Sepsis: essential information on the UK’s hidden killer

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By Sue George, Guardian News

It is estimated to kill more people a year in the UK than breast, bowel and prostate cancer combined, but awareness of sepsis and its effects remains disproportionately low. So why are so many people dying from the condition, and what is being done to save more lives?

Sepsis is a leading cause of death in the UK, but too few people know enough about it or understand what they could do to help. According to the UK Sepsis Trust, there are at least 260,000 cases of sepsis a year in the UK. An estimated 44,000 of those people die: a rate of about five people an hour. As many as 25,000 children are affected by sepsis in the UK every year.

“Sepsis is a very common condition,” says Dr Ron Daniels, chief executive and founder of the UK Sepsis Trust, and consultant in intensive care. “It is the body responding to an infection which begins to cause injury to tissues and organs. It can affect people of any age and present in a wide variety of ways.”

Most cases of sepsis are first suspected outside of hospital, by patients themselves or their loved ones, or by GPs. Initially, sepsis may present with symptoms similar to flu, gastroenteritis or a chest infection, but adults may then develop:
 Slurred speech.
 Extreme shivering, or pain in the muscles or joints.
 Passing no urine (in a day).
 A feeling “like they are going to die”.
 Skin that is mottled or discoloured.

Children with sepsis may have different symptoms, if they begin to develop sepsis, including:
 Breathing very fast.
 A “fit” or convulsion.
 Looking mottled, bluish or pale.
 A rash that doesn’t fade when pressed.
 Very lethargic or difficult to wake.
 Very cold skin to the touch.

Anyone suspecting sepsis should phone 111 or contact their GP. If anyone looks severely unwell in the context of an infection, and has any of the symptoms listed, they should go straight to A&E or call 999 as a matter of urgency.

People with sepsis can get worse very quickly after the initial onset of symptoms. Untreated sepsis can lead to septic shock, where blood does not reach the vital organs, leading to multi-organ failure. This can be fatal and, even when it is not, patients may be left with enduring health issues.

About a quarter of people who have had sepsis experience serious or permanent after-effects. This adds to the economic burden of sepsis, which is estimated to be up to £15.6bn a year.

“It’s critically important that treatment is delivered in a timely manner,” says Dr Tracy Ellison, director of medical affairs, Europe BD.

“Septic shock can lead to organ failure and death. Antibiotics are key to the treatment of sepsis, we need to give the right ones at the right time. Time is of the essence for patients with sepsis,” she says.

Because sepsis can arise from a variety of causes, from skin infection to pneumonia, there is no single test or sign that will lead to its diagnosis. Instead, spotting sepsis requires – in the first instance – both medical staff and members of the public to question whether symptoms might be the signs of sepsis and respond accordingly.

Hospital staff in England have generally adopted the Sepsis Six – a treatment pathway developed by the UK Sepsis Trust that delivers the basics of care. If a patient has any one of the “red flag” signs of sepsis, the Sepsis Six delivers the immediate treatment such as antibiotics, oxygen, intravenous fluids, and diagnostic tests.

Identifying bacteria in the blood starts with getting a suitable blood sample processed quickly. The faster lab pathologists can analyse a sample, the sooner the doctor can prescribe the right antibiotic for the case.

As Hugh O’Malley, BD’s UK marketing manager for diagnostic systems, explains: “Industry can help patients, because you are detecting microbes quicker with more accurate and timely results. This can lead to more effective, appropriate antimicrobial prescribing, reducing the use of broad-spectrum antibiotics. You can become more targeted because you understand what the organism is.”

Appropriate use of diagnostics can also help with other healthcare challenges, such as the lack of available hospital beds. National Institute for Health and Care Excellence guidelines stipulate that babies less than 72 hours old who have suspected sepsis should be started on antibiotics. But infants who seemed to have recovered were sometimes not discharged because blood culture results were unavailable. Delays in receiving these results – because it was the weekend, for instance – meant they remained in hospital, taking possibly unnecessary and toxic drugs.

BD supplied a blood culture incubator to the neonatal unit at Homerton hospital in London. As a result, the median stay in hospital was reduced by an average of 20.4 hours, along with a reduction in the overuse of antibiotics.

BD also provides training to show staff how to use the diagnostic systems most effectively. “We have sessions to train staff on how to receive the samples, how they are stored based on priority, how they are worked through the system, and how to run the programmes to get the results. We provide end-to-end training and education for this,” says O’Malley.

Given that earlier recognition and treatment of sepsis could save up to 14,000 lives a year, there is a clear need for this support. At present, the UK Sepsis Trust estimates that sepsis claims more lives than breast, bowel and prostate cancer combined.

According to Daniels, technology will become increasingly important in the recognition and management of sepsis, as well as in assisting in the responsible use of antimicrobials. “In identifying the organisms responsible for sepsis, the gold standard remains blood culture technology, which has existed largely unchanged for a century,” he says. “Emerging technology allows more rapid identification of bugs – within hours rather than days.”

“There is a profound opportunity to benefit patients,” says Ellison. “We need to make sure that the right samples are taken, leading to actionable results reaching patients at the right time for optimal outcomes.”