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General Surgery · CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)

Surgical sepsis

Sepsis

Surgical sepsis (general purulent infection) is a severe secondary infectious disease caused by various microorganisms. It manifests as a specific, inadequate body reaction to infection and is characterized by a specific clinical picture.

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PathogensStaphylococci, streptococci, pneumococci, Escherichia coli, etc.
Routes of disseminationHematogenous (primary) and lymphogenous.
Basis of pathogenesisSystemic inflammatory response syndrome (SIRS).
Key featureAlways a secondary disease; a primary focus is required.
2 min readFor medical studentsUpdated Sep 20, 2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesReviewed by medical editor: Aulov A. A., general practitioner · 09/24/2026

Causes and mechanisms of development

Sepsis has a polymicrobial nature. The pathogens can be either gram-positive (Staphylococcus, Streptococcus, Pneumococcus) or gram-negative bacteria (E. coli, Proteus, Pseudomonas aeruginosa). In most cases, a monoculture is detected, but microbial associations also occur.

The condition arises as a complication of primary purulent inflammation (abscess, osteomyelitis, wound) or against the background of trauma and burns. The infection spreads predominantly via the hematogenous route (through thrombi and emboli from affected veins), and less commonly via the lymphogenous route.

According to the widely accepted I.V. Davydovsky theory, sepsis is primarily a specific (inadequate) reaction of the macroorganism to an infectious focus. The triggering mechanism is a breakdown in the normal immune response, which leads to a massive release of inflammatory mediators (cytokines) and the development of Systemic Inflammatory Response Syndrome (SIRS).

Diagnostic criteria for SIRS

To confirm SIRS, certain clinical and laboratory signs must be present:

  • Elevated body temperature above 38 °C.
  • Accelerated heart rate (HR) over 90 beats per minute.
  • Increased respiratory rate (RR) over 20 per minute.
  • Blood test changes: leukocytosis (over 12 × 10⁹/L) or a left shift in the differential (more than 10% immature neutrophils).
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Classification

Surgical sepsis is classified according to several criteria:

  1. By etiology: staphylococcal, streptococcal, pneumococcal, anaerobic, etc.
  2. By time of onset: early (up to 14 days from the onset of illness/trauma) and late (developing 2 weeks or more later).
  3. By clinical presentation: fulminant (developing over hours), acute, subacute, chronic, recurrent.
  4. By primary focus: wound, abdominal, gynecological, odontogenic, cryptogenic (when no focus is found), and others.

Clinical presentation

Symptoms depend on the form and severity of the course.

  • General symptoms: fever (often with severe chills and drenching sweats), tachycardia, rapid breathing. The patient may be apathetic or, conversely, in a state of euphoria.
  • Appearance: the face first flushes, then turns pale; in severe cases, facial features become sharp. Icteric (yellowish) sclera and skin, and petechial hemorrhages are frequently observed.
  • Internal organs: enlargement of the liver (hepatomegaly) and spleen (splenomegaly) is characteristic.
  • Local manifestations in the wound: granulations become sluggish, pale, and watery; epithelialization stops. Discharge becomes scanty and serosanguinous/seropurulent.

Class and exam questions

What distinguishes sepsis from ordinary inflammation?

In sepsis, the normal adaptive reaction to infection fails. An excessive, uncontrolled release of inflammatory mediators occurs, leading to systemic organ damage rather than just a local fight against microbes.

What is the difference between staphylococcal and streptococcal sepsis?

Staphylococcus promotes fibrin deposition, which is why purulent metastases form in organs in 90-95% of cases. Streptococcus releases streptokinase (an enzyme that dissolves fibrin), causing microbes to anchor less firmly in tissues, resulting in less frequent metastasis.

What is cryptogenic sepsis?

This is a rare diagnosis made when, despite all examinations, the primary source of infection cannot be found.

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What else to study on this topic

  • Historical aspects of theories on the origin of sepsis
  • Features of septicopyemia and septicemia
  • Mechanisms of endogenous intoxication in sepsis
  • The role of immunity and premorbid background (diabetes mellitus, hormonal deficiency)
  • Pathological anatomy of changes in internal organs

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Other topics from the section "CHAPTER 11. SURGICAL INFECTION (PURULENT-INFLAMMATORY DISEASES)"

Surgical infectionPathogens of surgical infectionPathogenesis of surgical infectionEndogenous intoxication in surgeryTreatment of surgical infectionFolliculitisAbscessErysipelasNecrotizing fasciitisCellulitisParaproctitisParotitisMastitisLymphangitisLymphadenitisSuppurative bursitisPanaritiumOsteomyelitisAtypical forms of osteomyelitisSuppurative arthritisPeritonitisPurulent pleurisySepsisSurgical Infection: General Concepts and Pathogenesis
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