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Doctors seek to reduce blood infection deaths

/ Source: The Associated Press

An international group of doctors is pushing for aggressive treatment to prevent half a million deaths worldwide from a common bloodstream infection.

Sepsis kills more than 200,000 people annually in the United States alone — more deaths than from lung and breast cancer combined. Muppets creator Jim Henson died from it 14 years ago.

Later this month a coalition of leading critical care specialists will urge doctors, governments and health agencies worldwide to adopt the first-ever sepsis treatment guidelines. Their plan calls for fast use of powerful antibiotics and other aggressive action.

The number of sepsis cases has increased dramatically since the 1980s while death rates have remained stubbornly high, underscoring the need for rapid recognition and treatment, said Dr. Margaret Parker, a guidelines author.

“The goal of this whole project is to decrease the mortality of sepsis worldwide,” said Parker, incoming president of the suburban Chicago-based Society of Critical Care Medicine, which represents more than 11,000 specialists.

Sepsis is estimated to affect 18 million people worldwide each year and kill 1,400 people each day. In the United States alone, 750,000 people yearly develop sepsis and about 30 percent of them die.

Antibiotic overuse problem

Part of the problem is antibiotic overuse that has created drug-resistant germs. But also, until now there’s been no consensus about how to diagnose and treat sepsis, said Dr. Mitchell Levy of Brown University, another co-author.

The guidelines are the result of recent research showing benefits from potentially lifesaving strategies, including Xigris, approved in 2001 as the first drug to directly attack sepsis; and changes in ventilator use that improve survival chances.

The guidelines are the centerpiece of a campaign launched by specialists from 11 major medical societies on three continents seeking to slash the number of deaths worldwide by 25 percent in five years. The creators plan to unveil their recommendations Feb. 24 at the critical care society’s annual meeting in Orlando, Fla.

Sepsis typically starts as a bacterial infection that can originate from pneumonia, skin infections called cellulitis, and urinary infections. The infections may come from bacteria inside the body that grow out of control or from outside germs that invade the body through wounds or IV lines.

These infections spread rapidly, setting off chemical reactions that damage tissue and can lead to organ failure and death.

In February last year, St. Louis-area stockbroker David Grand developed respiratory symptoms, a high fever and weakness; his doctor diagnosed the flu. The next day Grand could barely move and was hospitalized with bacterial pneumonia and low blood pressure, two warning signs of sepsis.

The rapid infection shut down his kidneys and damaged his heart. The formerly fit father of three was hospitalized for five weeks and nearly died.

Mostly recovered, Grand, 43, called his hospital care “phenomenal” but said he’s all for guidelines that will encourage doctors “to get their act together and be aggressive with this stuff.”

New guidelines, aggressive treatment

The new guidelines outline key symptoms of severe sepsis, including high fever, elevated heart rate and low blood pressure, said Dr. R. Phillip Dellinger, one of the authors and director of critical care at Cooper University Hospital in Camden, N.J.

Aggressive treatment should begin in the emergency room and include immediate use of broad-spectrum antibiotics rather than waiting a few days for test results to identify the specific germ. “If you wait that long, you’ve lost the battle,” Parker said.

Dr. Charles Alex, a critical care specialist at Loyola University Medical Center who wasn’t involved in writing the guidelines, called sepsis one of the most challenging conditions faced by intensive-care doctors.

“There’s still a lot of controversy as to how to monitor these people, what kind of special drugs are available,” said Alex, who thinks guidelines will help by standardizing care.