. Capp R, et al. Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival. Crit Care Med 2015. doi:10.1097/CCM.0000000000000861 DOI  
  25. Raith EP, UdyAA, Bailey M,, et al. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA 2017; 317: 290-300. doi:10.1001/jama.2016.20328 DOI  
  • Terje Johannessen, professor i allmennmedisin, Trondheim
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Bjørn Waagsbø, overlege ved avdeling for infeksjonssykdommer, St. Olavs Hospital, Trondheim