Can we win the fight against sepsis and antibiotic resistance?
Approximately 50,000 patients in the UK die from sepsis each year. On World Sepsis Day Dr Timothy Felton Consultant in Intensive Care and Respiratory Medicine at MFT and Respiratory Medicine at The University of Manchester and NIHR Manchester Biomedical Research Centre (BRC) researcher, discusses the challenge of tackling sepsis in the face of the increasing challenge posed by antibiotic resistance.
What is sepsis?
Sepsis is the body “over-reacting” to an infection. Normally the immune system fights infection but in sepsis it has an abnormal response and starts to damage the body’s own tissues and organs. Most often, sepsis occurs in patients with lung infections, such as pneumonia but, it can occur as a result of both rare and common infections. Although very young children (under one year) and older people (over 75 years) are at a higher risk of developing sepsis it can occur in any patient regardless of age, race or gender.
Getting the diagnosis right every time
There is no single test to identify sepsis. Sepsis is usually suspected when a patient with an infection develops problems with organs that aren’t related to the initial infection. They may become confused (if the brain is affected); breathless (if the lungs are affected) or not pass urine (if the kidneys are affected). Laboratory tests can help to identify patients with an infection and with organ problems, such when the kidneys are affected. However, many patients become confused, breathless, or don’t pass urine – but don’t have sepsis.
Early antibiotics save lives
There are no specific treatments for sepsis but we know giving the right antibiotic as early as possible saves lives. Because there’s no simple test for sepsis many patients who are given antibiotics as a precautionary measure won’t actually have sepsis. This overuse of antibiotics comes with its own problems – specifically the increase in antibiotic resistance.
Antibiotic or antimicrobial resistance occurs when an antibiotic is unable to kill a micro-organism (bacteria or fungi) because that micro-organism has changed in response to the use of these medicines. Antibiotic resistance is increasing, partly, because of antibiotic over-use in patients.
If antibiotic resistance isn’t addressed soon procedures such as surgery and chemotherapy that can be complicated by infection could become life-threatening, with sepsis becoming untreatable within the next 30 years.
Improving outcomes from sepsis without contributing to antibiotic resistance
At Manchester BRC we are working on tests to identify patients with sepsis early.
Additional funding has been awarded to the team from the National Institute of Health Research (NIHR) to help develop individualised antibiotic treatments. The aim is to treat patients with sepsis with the most effective antibiotic dose, for the shortest period of time. A clinical trial currently being run in the UK by researchers in Manchester, aims to identify a test to advise doctors on when to stop the antibiotic course. This will ensure the antibiotic course is stopped when the infection has been treated.
In a further study, which will be delivered at the NIHR Manchester Clinical Research Facility researchers will be measuring antibiotics in the blood of patients, and increasing the dose if the blood levels are low.
Our aim is to give “the right antibiotic to the right patient and the right dose for the right duration.” By using this individualised approach to patients with sepsis we hope to ensure we successfully treat patients with sepsis while not contributing to the increasing levels of antibiotic resistance.