Sepsis — the body’s dysregulated overreaction to infection — is one of the biggest causes of death in U.S. hospitals. According to the Centers for Disease Control, one in three adults who die in hospitals had sepsis during their stay.
A recent Brown-affiliated study examined how sepsis patients’ chances of being discharged from the hospital to their home can be improved when healthcare providers adhere to proper care procedures. Researchers found that timely antibiotic and fluid administration are correlated with patient discharge to their home after sepsis.
According to Hallie Prescott, first author and associate professor in pulmonary and critical care medicine at the University of Michigan, “sepsis is a time-sensitive medical emergency.” She noted the importance of quick diagnosis and treatment of the condition, as this can lead to lower mortality rates and the “increased ability to go directly home.”
Associate Professor of Surgery Sean Monaghan, who is a trauma, critical care and acute care surgeon, explained that sepsis is “organ dysfunction caused by an infection.”
“Organ dysfunction can be things like altered mental status, trouble breathing, low blood pressure (or) kidney or liver damage,” Monaghan, who was not involved with the study, wrote in an email to The Herald. “These all happen because the immune system is working so hard to fight the infection that it causes damage to the body and can lead to death.”
Prescott wrote that treatment for sepsis includes antimicrobial therapy and, in some cases, surgical procedures in the area of infection.
The most severe form of sepsis is septic shock, Prescott added, which is defined by a lack of blood flow that prevents tissues from receiving the oxygen they need.
“The longer sepsis progresses, the more difficult it is to treat, and higher the mortality,” Prescott wrote. “Thus, prompt recognition and treatment are critical.”
Researchers analyzed a population of almost 39,000 patients hospitalized for sepsis, with roughly 35,000 of those patients eligible for antibiotics and 27,000 eligible for fluid resuscitation. For those eligible, antibiotics were delivered in a timely manner for around 75% of cases, and fluids were administered in roughly 50% of cases.
The timely administration of antibiotics was associated with a 3.0 percentage point increase in patient discharge to home, while fluid resuscitation was associated with a 1.1 percentage point increase.
“This is important because the majority of patients survive sepsis, but experience difficult or incomplete recoveries,” Prescott explained. Instead of being able to return to their homes, “many patients spend time in nursing or rehabilitation facilities after hospitalization.”
According to Monaghan, the study confirmed what medical scientists already knew: “Timely appropriate antibiotics and supportive care with fluid resuscitation are the best treatment we have,” he wrote.
Prescott explained that various factors can prevent timely administration of antibiotics and fluids from occurring.
For example, “the diagnosis of sepsis can be difficult in real-time, as other conditions may present similarly, and there is no single test to rule in or rule out sepsis,” Prescott wrote.
Additionally, sepsis is most commonly diagnosed in emergency departments, which are often very busy.
“Clinicians are stretched thin, making it difficult to rapidly (evaluate) patients and balance quick treatment of sepsis with judicious use of antibiotics,” Prescott wrote.
Furthermore, the administration of antibiotics can come with unintentional consequences, according to Monaghan.
“There are definitely risks of faster antibiotic administration, the primary one being inappropriate use that results in increased antimicrobial resistance,” he wrote. “In addition, the antibiotics chosen in the early stage are based on most likely scenarios, so if a patient had a resistant pathogen, those antibiotics would not work.”
Prescott explained that the best way to improve sepsis treatment would be to “avoid sepsis altogether,” noting vaccinations as “one of the very most effective tools we have to limit the development of sepsis.”
“Vaccines are safe and highly effective at preventing life-threatening infection and sepsis, so I would like to see renewed support for vaccination,” she added.
There is not a specific vaccine for sepsis — which is not caused by any one specific pathogen. But Prescott explained that this study supports “current policy focused on tracking and improving timely treatment of sepsis.”
Alice Xie is a section editor for Science and Research from Los Angeles, California. She studies Applied Mathematics and Biology, and enjoys reading gut wrenching literature in her free time.
