A new tool in the clinical management of sepsis

Sepsis is the body’s immune response to infection and it is estimated that sepsis counts for more deaths in the UK annually than bowel cancer, breast cancer and prostate cancer combined (Professor C Rowan, personal communication). Presence of infection causes stimulation of cytokines that mediate and regulate immunity, inflammation and haematopoiesis. In the case of sepsis, the presence of endotoxins or exotoxins from microorganisms triggers an inflammatory cascade that can result in systemic inflammatory response syndrome (SIRS). This cascade may cause blood clotting and changes to circulation, resulting in end-organ dysfunction, while hypotension during septic shock can be fatal.

The focus of infection can arise anywhere but most commonly from the lungs, urinary tract or skin. In patients in intensive care, who have had surgery or are receiving therapy requiring indwelling devices, there is a risk of organisms passing into the bloodstream, causing bacteraemia or fungaemia. Intravenous catheter infection bacteraemia is most commonly caused by Gram-positive organisms, with staphylococci accounting for most isolates.1

The emergence of antimicrobial resistance (AMR), particularly methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), poses significant challenges in the treatment of bacteraemic patients. Of greater concern is the increasing prevalence of extended-spectrum beta-lactamase (ESBL) and carbapenamase-producing Gram-negative organisms such as Klebsiella pneumoniae.