Sepsis - the importance of early detection

The facts speak for themselves — sepsis mortality rates are still unacceptably high: 15-25% for patients with sepsis, reaching levels of 30-50% in septic shock [1]

Many patients arrive in the emergency department with a local infection or, in some cases, develop an infection after surgery or major trauma. Bacterial infections in particular can enter the bloodstream, causing systemic infection and an extreme immune response resulting in a condition known as sepsis. This serious, sometimes life-threatening condition is responsible for the deaths of more patients than AIDS, prostate and breast cancer combined [2].

Sepsis can be difficult to identify, particularly in the initial stages, and it presents a considerable diagnostic challenge to emergency department and intensive care clinicians. When sepsis goes undetected for too long, or if effective antibiotic treatment is not initiated quickly enough, it can rapidly progress to septic shock, becoming ever more lethal as the severity of the condition increases. The risk of mortality increases by 7.6% with every 1 hour delay in administering antibiotic therapy in septic shock patients with hypotension [3-4].

Time of hypotension before therapy

Data derived from Kumar et al. Crit Care Med 2006; 34:1589–96

Although strict guidelines for the implementation of early and effective therapies have improved the chance of survival, the mortality and morbidity rates associated with sepsis remain higher than any other infection-related condition. Sepsis is increasingly recognized in patients presenting at the emergency department, particularly those with upper respiratory complaints such as community-acquired pneumonia, and is especially prevalent in the elderly [5].

In the last decade, the number of reported emergency department cases has tripled, exceeding the number of myocardial infarctions. There are more cases of sepsis than of lung-, breast-, prostate cancer and HIV combined [2, 4]. 

As the pathogenesis of sepsis is not fully understood, and as there is no specific treatment available, early diagnosis of sepsis is key to start effective antibiotic therapy without delay to ensure the best possible patient outcomes [3].

 

           
  1. Riedel S, et al. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol 2011; 135:182-89.
  2. http://www.world-sepsis-day.org/?MET=SHOWCONTAINER&vCONTAINERID=11
  3. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34:1589-96.
  4. Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med 2000; 26,1: 64-74
  5. Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Crit Care Med 2007; 35:1928-36.

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