Sepsis is a whole body response to infection. The term usually implies septicaemia as indicated below. The damage to the body is due the invading bacteria as well as the body’s response to them. When the body overreacts to infection, life threatening complications can occur. A lot has been written on sepsis in both medical literature and other media. Many organisations and individuals are working hard in making sepsis awareness an important issue so as to reduce the number of deaths it causes.

There are many other related terms which should be clearly defined if we are to communicate effectively on this important issue. These include:-

1. Bacteraemia (Bacteremia)-Presence of bacteria in the blood stream. It usually denotes a transient phenomenon marked by a spike in temperature.
2. Septicaemia (Septicemia)(Also called blood poisoning in the popular media)-Presence of bacteria in the blood stream is established. The organisms have a primary and sometimes a secondary source.
3. Toxaemia (Toxemia) –Presence of toxins (from microorganisms or from a damaged part of the body itself) in the blood stream.
4. Viraemia (Viremia)-Presence of virus particles in the blood stream. A few viral infections are treated with anti-viral drugs. Virologists are the experts in this field.
5. Fungaemia (Fungemia) –Presence of fungi in the blood stream. This treated with antifungal drugs. Mycologists are consulted for the treatment of complicated cases.
6. Parasitaemia (Parasitemia)-Presence of parasites like malaria in blood. Parasitologists are the experts in managing difficult cases.
7. SIRS (Systemic Inflammatory Response Syndrome) can be caused by any insult to the body including infection. This is in contradistinction to SARS (Severe Acute Respiratory Syndrome) which is caused by a virus.

All these can cause similar signs and symptoms the most common being fever. In order to manage sepsis effectively, the roles of key people should be clearly defined;-

1. The patients, the patients’ carers, relatives, friends others who present with them to the first line professionals. Their main duty is to seek medical advice early –as soon as symptoms appear or just feeling very unwell. The other duty is to tell an accurate story if that is possible.
2. The frontline professionals who first see the patient and these include General Practitioners, doctors in Accident and Emergency Departments, on ward rounds, on call and others. They have the skills to take history, examine the patient and make a provisional descriptive diagnosis which entails-severity, likely site of infection (from where the organisms invade the blood stream), causative organism (at this stage, terms like viral, bacterial and fungal can do) and the state of host defences locally (at the site of infection) and generally. Their second duty is to collect the relevant specimens which must include blood cultures which should quickly sent to the laboratory accompanied with a request form with the provisional descriptive diagnosis and other relevant clinical details. They then start empirical therapy based on the local guidelines which are usually formulated by the microbiologist and the antibiotic pharmacist.
3. The biomedical scientist and the microbiologist in the laboratory. The former processes the specimens identify the causative organism and perform tests to provide the most suitable antimicrobial drug/antibiotic to treat the infection. The microbiologist who understands the interaction between the organism, the body and the antibiotic (also called the pharmacodynamics) interprets the results. This information is passed on to the attending doctor as soon as possible. A final report should always be issued. From this and other information, the attending clinician should make the final descriptive diagnosis. The other responsibility of the professionals in the microbiology laboratory is to have the latest technologies for detecting pathogens and performing susceptibility tests.
4. The other professionals play important roles. These include Infectious Diseases Physicians who some centres are the specialist in this field. Radiologists help in pinpointing the site of infection and sometimes in the collection of specimens from inaccessible sites. Antibiotic pharmacist who understand the interaction between the body and antimicrobial drug (otherwise known as pharmacokinetics) work closely with microbiologists in monitoring antimicrobial therapy. The surgeons have the skills to deal with what is called source control of the infection. This entails drainage of infected fluids and removal of infected tissues as well as infected devices. They also restore optimal function (for example flow of urine, gut contents, tears in the eyes) which may an important component of the local host defences against infection.

Effective management of sepsis depends of the skills of all these professionals working together in well managed institutions. The most important factor in reducing sepsis mortality is how quickly effective therapy is started. To give them confidence and dispel fear, patients should be empowered by giving them adequate information on the way infections are managed- in other words who does what.