Sepsis Management

Sepsis is now defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection1. This serious condition incurs long hospital stays, and high morbidity and mortality. The WHO has recognized sepsis as a Global Health Priority2, and the Surviving Sepsis Campaign’s latest guidelines3 (2016) offer very clear strategies for better patient outcomes.

When time is critical, you need accurate information – and you need it fast. bioMérieux is your partner along the sepsis management pathway, bringing you rapid and reliable results to support clinical decisions for better patient care. 

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Sepsis: every minute counts

Treat sepsis early – save lives

“Rapid initiation of simple, timely interventions, including antimicrobials and intravenous fluids, can reduce the risk of death by half. Patients with suspected sepsis should be referred immediately to an appropriate facility. Early sepsis treatment is cost effective, and reduces the number of hospital and critical care bed days for patients” 

-World Sepsis Day website

Sepsis is a complex inflammatory process that is largely under-recognized as a major cause of morbidity and mortality worldwide. Yet, with an estimated 30 million cases each year worldwide, sepsis causes 1 death every 3-4 seconds4. It is the leading cause of death from infection around the world, despite advances in modern medicine like vaccines, antibiotics, and acute care4.

Sepsis is caused by an acute response of the body’s immune system to a severe infection, often resulting in damage to the patient’s own tissues and organs.. It can lead to shock, multiple organ failure, and death, especially if it is not recognized early and treated promptly. Long-term effects for sepsis survivors include permanent organ damage, as well as physical and cognitive disability3,4.

Despite medical advances, the number of sepsis cases continues to rise rapidly3,5,6. Along with rising incidence there are rising costs: in the US, hospital treatment accounts for nearly $24 billion per year5; in Germany, costs for treating a typical case are reported to have more than doubled in the last decade7.

 

The “Golden hour”

Early diagnosis and appropriate treatment make a critical difference when it comes to improving sepsis patient outcomes. Indeed, chances of survival go down drastically the longer initiation of treatment is delayed. If a patient receives antimicrobial therapy within the first hour of diagnosis, chances of survival are close to 80%; this goes down by 7.6% for every hour after8. Yet, if a patient initially receives inappropriate antimicrobial treatment, they are five times less likely to survive9.

A Global Health Priority 

In 2017, the World Health Organization (WHO) adopted a resolution recognizing sepsis as a Global Health Priority and is focused on improving the prevention, diagnosis, and management of sepsis2

 

Updated guidelines: protocols for efficient response

The Surviving Sepsis Campaign, a joint collaboration of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, published the fourth edition of its guidelines in 2016: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 20163. Based on a wide body of research, these guidelines offer key recommendations to ensure best patient outcomes.

The Surviving Sepsis recommendations start with initial resuscitation and carry through 10 recommendations of care and monitoring, along with special considerations for pediatrics10. The microbiology laboratory plays a vital role throughout the sepsis management pathway, in particular for some of the most critical recommendations: routine patient screening, diagnosis and antimicrobial therapy.

 

Some key Surviving Sepsis recommendations (summarized)*

  • Sepsis and septic shock are medical emergencies, and it is recommended that treatment and resuscitation begin immediately (BPS**)
  • Hospitals and hospital systems should have a performance improvement program for sepsis, including sepsis screening for acutely ill, high risk patients (BPS)
  • Appropriate routine microbiology cultures (including blood) should be obtained before starting antimicrobial therapy in patients with suspected sepsis or septic shock if doing so results in no substantial delay in the start of antimicrobials (BPS). Appropriate routine microbiology cultures always include at least 2 sets of blood cultures (both aerobic and anaerobic bottles)
  • Administration of IV antimicrobials should be initiated as soon as possible after recognition and within one hour for both sepsis and septic shock . (strong recommendation, moderate quality of evidence)
  • Empiric broad-spectrum therapy with one or more antimicrobials should be prescribed for patients presenting with sepsis or septic shock to cover all likely pathogens (including bacterial and potentially fungal or viral coverage) (strong recommendation, moderate quality of evidence)
  • Daily assessment should be made for de-escalation of antimicrobial therapy in patients with sepsis and septic shock (BPS)
  • Measurement of procalcitonin levels can be used to support shortening the duration of antimicrobial therapy is sepsis patients (weak recommendation, low quality of evidence)
  • Procalcitonin levels can be used to support the discontinuation of empiric antibiotics in patients who initially appeared to have sepsis, but subsequently have limited clinical evidence of infection (weak recommendation, low quality of evidence)

*Full guidelines available at: http://www.sccm.org/Documents/SSC-Guidelines.pdf
** BPS – Best Practice Statement 

Clinicians depend upon rapid and reliable diagnostics for clinical decision-making every step of the way. So how can in vitro diagnostics help you meet that challenge?

