Resolving to save lives
The term ‘sepsis’ dates back to at least the time of Hippocrates, who considered it the process by which flesh rots and wounds fester. Nowadays, it is defined as a life-threatening organ dysfunction resulting from infection.
Despite its very long history, sepsis has existed in a ‘backwater’ as described by Sir Liam Donaldson, former Chief Medical Officer of England, and many patients globally have died prematurely or have faced long-term disability.
The Global Sepsis Alliance (GSA) was founded in 2010 with the aim to raise awareness for sepsis worldwide and reduce sepsis deaths by 20% by 2020. Earlier this year, the World Health Assembly, the decision making body of the World Health Organization, adopted a resolution suggested by the GSA on improving the prevention, management and diagnosis of sepsis.1
Current estimates of 30 million episodes and six million deaths annually have been made from a systematic review,2 although this is likely to be a significant underestimate as no data were available for low to middle income countries and so the estimate was based on data on hospital-treated sepsis in high income countries. The true burden of sepsis therefore remains unknown.
The resolution makes a number of recommendations for action to reduce the global burden of the disease such as increased awareness, prevention, early recognition and urgent treatment according to locally developed guidelines.3
A key recommendation calls for health care workers to promote public awareness by using the term “sepsis” in communication with patients, relatives, and other parties. National surveys consistently report low community awareness of sepsis, its signs and symptoms, its causes, and its toll of death and disability. Awareness programmes should also teach health care workers to recognise sepsis and understand its true time-critical nature as a medical emergency.
The WHO resolution recognises the perceived conflict between rapid administration of antibiotics for sepsis and the important issue of combating antimicrobial resistance. Reducing the burden of sepsis must be played out alongside measures to minimise resistance and be consistent with the Global Action Plan on Antimicrobial Resistance. Because this is a condition that is appropriate to treat empirically with broad-spectrum drugs, development of methods for rapid diagnosis of the causative organisms and subsequent de-escalation is crucial.
September 2017 saw updated NICE guidelines for sepsis (NG51), the fifth annual World Sepsis Day from the GSA on 13 September, and the World Sepsis Congress Spotlight on maternal and neonatal sepsis, which is an often-overlooked facet of the disease. Progress towards GSA’s vision of a ‘world free of sepsis’ is being made and together with the WHA resolution has the potential to save millions of lives, but will require coordinated efforts by policy makers, health care personnel, researchers and clinicians to realise the dream.
References
1. WHA adopts resolution on sepsis. www.global-sepsis-alliance.org/news/2017/5/26/wha-adopts-resolution-on-sepsis
2. Fleischmann C et al. Assessment of global incidence and mortality of hospital-treated sepsis: current estimates and limitations. Am J Respir Crit Care Med 2016;193:259-72
3. Reinhart K et al. Recognizing sepsis as a global health priority – a WHO resolution. N Engl J Med 2017;377:414-17.