Sepsis is a global health burden affecting an estimated 30 million people worldwide and causing an estimated six million deaths per year.1
It is the leading cause of death for hospitalized patients, seen in more than one-third (35 percent), of patients whose hospitalization culminated in death.2 Sepsis is also a costly drain on healthcare systems and a frequent reason for hospital re-admissions. According to a U.S. government report of inpatient care from 2005-2014, sepsis costs American hospitals $27 billion, making it the number one cost driver for hospitals.3 The high cost of sepsis includes direct care for sepsis patients as well as screening for multi-resistant pathogens when patients require isolation or during outbreaks.
Hospital administrators and clinicians must do more to educate healthcare workers about sepsis. It represents a major threat to patient safety and public health. Improvements in prevention, treatment and management of sepsis in the healthcare setting are greatly needed. Importantly, it is crucial for hospital administrators, physicians and clinical staff to understand the role of antimicrobial resistance (AMR) in sepsis treatment to ensure there are adequate opportunities for successful treatment.
Sepsis Definition & Causes
Sepsis is a life-threatening complication of infection that occurs when the body’s response to infection injures its own tissues and organs. It is an immune response that can lead to septic shock, multiple organ failure and death if not recognized and treated early.
Almost any microorganism can cause sepsis, including bacteria, fungi, viruses and parasites, such as those that cause malaria. The most common etiological pathogens are bacteria:
• Streptococcus pneumoniae
• Haemophilus influenzae
• Staphylococcus aureus
• Escherichia coli
• Salmonella spp.
• Neisseria meningitidis
Sepsis can also manifest from viral infections as well, including seasonal influenza viruses, dengue viruses and highly transmissible pathogens that are public health threats, such as avian and swine influenza viruses, severe acute respiratory syndrome, coronavirus, Middle East respiratory syndrome and most recently, Ebola and yellow fever viruses.
Sepsis Risk Factors
Increased risk for sepsis is associated with chronic diseases, such as chronic obstructive pulmonary disease, cancer, cirrhosis, AIDS and other immunodeficiency disorders. Sepsis is also associated with demographic and social factors, including diet and lifestyle, tobacco and alcohol use, poverty and race. Access to quality health care systems, in particular quality intensive care, is closely correlated with lower sepsis and sepsis fatality rates.
Sepsis often presents as the clinical deterioration of common and preventable infections of the respiratory, gastrointestinal and urinary tract, or of wounds and skin. It is often largely preventable but is frequently underdiagnosed at an early stage when it is still potentially reversible. Improved awareness and education can have a significant impact on recognizing and stopping sepsis from progressing to septic shock.
Critically ill patients undergoing treatment in the hospital intensive care unit, patients with wounds or other serious injuries such as burns, or who require invasive devices such as intravenous catheters or breathing tubes are especially vulnerable to sepsis that progresses to septic shock. Hospital mortality rates could be cut in half with quality improvements such as mandatory sepsis protocols, effective hygiene practices, including hand washing, and proper surgical site preparation. Cross-functional teams must work together to ensure system-wide protocols are in place across departments, including the emergency room. Moreover, vaccinations to prevent infections are essential for curbing infection rates at the community level. In developing countries, programs that address malnutrition and improve delivery of clean water and sanitation can also help reduce the spread of infections that can progress to sepsis.
Sepsis Treatment and the Role of AMR
Successful sepsis treatment requires resolution of the underlying infection as well as life-saving medical interventions such as fluid resuscitation or vital organ support. In most cases sepsis can be treated with antibiotics, intravenous fluids and medicines to address specific symptoms. Sepsis is a time-critical emergency; a prompt and correct diagnosis is crucial for identifying the drugs most likely to be effective in combatting the underlying infection and preventing an infection from progressing into sepsis.
The growing threat of antimicrobial resistance (AMR) is a significant challenge to the prevention and successful treatment of sepsis. Delayed, incomplete and ineffective therapies contribute to the increasing threat of AMR and can increase a patient’s risk for developing sepsis. As more pathogens become resistant to available antibiotics, more people are at risk for developing sepsis and progressing to organ failure. Without curbing AMR and ensuring that clinicians can recognize the signs of sepsis and institute treatment best practices quickly, the global sepsis burden will grow.
Priority must be given to hospital-wide programs and policies that improve antibiotic stewardship and education of nurses, physicians and healthcare workers in the emergency department, patient wards and ICU. These initiatives need to be cross-cutting, multi-disciplinary and they require a commitment from all stakeholders, including hospital board members. Patients should be encouraged to seek appropriate treatments and know what to expect from clinical care. The vital work of hospitals must include a focus on improving quality of care and reducing the burden of sepsis through well-coordinated surveillance and public health efforts.
I encourage healthcare providers to join me in supporting efforts to improve sepsis outcomes, both through training programs on best practices for detecting and treating sepsis, and through programs designed to address the growing threat of AMR.
One way to become involved and help elevate awareness and educate others is to join the “I’m a resistance fighter™” campaign. Created by BD (Becton, Dickinson and Company), the campaign helps increase awareness of the need to combat AMR, because all of us have a role to play. To learn more about the campaign and share a story of survival, remembrance or commitment, visit https://www.antimicrobialresistancefighters.org.
1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471157/pdf/cc14101.pdf
2 TBD
3 Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), HCUP Fast Stats, Trends in Inpatient Stays (www.hcup-us.ahrq.gov/faststats/landing.jsp) based on the HCUP National (Nationwide) Inpatient Sample (NIS)