Sepsis: What’s New

Sepsis: What’s New

Sepsis in simple terms may be described as a syndrome of severe infection with organ dysfunction. Significant progress has been made in the past decade in managing patients with sepsis but mortality of this condition often remains > 25%. In older patients and those with pre-existing medical conditions, the mortality may be 50% or more. The infections precipitating sepsis are diverse and an initial trivial infection may rapidly progress to the life threatening condition that we term as sepsis.

Early recognition and rapid treatment is necessary to prevent an infection from progressing to sepsis. Early and effective antibiotic therapy is essential but despite this, some patients continue to deteriorate requiring more aggressive management including transfer to the critical care unit, medications to support the blood pressure and interventions to support organ dysfunction such as mechanical ventilation, dialysis support etc. The site of infection must be actively searched for and when appropriate, “source control” of the infection may require additional interventions such as drainage of infected area via radiological or surgical approaches. Much of the improvements in treating sepsis requires meticulous attention and execution of care delivery for critically ill patients. A coordinated team approach using the appropriate resources is vital for success in managing patients with sepsis.

“Specific sepsis drugs” have been researched for many years and the unfortunate truth is that none have stood the test of time and none have been incorporated into routine medical practice. The focus of these novel sepsis drugs has been to attempt to control the massive inflammatory response that follows sepsis and cause organ dysfunction. The failure of finding a single “wonder” drug that can treat all forms of sepsis has essentially given way to a more targeted approach. This is the thrust of ongoing research and new drug targets continue to be actively investigated.

Even if novel agents are discovered that can dramatically change mortality in sepsis, the management of sepsis continues to require
1. Early recognition and early effective antibiotic treatment
2. Rapid management and support of various organ systems
3. Source control of the infection (if possible)

In recent years, there is increasing recognition that even in patients who survive their episode of sepsis, morbidity such as muscle wasting, nutritional deficiencies and psychological issues remain as long term problems.