Earlier detection to help reduce sepsis burden

A national plan to address the early diagnosis and management of sepsis is needed in both the primary and tertiary settings

---

Rates of permanent disability and death from sepsis could be reduced with a more comprehensive action plan for detecting and treating the condition earlier, experts say.

A national plan to address the early diagnosis and management of sepsis is needed in both the primary and tertiary settings, the authors of a perspective recently published in the MJA say.

Their comments follow a 2017 resolution from the World Health Organisation which called on member states, including Australia, to reduce the national burden of sepsis across all age groups.

Sepsis is responsible for at least 5000 deaths in Australia annually, the authors say. And this is likely to underestimate of the impact of this condition as the data does not include cases of sepsis in primary care, remote, emergency and ward settings.

“Capturing sepsis diagnoses through hospital coding significantly under-counts the burden of disease,” they said.

Pre-hospital awareness could be one step to reduce the incidence of sepsis in Australia, Professor Mary-Louise McLaws, an epidemiologist in healthcare infection and infectious disease control from the University of NSW, said.

“Forty percent of the patients in our state-wide program presented with a respiratory (infection) and close to 25% with urinary tract infections.

“Pre-hospital awareness could include educating the elderly in the community to be aware of any decline in their wellbeing,” she said.

Another issue facing doctors was the challenge of diagnosing sepsis quickly.

According to the International Surviving Sepsis Guidelines, developed by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine, a diagnosis of sepsis requires a proven or suspected presence of  infection and two or more of the following criteria:

• systolic blood pressure under 90mmHg
• pulse rate over 90
• fever over 38.3°C
• elevated CRP
• reduced capillary refill
• arterial hypoxaemia and
• acute drop in urine output

Professor McLaws said it was important to recognise that despite hypotension being a common characteristic of sepsis, even normotensive patients could have a serious infection which could quickly progress to septic shock.

Her own research had confirmed systolic BP under 90mmHg was a risk for sepsis-related death. But she had also found the risk of death was still increased significantly for patients with sepsis and a systolic BP up to 110mmHg. 

“A patient presenting to the emergency department from the community who reports being generally very unwell who is normotensive or hypotensive should be considered as a suspected case of sepsis and (doctors) should look for an underlying infection,” she said.

The study authors said a national action plan on sepsis would stimulate coordinated action to improve outcomes for patients.

“Sepsis initiatives in Australia should adopt strategies that have been successful in improving outcomes in other time-critical conditions such as myocardial infarction and stroke and should learn from the experiences that have improved sepsis care in other countries,” they concluded.

MJA, online 5 August