Sepsis is the body’s extreme, life-threatening response to an infection. It occurs when the immune system's response goes into overdrive, releasing chemicals into the blood that trigger widespread, systemic inflammation. Without timely recognition and intervention, sepsis can cause tissue damage, organ failure, and death.
7.1 Scope of Sepsis
Sepsis, a syndrome of acute organ dysfunction secondary to infection, is a common cause of hospitalization and death. In addition to being deadly, sepsis also contributes to new and worsened morbidity. Patients experience heightened risk for further health deterioration, hospital readmission, and death in the months, and even years, after the acute resolution of sepsis (Prescott et al., 2023).
In a typical year at least 1.7 million adults in America develop sepsis, leading to nearly 270,000 deaths. Sepsis contributes to more than a third of all hospital deaths. Sepsis, or the infection causing sepsis, starts outside of the hospital in nearly 87% of cases (NYSDOH, 2024 September).
Severe sepsis and septic shock impact approximately 73,000 adults and almost 600 children in New York each year. In 2018, almost 24% of these adult patients died from sepsis. The NYSDOH works with hospitals around the state to reduce death from sepsis. From 2015 to 2019 this work saved more than 16,000 lives (NYSDOH, 2024 September).
Most individuals who develop sepsis have at least one underlying medical condition, such as a weakened immune system or chronic lung disease. Nearly 25% to 33% of people with sepsis have visited healthcare services in the week before their hospitalization. Sepsis is the number one cost of hospitalization in the United States, consuming more than $62 billion in annual in-hospital costs (CDC, 2026, March 23).
The high mortality rate related to sepsis can be attributed to two factors: (1) difficult and often delayed diagnosis and (2) the lack of sepsis-specific treatments. The difficulty of sepsis diagnosis, especially early in disease, can result in delayed treatment with antibiotics (or monoclonal antibodies and antivirals, in the case of COVID-19) (Hancock et al., 2025).
This delay drastically increases mortality rates: for every hour that appropriate antibiotic therapy is delayed, the in-hospital mortality rate can increase significantly, with numbers often cited of up to 7.6% in septic shock (Hancock et al., 2025).
7.2 NYS Sepsis Care Improvement Initiative and “Rory’s Regulations”
Beginning in 2014, each acute care hospital in New York State that provides care to patients with sepsis is required by an amendment to Title 10 of the New York State Codes, Rules, and Regulations (Sections 405.2 and 405.4) to develop and implement evidence-informed sepsis protocols that describe their approach to both early recognition and treatment of sepsis patients (Sheikh et al., 2024).
This legislation, known as “Rory’s Regulations,” was enacted following the tragic death of 12-year-old Rory Staunton from sepsis, making New York the first state in the United States to mandate regulations for sepsis protocols (Sheikh et al., 2024).
These laws require hospitals to:
- Provide suitable training, resources, and equipment for healthcare providers to quickly recognize and treat sepsis in both adults and children (Sheikh et al., 2024).
- Gather sepsis data to improve the quality of care and provide this data to the state annually.
Hospitals must also Implement a Parents’ Bill of Rights that allows parents or guardians to always stay with pediatric patients. They must also review medical tests with the patient or the patient's parent or guardian before discharging a child patient (Sheikh et al., 2024).
Hospitals are required to report data to the NYSDOH. This is used to calculate each hospital’s performance on key measures of early treatment and protocol use. Hospitals are also required to submit sufficient clinical information on each patient with sepsis to allow the Department of Health to develop a methodology to evaluate “risk-adjusted” mortality rates for each hospital (Dierkes et al., 2022).
Risk adjustment permits comparison of hospital performance and takes into consideration the different mix of demographic and comorbidity attributes, including sepsis severity, of patients cared for within each hospital (Dierkes et al., 2022).
Between 2014 and 2016, following the implementation of Rory’s Regulations, the use of protocols for sepsis care in adults increased from approximately 74% to nearly 85%. During this period, mortality decreased from 30% to 25% (Dierkes et al., 2022). Recent studies highlight that New York’s regulatory approach continues to serve as a model for policy standards in other states and countries seeking to improve early recognition and outcomes for sepsis patients (Sheikh et al., 2024).
