Joshua Rhein, MD, explains why patients who are obese are more likely to develop sepsis.
Joshua Rhein, MD, an assistant professor of medicine at the University of Minnesota, was interviewed by Infection Control Today® (ICT®) to discuss the relationship between obesity and the likelihood of developing sepsis and other related infections.
ICT: Does obesity raise the chances of an individual developing sepsis? And if so, why?
Joshua Rhein, MD: Yes, it does. Obesity puts individuals at an increased risk for certain types of infection, which can lead to sepsis. Sepsis always starts as a more focused infection. And some of the infections we think about being at increased risk or we know are our increased risk with obesity are respiratory infections. This can be either upper respiratory infections, like colds or sinus infections, ear infections, or lower respiratory tract infections, like pneumonia. In addition to respiratory infections, we know that obese individuals are also at increased risk for skin and soft tissue infections, particularly well-studied surgical site infections (ie infections following surgery). Also, we know that individuals with obesity are at increased risk for urinary tract infections and certain types of gastrointestinal type infections.
When it comes to respiratory infections, we think about how obesity is associated with decreased lung volumes and decreased what we call pulmonary compliance or the flexibility of the lungs, and that can put people at risk for developing infection. When it comes to skin and skin infections, we know that obesity can lead to problems like disrupted circulation in the skin. Also, it will oftentimes have micro-breaks in the skin and delayed wound healing, which can lead to infection. The same is true with gastrointestinal-type infections; sometimes mechanical or barrier-type problems that are caused by obesity can lead to an increased risk for infection.
ICT: What extra precautions should be taken for a patient with obesity?
JR: One other aspect that we haven't really discussed is some of the comorbidities that often come with obesity, like diabetes, heart disease, and hypertension. And so, all of those individually are associated with an increased risk of infection as well. One of the best ways to take extra precautions with obesity is to try and make sure that all comorbidities are optimally managed.
Making sure that diabetes is well managed and well cared for, as well as some of these other comorbidities that we've talked about.
Another important aspect, just as with a nonobese population, is to make sure that you're vaccinated for potential infections as optimally as possible. Also, just understand that if you have obesity, you're at increased risk for some of these infections, and know some of the warning signs to look out for developing infection and to seek help when needed.
ICT: You’ve mentioned several, but what other infections are individuals more at risk for?
JR: It is also important to try to think about being at risk for developing new infections and also for the severity of infection once it's there; obese individuals are at higher risk for developing more severe infections as well. Sometimes that may be something to consider as well, and some of the gastrointestinal type infections, which may be mild and non-obese population, can take on increased severity like pancreatitis (pancreas infection) or gallbladder infection, both more common and more severe as well.
ICT: I had a friend who was a very large man; he was probably 350 pounds, and he was 29 years old and had pancreatitis and died. And I've always wondered if it had something to do with just the simple fact that he was an obese person. He had no heart problems. He didn't have any medical issues except the fact that he was very large. I've often wondered if that was what he died from.
JR: Yes, it's certainly possible. Probably not an area that, like infection, is particularly well studied when it comes to pancreatitis, but we know that obese individuals are more likely to develop, like gallstones with things that can lead to pancreatitis and more severe forms of pancreatitis. That, you know, normally pancreatitis isn't usually thought of as a primary infection, but it can get secondarily infected with severe pancreatitis is likely that obesity is a high-risk factor for that.
ICT: Do you have anything else you'd like to add?
JR: Obesity is severe and appears to be an increasing problem in our country. And so it's important that we keep this link between obesity and infections in our minds. With that should come more research because of the mechanisms for the increased risk that comes. Hopefully, a better understanding of the link between obesity and infection will lead to interventions in the future that can target interventions that can help prevent infections. Also, it is not known what some of the new weight loss drugs will have on our incidence of obesity and what sort of effect that can have on infection in the future as well.