News and Opinions  –  2020

4 take aways from WHO’s first global report on sepsis

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In September, the WHO released their first Global Report on the Epidemiology and Burden of Sepsis.

The report draws attention to:
- the threat of resistant infections to sepsis patients
- the opportunities that exist in integrating our surveillance and response to antibiotic resistance.

Here ReAct highlights four take aways in the shared challenges - and point out tools that unite the global effort against sepsis and antibiotic resistance.

Girl sleeping with sickness. Photo: Shutterstock.

1, Sepsis is disproportionately affecting patients in low- and middle-income countries

Sepsis is a life-threatening condition that is caused by the body’s response to an infection. In 2017, it affected about 49 million people and resulted in 11 million deaths, making sepsis responsible for one in every five deaths worldwide. However, sepsis is disproportionately affecting people in low- and middle-income countries. In fact, about 85% of the global sepsis cases and sepsis-related deaths were, according to 2017 data, occurring in low- and middle-income countries, particularly in sub-Saharan Africa and South-East Asia. These cases are also concentrated in vulnerable populations, such as neonates. Importantly, low- and middle-income countries are also disproportionately affected by resistant infections.

2, Sepsis and antibiotic resistance are intimately linked

Sepsis is generally treated with broad-spectrum antibiotics and therefore contributes substantially to the development and spread of antibiotic resistance. In turn, antibiotic resistance limits our ability to treat and manage sepsis. The Global Report on the Epidemiology and Burden of Sepsis (herein referred to as the “WHO’s sepsis report”) wields data from the 2020 GLASS report to highlight the problem. One critical example is that 12 countries reported to GLASS that 80-100% of Klebsiella pneumoniae isolates from blood were resistant to third-generation cephalosporins.

The WHO sepsis report highlights hospital-acquired sepsis cases as particularly concerning, as they often are associated with high rates of resistant bacteria and a longer length of stay within hospitals which worsens patient outcomes. The report further points out that more than half of all cases of health-care associated sepsis are preventable through appropriate infection prevention and control measures. Championing water, sanitation and hygiene and infection prevention and control within health-care settings must therefore remain at the forefront of efforts, as it tackles sepsis – but also antibiotic resistance.

3, There is a lack of information regarding sepsis, particularly in low- and middle-income countries

Although the sepsis burden generally is highest in low- and middle-income countries, this is also where the widest data gaps exist. As noted in WHO’s sepsis report, the majority of the sepsis epidemiology data are based on systematic reviews, which are limited by the scarcity of harmonized and comparable data.

One common bottleneck for data generation in resource-limited settings is the lack of appropriate diagnostics, without which, a consensus definition that relies on laboratory-based diagnostics cannot be applied. For neonates, such a validated definition has not yet been agreed upon. Other factors include the lack of high quality data collection systems and the variable application of clinical definitions. Our knowledge of the true burden of sepsis might also be impacted by for example health-seeking behavior as data availability will be limited to the patients that the health-care systems capture.

4, There are opportunities to leverage existing surveillance systems on sepsis and antibiotic resistance

Collecting information on the causes of sepsis and the antibiotic resistance profiles of bacteria is essential to inform treatment and our understanding of the epidemiology of sepsis. However, lack of diagnostic capacity and limited collection and completeness of medical records hinder this. GLASS has suggested template protocol for estimating attributable mortality of resistant bloodstream infections and exemplifies mechanisms through which a multinational surveillance program can support reliable estimates across countries.

Health-systems strengthening is key – to lower sepsis and antibiotic resistance

Roughly one in five deaths are due to sepsis, but as much 85% of all these deaths occur in low- and middle-income countries, which also are where the burden of antibiotic resistance is highest. Both sepsis and – to a large extent – the spread of resistant infections could be prevented if appropriate measures are taken. Ensuring universal health coverage, strengthened infection prevention and control and improved water, sanitation and hygiene is key. No matter how strong a surveillance system, and accurate our data, there are huge differences in the ability of different healthcare systems to properly address the combined threat of sepsis and resistant infections.

Health-systems strengthening is critical in suppressing the emergence of resistant infections and tackling the very present threat that it poses to sepsis patients. If we are to tackle the preventable suffering and death caused by sepsis and resistant infections, quality health care must be for all individuals and communities.

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