7.3 Causes of Sepsis
Sepsis is not a condition that arises on its own; it is a life-threatening, dysregulated host response triggered by a primary infection. It generally stems from infections located in the lungs, urinary tract, skin, abdomen, or other parts of the body (Srdić et al., 2024).
Invasive medical procedures can introduce bacteria directly into the bloodstream, precipitating the condition. A wide variety of microbes can trigger sepsis, including Gram-negative and Gram-positive bacteria, fungi, and viruses. Severe infections and widespread pathophysiological damage are also factors (Srdić et al., 2024).
The increased use of broad-spectrum antimicrobials that eliminate competing bacterial pathogens, as well as the rising use of immunosuppressive agents and invasive procedures have led to an increase in fungal infections.
An infection alone is often not sufficient to trigger sepsis. It usually requires a pre-existing patient susceptibility or vulnerability. Patients with compromised immune systems, older adults, and those with chronic diseases are significantly more susceptible to progressing from an infection to sepsis (Sepsis Alliance, 2026).
While most cases (can be 80%–87%) originate in the community, a substantial portion of severe cases develop in patients already hospitalized for other reasons. Hospital-acquired or hospital-onset sepsis typically affects critically ill patients with indwelling devices and is associated with higher mortality rates and greater healthcare utilization (Sepsis Alliance, 2026).
7.4 Early Recognition
In a classic, uncomplicated infection, the body’s immune response is self-limiting. The immune forces are called into action, the infection is controlled, and inflammation resolves. Sepsis, however, is characterized by a dysregulated and life-threatening host response to an infection (Srdić et al., 2024).
The first symptoms of sepsis are non-specific (fever, blood pressure, respiratory rate, and heart rate, elevated white blood cell count) making early diagnosis difficult. Based on the most recent Sepsis-3 criteria, sepsis is diagnosed if there is documented or suspected infection along with an indication of organ dysfunction, represented by an increase of two or more points in the Sequential Organ Failure Assessment (SOFA) score (Hancock et al., 2025).
Unlike a typical infection, in sepsis, the natural checks and balances fail. Instead of tapering off, the pro-inflammatory forces and immune mediators spread systemically beyond the infected region, leading to significant physiological and biochemical abnormalities (Zimmermann et al., 2021).
The immune response begins as pro-inflammatory signal molecules enter the bloodstream in large numbers. As these molecules travel through the vascular system, they cause dilation and increased permeability (leaking) of the endothelium lining the blood vessels (Zimmermann et al., 2021).
The usual orderly movement of oxygen, nutrients, and fluids through the capillary walls is disrupted. As a result of this microvascular dysfunction, vital organs become hypoxic (starved of oxygen), which can ultimately lead to multiple organ dysfunction or failure (Srdić et al., 2024).
If the dysregulated response continues, organ hypoxia and damage progress to severe sepsis. This is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, severely increasing the likelihood of mortality (Prescott et al, 2026).
Septic shock can develop when the circulatory system fails and the arterial wall muscles can no longer contract sufficiently to maintain adequate blood pressure despite adequate fluid resuscitation. This stage is associated with a dramatic decline in survival rates (Prescott et al, 2026).
The systemic collapse that occurs in sepsis was previously categorized as Systemic Inflammatory Response Syndrome (SIRS). SIRS can be triggered by a variety of non-infectious causes, including pancreatitis, trauma, or burns. When it is driven by a confirmed or suspected microbial infection, it is classified as sepsis. Unlike other forms of SIRS, sepsis requires immediate source control and antimicrobial treatment to remove or control the primary source of the infection within the first hour of recognition (Prescott et al, 2026).
7.5 Treatment
The initial step in the treatment of sepsis is to stop the infection, protect vital organs, and prevent a drop in blood pressure. International clinical practice guidelines recommend the prompt identification of sepsis and treatment with broad-spectrum antibiotic agents and intravenous fluids. For patients presenting with septic shock, empiric antimicrobials should be administered within 1 hour, whereas in sepsis without shock, the target remains within 3 hours to allow time to evaluate alternative diagnoses (Kamath et al., 2023).
