Sepsis still a deadly killer as scientists attempt to bring it under control
(HealthDay News) Sepsis is a bacterial blood infection, and it is indeed a major health threat. As many as 18 million cases of sepsis are reported in the United States each year, and about 215, 000 patients die from it annually.
While the actual mortality rate has declined, partially because the U.S. population has increased, deaths from sepsis have doub led in the last 20 years, a trend that alarms a group of critical-care doctors.
Severe sepsis accounts for one in five admissions to intensive care units and is a leading cause of death in non-cardiac ICUs, according to researchers. T he number of deaths sepsis causes has made it the 11th leading cause of death in America , experts say.
The question constantly facing health care providers is, how can incidents of sepsis be brought under control and eventually greatly reduced or eliminated?
Sepsis, or septic shock, is the body's response to an overwhelming bacterial infection. Symptoms include fever, pale extremities, confusion, skin rash, rapid heartbeat and decreased urine output. The condition can affect nearly every body system and cause multiple organ failures and death.
Sepsis is more common in men than in women, and it occurs more frequently in blacks than in whites. Newborns and people over age 55 also are more vulnerable to sepsis.
"We wanted to get an idea of whether sepsis truly is changing in the United States , and, if so, how. We were surprised by the magnitude of the change," says Dr. Gregory Martin, assistant professor of pulmonary and critical care at Emory University in Atlanta , Ga. , who has conducted extensive research into causes of sepsis.
Using data from the National Hospital Discharge Survey, the researchers found the national incidence of sepsis jumped from 469,596 cases to 684,035, an increase of 23.3 percent, between 1988 and 1998. Martin says the HIV epidemic that accelerated during the 1980s may have played a role, since HIV patients are more susceptible to infection.
More aggressive chemotherapy in cancer patients also may factor into the increase, since anti-cancer drugs can compromise a patient's immune system. Invasive procedures such as cardiac catheterization and major surgeries also make sepsis more likely.
Finally, Martin says doctors may simply be getting better at recognizing sepsis, which also could account for the increased numbers.
The total number of patients who died rose from 96,665 in 1988 to 119,125 in 1998. As mentioned earlier, current sepsis deaths are estimated by the National Institutes of Health at 215,000 annually.
The most common cause of sepsis, accounting for 52.9 percent of cases, was gram-positive bacteria, such as Staphylococcus and Streptococcus .
"The increases really are quite dramatic," which may point to changes in the organisms responsible for sepsis, says Martin.
"As incidence gets greater, we're going to have a much larger health care burden," Martin says, pointing to data showing that treating sepsis costs $20,000 to $40,000 per patient.
"It's a huge public health problem," says Dr. Gordon Bernard, professor of medicine, chief, Division of Allergy, Pulmonary and Critical Care Medicine and assistant vice chancellor for research at Vanderbilt University , in Nashville , Tenn.
Bernard says doctors fight sepsis by treating the underlying infection with antibiotics and with support for failing organs, including lungs, heart and kidneys.
But Martin says until recently, some two decades of clinical trials have not produced any real advances in specific treatments for sepsis.
In 2001, drug manufacturer Eli Lilly and Company, gained approval from the U.S. Food and drug Administration to market Xigris (drotrecogin alfa). But Xigris, designed to counter excessive blood clotting typical of the disease, also has been found not to be of use in some sepsis cases, especially those involving children.
Martin is optimistic about other, future treatments. "It wouldn't surprise me if in the next five or 10 years, we'll start to see more effective therapies."
On the Web
The National Institutes of Health offers the latest information on the dangers of sepsis at its MedLine Plus site.
Gregory S. Martin, M.D., Assistant Professor of Medicine, Division of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta , Ga. ; Gordon R. Bernard, M.D., professor of medicine, chief, Division of Allergy, Pulmonary and Critical Care Medicine and assistant vice chancellor for research, Vanderbilt University, Nashville, Tenn.; Nov. 5, 2001, abstract, American College of Chest Physicians annual assembly
Publication date: August 2008
Nicolle Charbonneau, HealthDay Reporter
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