Lorna Rothery interviewed Dr Lauren Sorce, PhD, RN, CPNP-AC/PC, FCCM, President of the Society of Critical Care Medicine and Co-chair of the Surviving Sepsis Campaign, to discuss the challenges of diagnosing and treating sepsis
How much do we know about the prevalence of hospital-acquired sepsis?
The epidemiological data on hospital-acquired sepsis shows that anywhere between 15 and 25% of hospitalized people get sepsis. It is a reportable incident for quality improvement here in the US. So, in theory, it shouldn’t be difficult to get that data, but how hospitals report it can vary. From that perspective, it may be a little bit hard to obtain.
The people most at risk are patients who are immunocompromised, have multiple chronic diseases, have been in the hospital for an extended period of time, and have multiple lines, tubes, and other medical devices. We’re always considering these risk factors for hospital-acquired sepsis.
Newborns are particularly vulnerable to sepsis; what are some of the challenges concerning neonatal sepsis diagnosis and treatment?
Neonatal sepsis can be difficult to diagnose because it is influenced by maternal health and various risk factors. For instance, if the mother is positive for Group B streptococcus and it is unknown at the time of delivery, the baby can be at risk. Premature birth and premature rupture of membranes are also risk factors for neonatal sepsis.
Neonatal sepsis is considered sepsis up to 90 days – within the first 90 days of life. Babies are susceptible due to immature immune systems, frequent handling and variations in access to healthcare based on socioeconomic status and community healthcare availability. When babies present with fever, there’s a recommended evaluation to diagnose neonatal sepsis. However, diagnosing neonatal sepsis can be challenging because neonates do not always develop a fever; they may have low body temperature instead. Therefore, it’s important to consider other signs of infection. Ensuring proper temperature management for neonates is crucial as temperature management is still developing. Notably, if a bundled-up baby still has a low body temperature after birth and hasn’t been exposed to cold, it could be an indication of infection. Neonates with sepsis may present differently than older individuals with sepsis, making it easier to miss the signs.
Hospitals and healthcare systems need to have strategies recognizing the differences in treating neonates, children, and adults. Pediatrics presents a challenge because of the wide range of ages and the varying presentation of symptoms. While sepsis can affect everyone, its approach should be standardized for each specific area. It doesn’t make sense to approach sepsis in New York the same way as in Johannesburg. The approach should adapt to what makes the most sense for that area while being systematized to improve survival and outcomes.
How is the increasing threat of antimicrobial resistance impacting sepsis-related treatment?
Antimicrobial resistance is a significant issue. Bacteria are getting smarter; they are evolving and developing proteins and mechanisms for their survival, including resistance to antibiotics. As patients develop resistance to antibiotics, we are forced to use more costly treatments, not only financially but also in terms of potential harm to the patient. We must develop new antibiotics. Currently, there are some bacteria for which only costly antibiotics can provide treatment. This is becoming a growing issue, not only in terms of healthcare costs but also in terms of the cost to patients and the development of these new antibiotics. Ultimately, the cost is human life if we are unable to treat the underlying cause of conditions like sepsis.
It’s important to note that sepsis can be caused not only by bacteria, which can be treated with an antibiotic if not resistant, but also by fungi and viruses. As it is known, there is no specific antibiotic for viruses. When appropriate therapies are lacking to combat the causative pathogens, patients risk losing their lives. This is the ultimate cost, not only for the patient and their family but also for our society.
There are various types of bacteria present in different hospitals worldwide, with varying levels of bacterial sepsis and antimicrobial resistance. For instance, a hospital in the northern United States may have more cases of a specific type of bacterial sepsis compared to a hospital in the southern United States. This pattern is observed globally. In some areas, access to effective antibiotics is limited due to antibiotic resistance and financial constraints. Disparities in healthcare access exist both within and across countries, such as the continent of Africa or the United States. These disparities can arise from challenges like long distances to health clinics, lack of transportation, or inadequate healthcare facilities. In the United States, antibiotics are generally widely available unless specific antibiotics are not stocked by a hospital due to their pharmacy formulary.
Could you tell me about the Surviving Sepsis campaign, how it came to be, and how it’s helping to improve the lives of sepsis patients?
The Surviving Sepsis Campaign was established by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine to provide guidelines for treating sepsis. These guidelines aim to make sense of the vast amount of research on sepsis and to offer clear recommendations or guidelines for clinicians to treat sepsis. The campaign reviews all available data and research, assesses its validity and relevance, and makes recommendations based on the findings. By doing so, it provides bedside clinicians with practical guidance on treating sepsis, which is crucial given the widespread nature of the condition. The rigorous methodology used by the campaign allows for a fair comparison of studies with different sample sizes and for meta-analysis to determine the overall effectiveness of certain treatments. It’s important to note that these guidelines are just that – guidelines – and are not mandates, allowing clinicians to adapt the information to treat individual patients. As a result of using these guidelines, improved outcomes and survival rates for sepsis have been observed. Additionally, the campaign identifies gaps in research and calls upon the scientific community to address these gaps to improve care and survival rates for sepsis patients.
In recent years, we have made some progress in involving patients more in their healthcare, and, in general, the healthcare sector has made significant strides in including patient advocates. As a pediatric critical care healthcare provider, I strongly feel the voice of the patient and their family is extremely important, especially when it comes to advanced treatments. It’s important to consider the family’s perspective when we move beyond just using antibiotics. While antibiotics are important, some patients may require more than that. What is the experience of families when seeking healthcare for their loved ones? How do patients ensure they are being heard when they go to the hospital and feel that something is wrong? I believe that engaging patients as advocates for healthcare and involving families when patients are unable to advocate for themselves is crucial in improving the care we provide.
Surviving Sepsis Campaign
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Society of Critical Care Medicine
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