Sepsis, a potentially life-threatening illness caused by the body's response to a major infection, can be tricky and time-consuming to diagnose — but a timely diagnosis is critical because sepsis can quickly cause a chain reaction of complications that can lead to tissue damage, organ failure, and death.
The dilemma for physicians is how to speed up the diagnosis when a severely ill patient arrives in an emergency department and needs immediate care. That’s the focus of a major, new research project at Intermountain Healthcare funded by the National Institutes of Health.
The five-year NIH grant will evaluate clinical tools to help researchers investigate early sepsis risk assessment processes and test a new management protocol they hope will dramatically accelerate the delivery of antibiotics and other treatment for sepsis patients.
“There are severe challenges to delivering optimal care for sepsis, particularly in busy emergency departments,” said Ithan Peltan, MD, MSc, the study’s leader and an attending physician in the Intermountain Medical Center Shock Trauma Intensive Care Unit. “This grant will help us adapt team-based strategies that have helped accelerate care for other time-critical conditions like stroke and heart attacks.”
Sepsis is a deadly but common complication of infection that results in over one million U.S. hospitalizations every year and kills 10 to 20 percent its victims. The diagnosis of sepsis, however, frequently requires a complex evaluation, which slows the initiation of life-saving treatments.
Sepsis occurs when the immune reaction to a severe infection damages the body itself. While any infection can trigger sepsis, pneumonia and urine infections are its most common causes.
The best course of treatment is early administration of antibiotics, said Dr. Peltan, but identifying patients with the potentially deadly infection early in its course is challenging. That’s because initial symptoms — like fever, accelerated heart rate, and shortness of breath — are common in a range of diseases.
“In our study, we’re going to work on better methods to identify sepsis patients within minutes of their first contact with medical personnel,” Dr. Peltan said. “We’ll then direct a team of doctors, nurses, pharmacists, and other caregivers to `swarm’ high-risk patients, collect the information necessary to diagnose sepsis, and begin antibiotic and fluid treatment immediately.”
Nationwide, sepsis patients commonly wait three to four hours or more before receiving their first dose of antibiotics. Dr. Peltan’s team hopes to significantly shorten that time frame and start antibiotics within 45 minutes.
“Research by our group and others has shown that sepsis deaths increase about 10 percent for every hour antibiotics are delayed. If we succeed at reducing door-to-antibiotic times by two hours, we hope to see a real benefit for patient outcomes,” he said.
The NIH funding will also allow Dr. Peltan’s team to investigate whether accelerating sepsis care has any unintended consequences.
Some experts, for instance, worry that regulations mandating rapid antibiotics for sepsis will increase rates of unnecessary antibiotic treatment. Such over-treatment is a problem because antibiotics themselves can have severe side-effects – including allergic reactions and a severe gut infection called clostridium difficile – and contribute to growing antibiotic resistance.
“Right now, important aspects of sepsis care are based on assumptions rather than facts,” Dr. Peltan said. “We desperately need this hard data on any trade-off between early treatment and over-treatment to allow truly informed decisions in both clinical care and policy.”