SUMMARY:

• Early use of antimicrobials in true cases of sepsis is of utmost significance.

• Sepsis often results in prescribing antibiotics before a precise diagnosis is made.

• Widespread misuse of antimicrobials contribute to multidrug resistance and mortality.

• Antibiotic stewardship programs can help enhance treatment and minimize resistance.

REVIEW:

• Patients with confirmed or suspected sepsis are typically started on antimicrobials early and before a precise diagnosis of sepsis is confirmed.

• Widespread misuse of antibiotic as well as suboptimal antibiotic therapy can contribute to the pathogen emergence of multi-drug resistance (MDR).

• MDR coupled with bacterial evolution of new mechanisms of resistance lead to limitations in correct treatment options.

  • In addition, major pharmaceutical companies are withdrawing from the development of new antimicrobial therapies due to lack of economic feasibility.

• MDR is sepsis patients are not caused by a single factor.

  • Pathogen Factors:
    • Morphologic changes
    • Decreased drug uptake
    • Bacterial self-repair mechanisms
    • Regulation of metabolism
    • Target site modifications
    • Others

• • Sepsis Patient Factors:
    •  Elderly
    •  Comorbidities
    •  Immunosuppression
    •  Polypharmacy
    • Lack of healthcare access

• • Difficult to treat Antibiotic Resistant Microbes:
    • ESKAPE

• • Common Pathogens in MDR in Sepsis

• Conventional blood cultures take 2-3 days to identify bacteria and even longer for sensitivities

• • In 22,655 patients with sepsis and septic shock a positive blood culture was identified in only 40.1% of patients.

• Novel diagnostic approaches for pathogen detection can be helpful

  • Surface-enhanced Raman Spectroscopy (SERS)
  • Matrix assisted laser description ionized time-of-flight mass spectrometry (MALDI-TOF MS)
  • Polymerase Chain Reaction (PCR) for microbial amplification
  • Point of Care Sensors (IL-6, IL-10, PCT, CRP, TNF alpha)

• Additional sepsis detection tools such as gene expression tools (SeptiCyte RAPID) can provide actionable results in 60 minutes.

• Antibiotic Stewardship Programs  help improve and measure the appropriate use of antibiotics and can improve the rates of antibiotic susceptibilities.

CONCLUSIONS:

• Antimicrobial resistance is estimated to be responsible for approximately 10 million deaths annually by the year 2050.

• Prescribing ineffective empiric antibiotic treatment in sepsis patients occurs in 10-40% of sepsis patients.

• Antibiotic stewardship programs are multifaceted collaborative efforts to enhance treatment and minimize resistance.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.