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Sepsis

Understanding sepsis and the challenges in diagnosis and delivering care

Antimicrobial resistance

Sepsis is a condition that can be caused by bacteria, fungi, or viruses in the blood and is the result of the body’s response to infection. Approximately 20% of deaths worldwide are sepsis-related.¹ The mortality rate is even higher for fungal infections.² Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.³ Patient survival decreases by ~8% with each hour of delay before effective treatment.⁴

With 48.9 million cases worldwide each year, its impact on human life and healthcare systems⁵ is staggering.

Sepsis is a risk to everyone, but certain people ar at higher risk including adults over 60, children under 1, people with weakened immune systems, chronic diseases, or no spleen.⁵ Sepsis rates are on the rise, likely due to increased awareness and tracking, increased longevity of individuals with chronic diseases, antibiotic resistance, and larger numbers of organ transplants.⁵

Sepsis represents a major global epidemiological burden

1. High risk of sepsis complications

Newborns, elderly and immunocompromised patients are at particular high risk⁶

2. Prevalence

It is estimated to affect approximately ~49 million people worldwide every year, potentially leading to 11 million deaths⁶

3. Diagnosis

Early sepsis diagnosis can be challenging and is critical to reducing mortality.⁴

4. High mortality

The incidence of sepsis and the number of sepsis-related risk deaths are increasing.³ In hospital sepsis mortality remains high (>15%).⁷

5. Therapy selection

An inappropriate initial antibiotic therapy is associated with an increase in mortality and morbidity⁸

6. Therapy control

It is key to identify the cause of sepsis infections early so that patients can be treated with the appropriate therapy as soon as possible to improve survival rates, reduce adverse effects of antimicrobials and reduce antimicrobial resistance.

Three stages of a sepsis infection³

Stage 1: General inflammation

A local infection – e.g. in the lung – overcomes the body’s defense mechanisms. Pathogens and the toxins they produce leave the original site of infection and enter the circulatory system.

Stage 2: Organ dysfunction

A general inflammatory response called SIRS (systemic inflammatory response syndrome) causes an individual organ to deteriorate or fail. Sepsis occurs when more than one organ begins to deteriorate.

Stage 3: Septic shock

Septic shock occurs when multiple organs stop functioning and cardio-circulatory failure leads to a sudden drop in blood pressure.

Blood culture identification

A clinician makes a rapid assessment of the patient's likelihood for having sepsis or septic shock and will decide to administer antimicrobial empiric therapy. Blood culture identification is also done to rule in or out blood stream infection and determine how best to direct and optimize antimicrobial therapy.⁶

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Challenges in diagnosis and delivering care

Timely treatment

Rapid identification of the causative agent(s) of bloodstream infections (BSIs) is critical. Traditional methods can take days to identify the cause of an infection and mortality can increase up to 8% for every hour effective antibiotics are delayed.⁴

Rapid identification of BSIs, in combination with antimicrobial stewardship has been shown to decrease time to targeted therapy by roughly 24 hours, while decreasing hospital length of stay by 2.5 days.^9,10

Antimicrobial stewardship

The rapid emergence of resistant microorganisms has led to an antibiotic resistance crisis. Up to 50% of antibiotics prescribed in hospitals are either unnecessary or inappropriate¹¹ and it is estimated that roughly 10 million people will die annually due to antimicrobial resistance by the year 2050.¹² Taking antibiotics when not needed can put patients at risk for serious adverse events and lead to the development of resistance. As such, careful and judicious use of antimicrobial agents has become a key component of mitigating the risk posed by resistant organisms.

Fungal infections

Fungal pathogens are a growing cause of BSIs and are associated with some of the highest rates of inappropriate therapy and mortality. The hospital mortality rate of invasive candidiasis is estimated between 46%-75%, with costs attributed to candidemia as high as $92,000 per case.² Non-albicans species of Candida and other emerging fungi are increasing in incidence, with immunocompromised patients at greatest risk. A delay in antifungal prescribing of >12 hours from the time of blood sample collection increased mortality by 2.09-fold.¹³

Blood culture contamination

Contaminants in blood cultures are common and can lead to unnecessary use of antibiotics that increase cost and toxicity. These contaminants can represent up to 15-30% of the organisms isolated in some hospitals.¹⁴The optimized identification of pathogens when combined with antibiotic stewardship, has been shown to decrease the duration of antibiotic therapy for blood culture contaminants by 17.8 hours.⁹

Blood culture contaminants can have a significant impact on hospital costs:

Length of stay can increase by 2 days¹⁵
Total cost of care per patient has been shown to increase by over $4,700¹⁵
Lab charges and pharmacy costs can increase more than $1000^16,17