 

Early patient management in sepsis

Sepsis : the first hour is crucial

When a patient presents with suspected sepsis, appropriate cultures (blood samples or samples from site of infection) should be obtained within the first hour, before starting antimicrobial therapy. Biomarkers such as procalcitonin (PCT) may also rapidly (20 minutes) give answers to support diagnosis or prognosis. To initiate appropriate therapy as early as possible, it is important not only to identify the pathogen, but also to test for resistance to antimicrobials. Antibiotic treatment effectiveness must be monitored continually. Finally, epidemiological surveillance and antimicrobial profiling help determine local epidemiology and hospital antimicrobial policies.

At bioMérieux, we understand that each of these steps is not an isolated activity but rather a continuum of care that involves close collaboration between the microbiology lab and the clinical care setting. That’s why we’ve developed a global patient-centric solution for sepsis to support you all the way along the continuum. We understand that actionable laboratory results lead to informed clinical decisions and improved patient outcomes.

 

Surviving Sepsis recommendations

bioMérieux supports your needs

DIAGNOSIS

  • Obtain appropriate cultures before starting antibiotics if doing so result in no substantial delay in the start of  antibiotics
     
  • Support early clinical diagnosis
     
  • Prognostic information using biomarkers
     
  • Monitoring for antibiotic therapy efficacy with aim to stop antibiotics earlier

Blood cultures

BacT/ALERT® 3D systems 
BacT/ALERT® VIRTUO
BacT/ALERT® Culture media
 

 

Blood culture identification

FilmArray Blood Culture Identification Panel

Site specific cultures

Conventional culture media
chromID® chromogenic media

Microbial identification / Antimicrobial resistance testing

VITEK® MS
VITEK® 2 / Advanced Expert System
Etest®

Procalcitonin (PCT) immunoassay

VIDAS® B·R·A·H·M·S PCT

ANTIMICROBIAL THERAPY

  • Administration of IV antimicrobials should be initiated as soon as possible and within an hour
     
  • Base initial empiric therapy on local epidemiology and resistance patterns (antibiogram)

Antimicrobial resistance profiles/Rapid result reporting

VITEK® 2  / Advanced Expert System
VITEK® 2 bioART
IT Solutions with Myla®

 

A partner you can count on for sepsis management

By microbiologists, for microbiologists

bioMérieux solutions are designed by microbiologists, for microbiologists. With more than 50 years’ experience working with laboratories, we’ve been by your side throughout the evolution of challenges facing labs around the world, including the growing threat of sepsis.

bioMérieux is acutely aware of the challenges the microbiology lab faces daily in the fight against sepsis and the need for leading-edge diagnostics. Along with our continual innovation in rapid diagnostic solutions and tests, we are also a sponsor of World Sepsis Day.

Like you, providing the best possible patient care is at the heart of our concerns. So you can count on us to be by your side, facing the sepsis management challenge.

 

 

 

 

Not all of the products are FDA cleared.
FDA cleared products may not be cleared for all indications mentioned on this site.
Product claims may differ from country to country on regulations and approvals. Please contact your country representative for further details.

 

References:

1.     Singer et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810

2.      Reinhart et. Al, Recognizing Sepsis as a Global Health Priority- A WHO resolution. N Engl J Med 2017; 377:414-417August 3, 2017

3.     Rhodes A., et al. “Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016”. Intensive Care Med (2017) 43:304–377

4.     WSD fact sheet 2017/www.world-sepsis-day.org

5.     Torio, Celesten, et. al. (2013). National Inpatient Hospital Costs: The Most Expense Conditions by Payer, 2013. Statistical brief #204. May 2016.  www.hcup-us.ahrq/reports/statbriefs

6.     International Organizations Declare Sepsis a Medical Emergency. Issued by an expert panel representing 20 adult and pediatric intensive care societies, October 4th 2010. 2010: Press release. http://www.prnewswire.com/news-releases/international-organizations-decl...

7.     Vincent JL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med, 34:344-353, 2006.

8.    Kumar, A, 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.

9.     Kumar, A, et. al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009 Nov;136(5):1237-48.

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