News and Opinions  –  2020

World Sepsis Day – antibiotics essential for treatment of sepsis

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2020-08-27

World Sepsis Day is coming up on September 13th. The day was initiated by the Global Sepsis Alliance in 2012 and aims to raise global awareness about sepsis, which every year causes many millions of deaths around the world. Bacterial infection is commonly the root cause of the condition, and prompt treatment with effective antibiotics is then essential for survival.

Photo: Shutterstock

What is sepsis?

According to a consensus paper published by international experts in 2016, sepsis should be defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection”.

The authors also support the following public description of sepsis, which was suggested in an article from 2011: “Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs”.

Thus, sepsis is not an infection in itself, but is rather an extreme bodily response. The medical consequences may include organ failure, shock and death. A variety of infections – bacterial, viral, parasitic and fungal – may lead to sepsis, including common conditions like pneumonia and urinary tract infections.

You can learn more in this short video. Produced for World Sepsis Day by the Global Sepsis Alliance.

Treatment with broad-spectrum antibiotics are standard practice

Sepsis is an emergency that needs immediate attention and treatment. Since bacterial infections are a frequent cause of sepsis, prompt treatment with broad-spectrum antibiotics are standard practice. Treating broadly is a way to maximize the chances of treatment success and patient survival, as there generally is not enough time to await laboratory test results that can inform about, for example, antibiotic susceptibility. Keeping antibiotic resistance at a minimum is thus fundamentally important to this group of patients, as increasing resistance levels may have disastrous effects. Whether the underlying infection is caused by a susceptible or resistant bacterium may in fact be a question of life and death.

Sepsis may also afflict patients with COVID-19

Sepsis may also be caused by viral infections. As scientific data about COVID-19 have piled up, it has become evident that sepsis also impacts the mortality in the current pandemic. Since COVID-19 is a viral disease, it cannot be treated with antibiotics. Antibiotic could however be used to treat secondary bacterial infections or bacterial co-infections, although these appear to be quite rare in this group of patients. A recent review article found that bacterial co-infections occurred in 7% of hospitalized patients with COVID-19. Despite this low frequency, a majority of hospitalized COVID-19 patients receive antibiotic treatment, which is problematic from an antibiotic resistance perspective.

Sepsis: a common complication of cancer

People with weakened immune systems are especially at risk of sepsis. Patients treated for cancer, and particularly those treated for blood cancer, is one such group. The immune systems of these patients may be weakened because of the cancer itself, the cancer treatment or both. Notably, sepsis is one of the most common reasons for admission of cancer patients to intensive care units, and sepsis causes close to a tenth of all deaths in this patient group. If the prevalence of antibiotic resistance increases, we can expect this number to rise much more.

Antibiotic resistance and neonatal sepsis

Neonates are another vulnerable group that is over-represented among sepsis patients.

Approximately 3 million newborns suffer from neonatal sepsis every year with half a million of these cases resulting in death. Good hygiene practices in hospitals and in communities, such as ensuring access to clean water can prevent many of these deaths. In hospitals, ensuring there are strong infection, prevention and control (IPC) programs help prevent infections and bacterial transmission, but can also prevent the progression of these infections into sepsis. Alarming is that three out of every ten neonatal sepsis deaths are likely caused by resistant pathogens. Exacerbating the problem is the lack of new antibiotics in development to help treat neonatal sepsis due to resistant pathogens. There are approximately 37 antibiotics in development trials, yet only two are being studied for use in children. The Global Antibiotic Research and Development Partnership (GARDP) is working to bring new antibiotics to market, to make them available to everyone in the world and has a focus on children and neonatal sepsis.

Photo: Solen Feyissa, Unsplash.

Are you a pediatrician? Know one?
ReAct is conducting a survey on neonatal sepsis

ReAct is conducting a web-based survey to help understand globally the perception and experiences of physicians treating neonates with sepsis caused by antibiotic-resistant bacteria. Particularly, it aims to understand their perception on the magnitude of the problem, and the awareness, policies or guidelines and challenges health professionals face when treating these patients. 30 questions in 10 minutes!

Last date to submit: 15 September. Please do share link to survey widely!
Questions? Contact celina.hanson@medsci.uu.se (request paper-based forms)

Link to survey in English

Link to survey in French

Link to survey in Spanish

 

References and and further reading

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

“Merinoff Symposium 2010: Sepsis ”– Speaking with One Voice”

Global Sepsis Alliance: SEPSIS AND COVID-19/CORONAVIRUS/SARS-COV-2

Co-infections in people with COVID-19: a systematic review and meta-analysis

ReAct policy brief: Successful cancer treatment relies on effective antibiotics

WHO: Factsheet on sepsis

The global burden of pediatric and neonatal sepsis: a systematic review

Access to effective antimicrobials: a worldwide challenge

GARDP: Making children’s antibiotics a priority

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