Unpacking Generalized Infections: Multiple Causes and Complex Treatment Approaches
Recognized by the World Health Organization (WHO) as a global health crisis, sepsis affects 50 million people each year. Of these, 11 million die from the disease. In Brazil, widespread infections are already the third cause of death in the country. Furthermore, among people who are cured, 30% to 40% are left with sequelae – such as weakness, cognitive disorders and disability –, which requires rehabilitation. Bruno Besen, intensive care physician at the Clinical ICU and researcher at the Clinical Emergency Laboratory of the Hospital das Clínicas of the Faculty of Medicine of USP, explains how the disease works and addresses doctors’ concerns.
sepsis
Some cases may begin in the community, with an individual developing an infection at home. The doctor explains that, in simpler cases, the patient is treated in an outpatient setting, using antibiotics, without the need for hospitalization. However, some cases progress to generalized infection – “a condition in which the infection loses control in the body and starts to affect the functioning of the organs”.
The majority of infections, however, begin when the patient is hospitalized, known as “healthcare-associated infections”. This scenario causes great concern in the medical community and contributes to global sepsis cases.
Origins
According to Besen, sepsis is divided into three phases. First, the patient develops a specific infection, such as pneumonia, urinary tract infection, appendicitis or meningitis, for example. Then, if this condition begins to affect other organs – due to a dysregulated response from the body itself – it becomes called sepsis. The last stage is called septic shock, in which the patient has an infection so intense that their blood pressure drops and organs are deeply affected.
The symptoms of sepsis are the same as the infection that triggered it – if it is pneumonia, for example, the patient presents with coughing, phlegm and fever –, in addition to other factors, such as shortness of breath and dizziness. What characterizes a generalized infection is the medical identification that [the infection] is affecting other organs beyond the initial focus”, says the specialist. One of the ways to speed up the treatment process is through early diagnosis, both in the hospital and outside, before the organs are affected. Furthermore, Besen points out that it is also important to avoid infection whenever possible.
When an individual has a bacterial infection, health professionals recommend antibiotics for treatment. During the pandemic, there was a misuse of antimicrobial medicines, which were not effective against viral diseases. “When we use medicines inappropriately and in large quantities, which is common in cases of antibiotics, bacteria begin to become resistant and patients lose a therapeutic alternative” he points out.
ICU treatment
As Besen explains, there are two medical specialties that can provide more effective treatment for patients with sepsis. The first, Emergency Medicine, is responsible for identifying serious cases in order to provide faster care. If the individual needs intensive care, they will go to Intensive Care, a specialty responsible for providing support so that the patient can recover from the infection.
“Our objective, in intensive care, is to carry out treatment with high quality, so that the care does not cause secondary infections, for example” explains Besen. Depending on the condition, the patient may need treatment for an extended period, and the efforts made by his body may result in consequences.
Some North American and Brazilian studies have shown that patients who recover from sepsis have a three-fold increase in developing mild and moderate cognitive disorders compared to people who have not. “There is a high prevalence of mental health problems after leaving the hospital. For example, a third may develop symptoms of anxiety, almost a third symptoms of depression, post-traumatic stress” he explains.
In addition, there is also a physical recovery component, from the moment patients have difficulty returning to basic daily activities. Therefore, Besen points out that it is of great importance for doctors to promote rehabilitation services so that patients can recover at this stage.
Superbugs
The doctor explains that, nowadays, this type of bacteria – organisms resistant to many antibiotics or to all antibiotics that do not have high toxicity – is a major concern for the medical community. If infections cannot be prevented by therapies and treatments, doctors end up using more antibiotics, which can lead to the emergence of superbugs.
Besen concludes that doctors are constantly looking for improvements to treat cases in the best possible way. This scenario can be achieved through early and efficient diagnoses and promoting access to therapy units for patients in need, mainly in the Unified Health System (SUS).