Diagnostic modalities include blood cultures and other testing to identify the source and site of infection and organ dysfunction. Treatment includes the administration of appropriate IV antimicrobial therapy, with source identification and de-escalation of antibiotics as soon as feasible. These recommendations are supported by observational studies and guidelines suggesting that early treatment with antibiotics and intravenous fluids reduces the number of avoidable deaths (Kamath et al., 2023).
7.6 Patient Education and Prevention
Sepsis is a medical emergency. A person with sepsis should look ill and should seek immediate care for worsening infection and signs and symptoms. Time matters. Call your doctor or go to the emergency department immediately if you suspect sepsis.
Healthcare providers can help patients and family members protect themselves against sepsis by teaching the signs and symptoms of sepsis and the importance of prompt and early treatment. If you have an infection and don’t get better or start feeling worse, ask your doctor, “Could this infection be leading to sepsis?”
Infection prevention is a critical part of preventing sepsis. This includes proper hand hygiene, wound care, and vaccination. Be aware that children and older adults, as well as immunocompromised people and those with chronic illnesses, are at higher risk for contracting sepsis than the general population.
Warning signs and symptoms of sepsis include:
- altered mental state, confusion
- shortness of breath
- fever
- clammy or sweaty skin
- extreme pain or discomfort
- high heart rate
Some steps you can take to prevent infections include taking good care of chronic conditions and getting recommended vaccines. Also:
- Know the symptoms of sepsis.
- Practice good hygiene, such as handwashing, and keeping cuts clean until healed.
- Act fast. Get medical care immediately when an infection is not getting better or if it gets worse.
Always remember, sepsis is a medical emergency. Time matters. Giving relevant history and information to healthcare providers can help with early identification and treatment of sepsis, leading to improved outcomes.
The Need for Sepsis Awareness: Dana Mirman’s Story
In 2011, a lack of awareness of sepsis—a disease responsible for more American deaths each year than breast cancer, prostate cancer, and AIDS combined—nearly cost me my life. It began with a little bump on my shoulder one afternoon. I did not know that within 24 hours, that small bump would develop into life-threatening septic shock and I would find myself in the ICU.
The little bump became swollen, and I developed symptoms that felt like the worst flu of my life. My husband discovered my temperature was over 104 degrees, and rushed me to the emergency room, on a hunch that this was not an ordinary “flu.”
He had never heard of sepsis. I had heard the word, but thought it was a rare, largely obsolete disease. I didn’t know anything about the symptoms and certainly had no idea it could be happening to me.
When I arrived at the hospital, I was the sickest I had ever been in my life. My temperature was soaring, my blood pressure was falling, and my arm was in excruciating pain. I soon learned the bump on my arm actually was a skin infection, which had led to cellulitis. The doctors acted quickly, and I was admitted to the ICU, where I vacillated between life and death. I was cognizant enough to worry whether I would make it out of the hospital and if so, whether all my limbs would be coming home with me.
After several terrifying, agonizing days, I began to recover, transitioning first out of the ICU and then out of the hospital. I went home to begin a deceptively arduous recovery. Having survived and avoided severe complications like amputations, I expected my recovery would be swift, but it was not.
Weeks turned to months, even years, before I began to feel like “myself” again. I did not know about post-sepsis or post-ICU syndrome, which can affect many sepsis and ICU patients. It took nearly three years to get my strength back, although some of the physical and emotional impacts still linger.
As difficult as my recovery was, I am lucky to be alive. I am lucky that the doctors and nurses at my hospital were aware of sepsis. They saved my life. Others—who either do not make the decision to seek emergency medical care, or whose symptoms are overlooked or misdiagnosed—are not as lucky.
But surviving sepsis should not be a matter of luck. The public and medical professionals must be aware of sepsis. We must know the name of this deadly disease, and we must know the symptoms. By being aware of the symptoms, we will be able to save more lives. The CDC’s efforts to increase sepsis awareness and improve treatment will result in fewer lives lost to this sudden, swift, and often-fatal disease.
Source: CDC’s Safe Healthcare Blog, 2014, 2024