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13th September: World Sepsis Day

Sepsis is one of the most common, least-recognised illnesses in both the developed and developing world. Globally, 20 to 30 million patients are estimated to be afflicted every year, with over 6 million cases of neonatal and early childhood sepsis and over 100,000 cases of maternal sepsis. Worldwide, a person dies from sepsis every few seconds. Find more factsand the official World Sepsis Declaration here:

Sepsis is common and carries a high risk of death and long-term complications

Sepsis remains the primary cause of death from infection despite advances in modern medicine, including vaccines, antibiotics, and intensive care. Sepsis, which is often misunderstood by the public as “blood-poisoning” is one of the leading causes of death around the world. Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multiple organ failure, and death, especially if not recognized early and treated promptly. Between one third and one half of patients with sepsis die 1 2. In the developing world, sepsis accounts for 60-80% of lost lives per year in childhood, killing more than 6 million neonates and children yearly and is responsible for more than 100,000 cases of maternal sepsis 3. Every hour, about 50 people die from sepsis. Sepsis causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined. Globally, an estimated 20 – 30 million cases of sepsis occurs each year. Experts in the field believe sepsis is actually responsible for the majority of the mortality associated with HIV/AIDS, malaria, pneumonia and other infections acquired in the community, in healthcare settings and by traumatic injury 4. Patients surviving sepsis have double the risk of death in the following 5 years compared with hospitalised controls and suffer from physical, cognitive and affective health problems 5.

Incidence is increasing dramatically

The incidence of sepsis is increasing dramatically, due to the ageing population 1 4 and despite the advantages of modern medicine including vaccines, antibiotics and intensive care. Hospitalisations for sepsis have more than doubled over the last 10 years 4 7 9 and have overtaken those for myocardial infarction in the US 8 9. International and national surveys indicate that 20- 40% of sepsis patients that require treatment in the intensive care unit developed sepsis outside the hospital 10. The incidence of sepsis developing after surgery trebled from 1997 to 2006.

The diagnosis of sepsis is often delayed

Sepsis is often diagnosed too late, because the clinical symptoms and laboratory signs that are currently used for the diagnosis of sepsis, like raised temperature, increased pulse or breathing rate, or white blood cell count are unspecific. In children, the signs and symptoms may be subtle and deterioration rapid. Sepsis is under-recognized and poorly understood due to confusion about its definition among patients and healthcare providers, lack of documentation of sepsis as a cause of death on death certificates, inadequate diagnostic tools, and inconsistent application of standardised clinical guidelines to treat sepsis 4.

Costs of sepsis are high an rising

An estimated $14.6 billion was spent on hospitalisations for sepsis in the US in 2008, and from 1997 through 2008, the inflation-adjusted aggregate costs for treating patients hospitalized for this condition increased on average annually by 11.9% 8. The costs related to long-term sequelae of sepsis are unknown. In Europe, it has been estimated that a typical episode of sepsis costs healthcare services approximately 25,000 Euros. Given the considerable loss of life years the human costs of sepsis are enormous 12.

Sepsis is a medical emergency

Rapid initiation of simple, timely interventions including antimicrobials 13 14, intravenous fluids 14 and targeted treatment to restore the circulation 15 can halve the risk of dying. Patients with suspected sepsis should be referred immediately to an appropriate facility. Early sepsis treatment is cost effective, reducing hospital and Critical Care bed days for patients. Unfortunately, sepsis is still mostly overlooked and recognised too late.

That is why the Global Sepsis Alliance calls in its World Sepsis Declaration:

In the developed world, sepsis is dramatically increasing by an annual rate of between 8-13 % over the last decade, and now claims more lives than bowel and breast cancer combined. Reasons are diverse, but include the aging population, increasing use of high-risk interventions in all age groups, and the development of drug-resistant and more virulent varieties of infections. In the developing world malnutrition, poverty, lack of access to vaccines and timely treatment all contribute to death. Despite its remarkable incidence, sepsis is practically unknown to the public and is often misunderstood as blood poisoning. Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multiple organ failure, and death, especially if not recognised early and treated promptly. Sepsis remains the primary cause of death from infection despite advances in modern medicine, including vaccines, antibiotics, and acute care with hospital mortality rates between 30 and 60%. To stem the rising tide and take appropriate steps to ultimately reverse the global increase in the numbers of deaths from sepsis, we – the global sepsis community – issue this common call to worldwide action. We ask all relevant stakeholders, by committing to the goals and key targets set out below, to initiate necessary priority actions, and to secure resources and support from governments, development agencies, professional organizations and health care commissioning groups, philanthropists and benefactors, the private sector and all of society. We call on each country to formalizse a nationally achievable, staged development plan intended to deliver these targets by 2020.

