CDC Puts Spotlight on Sepsis as 'Medical Emergency'

Megan Brooks

August 23, 2016

Federal health officials are calling on healthcare providers to do more to prevent, recognize, and treat sepsis before it can cause life-threatening illness or death.

"We as a country could do much more to prevent patients from getting infections that lead to sepsis," Tom Frieden, MD, MPH, director, Centers for Disease Control and Prevention (CDC), said during a media briefing today discussing a report on sepsis published online August 23 in CDC Vital Signs.

"This report is putting a face on sepsis and documenting that it is still a huge problem, and it doesn't have to be. Far too many people die from sepsis today. Sepsis is an unrecognized killer [and] a medical emergency," Dr Frieden said.

"An infection that is getting worse and is not treated can lead to sepsis. We call on healthcare providers to take opportunities to prevent, identify, and rapidly treat patients with sepsis and to educate patients and family members about sepsis," he added.

Each year, from 1 to 3 million people in the United States are diagnosed with sepsis. The mortality rate from sepsis is between 15% and 30%. Many who survive sepsis have a prolonged stay in a nursing home or other long-term care facility, Dr Frieden noted.

Surprise: 80% of Sepsis Cases Begin Outside the Hospital

To describe characteristics of patients with sepsis and to inform sepsis initiatives, the CDC partnered with the New York State Department of Health and Emerging Infections Program on a retrospective chart review of 246 adult and 79 pediatric patients from four New York hospitals with administrative codes for severe sepsis or septic shock. The median age of adult patients was 69 years, and 52% were male. The pediatric group included 31 infants younger than 1 year and 48 children between 1 and 17 years of age.

Mirroring other studies, sepsis most commonly occurred among patients with one or more comorbid conditions. But what's "new and different," Dr Frieden said, is the finding that about 80% of patients develop infections leading to sepsis outside a hospital. "This may be surprising to many in the field," Dr Frieden said, "as we've been focusing on and making progress reducing sepsis in the hospital."

The study also found that nearly three quarters of sepsis patients (72%) had seen a healthcare provider in the month preceding sepsis admission or had chronic diseases requiring frequent medical care, "suggesting that opportunities exist for prevention or earlier recognition of infections leading to sepsis," Lauren H. Epstein, MD, of the CDC, and colleagues note in their report.

They say sepsis is most often associated with infections of the lung, urinary tract, skin, and intestines, the data show. Pneumonia is the most common infection leading to sepsis.

The most common pathogens isolated from blood cultures were Escherichia coli in adults aged 18 years and older, Klebsiella spp in children aged 1 year or older, and Enterococcus spp in infants younger than 1 year. In a third of patients, no pathogen was isolated.

Overall, one quarter of patients with sepsis died, including 65 (26%) adults and 17 (22%) infants and children.

Dr Frieden emphasized that individuals with an infection who are at high risk for sepsis include people aged 65 years or older, infants younger than 1 year, people with weakened immune systems, and those with chronic medical conditions, such as diabetes. "But even healthy children and adults can develop sepsis from an infection, especially when not recognized early and treated promptly," he said.

Dr Frieden also noted that six of the key signs and symptoms of sepsis are "not widely known." They are shivering, fever, or feeling very cold; extreme pain or discomfort; clammy or sweaty skin; confusion or disorientation; shortness of breath; and a high heart rate.

The CDC encourages healthcare providers to do the following:

  • Educate patients and their families. Stress the need to prevent infections, manage chronic conditions, and if an infection is not improving, promptly seek care. Don't delay.

  • Think sepsis. Know the signs and symptoms to identify and treat patients earlier.

  • Act fast. If sepsis is suspected, order tests to help determine whether an infection is present, where it is, and what caused it. Start antibiotics and other recommended medical care immediately.

  • Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy 24 to 48 hours or sooner to change therapy as needed. Determine whether the type of antibiotics, dose, and duration are correct.

Dr Frieden said the CDC is working on five key areas related to sepsis:

  • Increasing sepsis awareness by engaging clinical professional organizations and patient advocates.

  • Aligning infection prevention, chronic disease management, and appropriate antibiotic use to promote early recognition of sepsis.

  • Studying risk factors for sepsis that can guide focused prevention and early recognition.

  • Developing tracking for sepsis to measure the impact of successful interventions.

  • Preventing infections that may lead to sepsis by promoting vaccination programs, chronic disease management, infection prevention, and appropriate antibiotic use.

CDC Vital Signs. Published online August 23, 2016. Full text

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