‘’Hospitals should implement standardised diagnostic and therapeutic approaches for sepsis management’’

Patients admitted in ICUs are more at risk of contracting sepsis. What are the main causes of this phenomenon? And which patients are more at risk of contracting sepsis within ICUs?

Patrick R Murray

Patients admitted to the ICUs are the most critically ill patients in the hospital. Their ability to fight off infections is commonly compromised either through their underlying disease or through medical treatment that may impair their immune responsiveness. If the patients have infections of the lung, urinary tract, intestinal tract or skin, they frequently display systemic signs as the infecting organisms spread from the site of infection into the blood stream and then to distant organs. These patients also frequently have intravenous catheters which can serve as an entry site for hospital-acquired pathogens.

Additionally, immuno-compromised patients, patients with intravenous catheters, patients receiving broad spectrum antibiotics, patients on respirators or other inhalation therapy devices are the ones that are at high risk of contracting sepsis within the ICUs.

Which are the common sites of infection in patients that result in sepsis?

The common sites for infection in patients that might end up in sepsis include lungs in the form of pneumonia; urinary tract from pyelonephritis and the intestinal tract originating from intraabdominal abscess.

Can you give some statistics on mortality in patients with sepsis on the global front?

The number of deaths as a result of sepsis has been increasing ever since. The four major factors responsible for this rise in the incidence of sepsis are:

• Rise in the number of organ transplants and other surgical procedures that require suppressing the patient’s immune system
• Increase in the number of elderly people in the population
• Overuse of antibiotics to treat infectious illnesses, resulting in the development of drug-resistant bacteria.

It is commonly stated that two to 30 per cent of patients with severe sepsis will not survive, but this can vary enormously with as many as 70 per cent of patients in resource-limited countries dying.

Can you tell us about your research in sepsis management?

My work and that of BD Diagnostics is involved with improved diagnostics – more rapid detection through improved blood culture technology of the bacteria and fungi responsible for sepsis, rapid identification of the pathogens with mass spectrometry, and rapid antimicrobial susceptibility test results to guide therapy with automated platforms such as the BD Phoenix system.

How can hospitals help in reduction of sepsis cases within ICUs? And what precautions should hospitals take in this regard?

Hospitals should come up with defined policies to reduce the use of broad spectrum antibiotics; limit the use of intravenous catheters, urinary catheters and inhalation therapy. Also, they should implement standardised diagnostic and therapeutic approaches for the management of patients with suspected sepsis.

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