Global goals:

Place sepsis on the development agenda. The Declaration will increase the political priority given to sepsis by raising awareness of the growing medical and economic burden of sepsis.
Ensure that sufficient treatment and rehabilitation facilities and well-trained staff are available for the acute and long term care of sepsis patients.
Support the implementation of international sepsis guidelines to improve earlier recognition and more effective treatment of sepsis and enable adequate prevention and therapy for all people throughout the world.
Mobilise stakeholders to ensure that strategies to prevent and control the impact of sepsis globally are targeted at those who are most in need.
Involve sepsis survivors and those bereaved by sepsis in planning strategies to decrease sepsis incidence and improve sepsis outcomes at local and national levels.

Key targets to be achieved by 2020:

The incidence of sepsis will decrease globally through strategies to prevent sepsis

By 2020, the incidence of sepsis will have decreased by at least 20% by promoting practices of good general hygiene and hand washing, clean deliveries, improvements in sanitation, nutrition and delivery of clean water and through vaccination programs for at risk patient populations in resource poor areas.

Sepsis survival will increase for children (including neonates) and adults in all countries through the promotion and adoption of early recognition systems and standardised emergency treatment

By 2020, at least two-thirds of acute health systems and community and primary care organisations in participating countries will support the Declaration and have incorporated routine sepsis screening into the care of the acutely ill patient.
By 2020, sustainable delivery systems will be in place to ensure that effective sepsis control programs are available in all countries. All countries will be monitoring time taken for patients with sepsis to receive the most important basic interventions, antimicrobials and intravenous fluids in accordance with international consensus guidelines.
By 2020, we intend that survival rates from sepsis for children (including neonates) and adults will have improved by a further 10% from their levels at 2012. This will be monitored and demonstrated through the establishment of sepsis registries, and is intended to build upon the improvements seen following the launch of the Surviving Sepsis Campaign and the International Pediatric Sepsis Initiative.

Public and professional understanding and awareness of sepsis will improve

By 2020, sepsis will have become a household word and synonymous with the need for emergent intervention. Lay people will much better understand what the early warning signs of sepsis are. Families’ expectations of delivery of care will have risen such that delays are routinely questioned.
By 2020, all member countries will have established learning needs for sepsis among health professionals and ensured the inclusion of training on sepsis as a medical emergency in all relevant undergraduate and postgraduate curricula. Recognition of sepsis by health professionals as a common complication of high risk medical interventions will have significantly improved, thereby reducing the numbers of patients who become exposed to the risk.

Access to appropriate rehabilitation services will have improved for all patients worldwide

By 2020, all member countries will have set standards and established resources for the provision of follow up care following discharge from hospitals of patients who have suffered sepsis.

The measurement of the global burden of sepsis and the impact of sepsis control and management interventions will have improved significantly

By 2020, all member countries will have established voluntary or mandated sepsis registries which are consistent with and complementary to the data requirements of the international community, helping to establish sepsis as a common health problem. The international community will be working toward the establishment of an international sepsis registry.

(Source: The World Sepsis Declaration)

Further information:

Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care., Angus DC et al., Crit Care Med, 2001.
Epidemiology of sepsis in Germany: results from a national prospective multicenter study., Engel C et al, Intensive Care Med, 2007.
World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative., Kissoon N et al, Pediatr Crit Care Med, 2011.
http://www.prnewswire.com/news-releases/international-organizations-declaresepsis– a-global-medical-emergency-104142073.html
The lingering consequences of sepsis: a hidden public health disaster?, Angus DC., JAMA, 2010.
Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003., Dombrovskiy VY et al., Crit Care Med, 2007.
Nationwide trends of severe sepsis in the 21st century (2000-2007), Kumar G et al, Chest, 2011.
Inpatient care for septicemia or sepsis: A challenge for patients and hospitals., Hall MJ et al., NCHS data brief.
Population trends in the incidence and outcomes of acute myocardial infarction., Yeh RW et al., N Engl J Med, 2010.
Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry., Beale R et al, Infection, 2009.
Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample., Bateman BT et al, Anesthesiology, 2010.
Sepsis in European intensive care units: results of the SOAP study., Vincent JL et al., Critical Care Medicine 2006.
Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock., Kumar A et al., Crit Care Med, 2006.
The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study., Daniels R et al., Emerg Med J. 2011.
Early goal-directed therapy in the treatment of severe sepsis and septic shock., Rivers E et al., N Engl J Med, 2001.