Sepsis and Antimicrobial Resistance Awareness Gain Ground, But Action Must Continue

Sepsis is a life-threatening condition caused by the body’s extreme response to an infection. Annually, 30 million people worldwide acquire sepsis and an estimated 6 million people die from the condition.¹ For those who survive, ongoing complications can include physical and cognitive disabilities, organ dysfunction, impaired quality of life, and risk for future infection.

Despite its high incidence and mortality, sepsis often is not recorded as the cause of death. Until recently, there were not even clinical criteria to clearly define it.

Recent initiatives aimed at improving sepsis awareness were designed to reduce the burden of sepsis. These include:

• The launch of World Sepsis Day in 2012, by the nonprofit organization, Global Sepsis Alliance. The goal is to raise awareness of proper prevention, diagnosis, and treatment of sepsis and reduce deaths by 20% by 2020. The day is marked annually on September 13 during Sepsis Awareness Month.
• Establishment of the World Sepsis Congress in 2016, also by the Global Sepsis Alliance. This year, it’s second, 20,000 registrants from more than 166 countries participated in 17 different online sessions over 2 days to learn more about sepsis and how to address the global burden.
• Adoption of a resolution to improve, prevent, diagnose and manage sepsis globally, by the World Health Assembly and the World Health Organization in 2017.2 The resolution urged the 194 United Nations Member States to implement appropriate measures to reduce the human and health economic burden of sepsis and established sepsis as a global health priority.
• The creation of the “I’m a Resistance Fighter” campaign in 2017 by BD (Becton, Dickinson and Company) to bring awareness to antimicrobial resistance, which is one critical way to address sepsis mortality. The initiative is driving global, concentrated efforts to raise awareness of the need to combat antimicrobial resistance through collective action.

The public and private sector are encouraged to join, via the website, www.antimicrobialresistancefighters.org, and become Resistance Fighters sharing professional expertise to ignite action including innovation for change.

What Else Can Be Done to Reduce Global Sepsis Deaths?

Prevention is the first step in stopping sepsis. National immunization programs are urgently needed, as many vaccine-preventable diseases contribute to sepsis in adults and children. Other preventive measures include clean childbirth practices, improvements in sanitation, nutrition, and delivery of clean water, especially in resource-poor communities. Improved diagnostics can also help clinicians identify the source of infection and target antimicrobial therapy so that it is most effective.

Without prompt recognition and treatment, sepsis can progress to septic shock, organ failure and death. The majority of sepsis deaths can be prevented with rapid diagnosis and treatment.³

Integrated approaches to preventing and managing sepsis are greatly needed through the following efforts:

• Hospitals and health care facilities need to establish institutional programs that educate nurses, physicians, and other health care workers in the intensive care unit, where patients are especially vulnerable to infections, about sepsis.
• Effective hygiene practices—including hand-washing, surgical site preparation, and other surveillance systems—need to be implemented across departments, including the emergency department and general medical-surgical units.
• Frontline health care workers should be trained to recognize the early signs and symptoms of sepsis and initiate antibiotics early and promptly.
• Public awareness of sepsis must continue so that patients and family members can also learn to recognize the signs and symptoms of sepsis.

Antimicrobial resistance threatens our ability to treat sepsis successfully. As antimicrobial therapies become less effective, more people are at risk for infections that can progress to sepsis. We must encourage responsible use of effective antimicrobials because delayed, incomplete, and ineffective antimicrobial therapy contributes to the sepsis burden. Antibiotic stewardship and education need to be cross-cutting, multidisciplinary, and collaborative.

I applaud these efforts to reduce the global health burden of sepsis. Increased awareness of sepsis and antimicrobial resistance must continue if we are to save lives.

Prof. Dr. Reinhart is a board-certified anesthesiologist and intensive care physician in Jena, BIH, visiting professor/Charité Foundation Berlin, Germany, and chair of the Global Sepsis Alliance.

References:

1. 35th International Symposium on Intensive Care and Emergency Medicine. Crit Care. 2015;19 Suppl 1:P1-P578. www.ncbi.nlm.nih.gov/pmc/articles/PMC4471157/pdf/cc1410pdf.
2. WHA adopts resolution on sepsis [news release]. Jena, Germany: Global Sepsis Alliance, May 26, 2017. https://www.global-sepsis-alliance.org/news/2017/5/26/wha-adopts-resolution-on-sepsis.
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 Jun;34(6):1589-96.