Sepsis: Catching a killer

Paul Bechtelheimer thought he had the flu. He came home from work on a Thursday, took two aspirin and went to bed with a low-grade fever.

By Sunday, the Washington Township man was on a ventilator at nearby Kennedy University Hospital. Doctors told his wife to assemble his family members. His immune system was attacking an infection and, in the process, shutting down his organs.

“On Saturday, I felt OK,” recalled Bechtelheimer, now 61. “By Sunday, I was hurting so bad, I couldn’t breathe.”

The leading killer in hospitals isn’t heart attack or stroke or cancer. It’s sepsis, a life-threatening response to infection that’s easily overlooked by health care providers and little understood by the public.

Statewide, the mortality rate for severe sepsis in hospitals is nearly 30 percent, according to the New Jersey Hospital Association. Nationally, the rate ranges between 20 and 50 percent. But with sepsis becoming a national priority, a collaborative of state hospitals has spent the past year paying close attention to sepsis screening and treatment.

At least one health system has found an approach that works.

Launched three years ago, Kennedy Health’s sepsis program cut its sepsis mortality rate to less than 12 percent in 2014. The health system shared information about its program with the statewide collaborative in August, and it has been spotlighted by the American Hospital Association.

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Its efforts started with a four-person committee assembled to examine the data and educate employees to recognize the early signs of sepsis, explained Marianne Kraemer, Kennedy’s chief nursing officer. It has since grown to two committees and a hospitalwide effort.

“You have to change your culture,” Kraemer said. “So that if patients do come in septic, we can see it sooner.”

When Bechtelheimer’s wife came home from work Friday, she found him feverish, disoriented and shaking. She insisted on taking him to the hospital, and when he refused, she talked him into going to an urgent care center in Sicklerville.

Alarmed by his symptoms, the urgent care doctor said he needed to be hospitalized immediately. They called an ambulance. At Kennedy’s emergency department, Bechtelheimer was soon diagnosed with sepsis, though it would take doctors a couple more days to find the mystery source of his infection.

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Sepsis is not a simple disease, explained Dr. R. Phillip Dellinger, an international sepsis expert and researcher at Cooper University Hospital in Camden. Together with Christa Schorr, a Cooper nurse and associate professor, Dellinger leads the collaborative’s sepsis reduction efforts.

“It’s a more difficult diagnosis to get your arms around,” Dellinger said. “If allowed to go undiagnosed and untreated during the early phases, sepsis can produce very deleterious patient outcomes.”

National attention is making a difference. In 2012, a 12-year-old boy died four days after scraping his arm in gym class. His symptoms were misdiagnosed by his pediatrician and by emergency room doctors. The Rory Staunton Foundation for Sepsis Prevention has since made it a priority to educate the public about the dangers of sepsis.

Unlike a heart attack or stroke, the warning signs are subtle, Dellinger said. A patient experiencing sepsis might have a fever or a low temperature, a fast heart rate, rapid breathing, pale or mottled skin, pain or confusion. To treat it, doctors must figure out what is causing the infection and administer appropriate antibiotics and intravenous fluids.

The infection can be caused by one of 100 organisms, Dellinger explained. Depending on its source, sepsis can affect up to eight organ systems. In one person, it may cause unstable blood pressure. In another, it may cause the loss of limbs.

“It’s a tough one,” Dellinger said. “Different organisms may release different toxins, which may act differently in different patients.”

Some people may be genetically predisposed to sepsis. Researchers are looking for biomarkers to help them spot the process and project potential severity, Dellinger said.

For now, doctors and nurses must react quickly to suspicious symptoms, said Dr. Cindy Hou, Kennedy’s infection control officer. Staffers wear badges with cheat sheets as reminders to look for sepsis. Even technicians are trained to recognize the symptoms.

“Once sepsis awareness is out there, you don’t just need to go by the numbers,” Hou said. “You can have that sixth sense, that ‘I know they’re septic.’ ”

And it’s common.

Dr. Henry Schuitema, Kennedy’s chief of emergency medicine, sees several cases every day in the emergency department. When sepsis is suspected, all available staff are brought to the patient’s bedside to respond. While waiting for lab results, doctors can order antibiotics and fluids to reverse sepsis before it cascades into severe sepsis or septic shock.

“It’s working collaboratively as a team, to the point where you’ve got to do it right every single time,” Schuitema said. “We’re doing well now, but it’s a very, very difficult disease to control at times.”

As Bechtelheimer’s condition worsened, his doctors discovered the source of his infection. He had a kidney stone, and his body was fighting E. coli bacteria. His body’s immune response was shutting down his kidneys, lungs and heart.

With antibiotics, intravenous fluids and mechanical support, he began to rally. By the following weekend, he was back home, 30 pounds lighter — and wiser.

“I was at the right place at the right time and got the right treatment,” Bechtelheimer said. “I was very fortunate to get the kind of care I got at Kennedy. I owe my life to those people.”

Kim Mulford: (856) 486-2448; kmulford@gannettnj.com