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Information | What is sepsis?

Sepsis - The Main Cause of Death for Patients in Intensive Care Units Worldwide

Despite of our increased understanding of sepsis and developing better antibiotics, mortality rates due to septic shock remain high and thus sepsis is one of the most challenging problems worldwide. According to Centers for Disease Control and Prevention (CDC), 500,000 cases of sepsis occur annually in the United States, an increase of almost 140 percent over the past decade. Because of difficulty of diagnosis of sepsis and frequent prescription of inadequate antibiotics, the burden of sepsis remains high.

One thirds of patients suffering from septic shock are fatal and 3 to 5 percent of patients admitted to intensive care units are known to be affected by sepsis. If these patients develop severe sepsis or septic shock, multiple-organ failure can occur and thus the mortality rate will increase dramatically. Current death rate due to sepsis is 28 to 50 percent, which is exceedingly high. According to the other report, patients who develop severe sepsis are more than 500,000 each year. The number of patients with sepsis increase for the following reasons: growth of the number of hospitals, increase the cases of immunosuppressant treatment for patients with cancer, autoimmune diseases, or organ transplant, expensive cost of antibiotics, increase the number of young and old patients, usage of artificial ventilator for long period of time. Therefore, treating patients with sepsis costs 5 to 10 billion a year in the United States . When a patient is admitted for other than sepsis, an estimated cost of treatment is 750 dollars; however, a patient with sepsis costs around 930 dollars in England.


What is Sepsis?

Sepsis is defined as systemic inflammatory response syndrome (SIRS) caused by infection. Many different microbes can cause sepsis. Although bacteria are most commonly the cause, viruses and fungi can also cause sepsis. Infections in the lungs (pneumonia), bladder and kidneys (urinary tract infections), skin (cellulitis), abdomen (such as appendicitis), and other organs (such as meningitis) can spread and lead to sepsis. Infections that develop after surgery can also lead to sepsis. Sepsis can progress to severe sepsis leading to more fatal condition, septic shock.



An immunocompromised patient, the elderly, and an infant have very weak defense mechanism against infection. In addition, patients with serious diseases, such as diabetes, cancer, kidney failure, cirrhosis, and bedsore, have a high risk of being infected by microbes. Bone-marrow cancers, such as leukemia, lymphoma, and myeloma, affect the body immune system directly and thus sepsis can occur easily patients with these conditions.

Symptoms of Sepsis
Common symptoms of sepsis are as follows:
Fever or Hyporthermia, Increase level of C-reactive protein (CRP)
Rapid heart beat, Increase in cardiac output and decrease in systemic vascular resistance
Hyperventilation, Tachypnea accompanied with respiratory alkalosis
Increase in procalcitonin concentration, Increase in Interleukin 6 and 8
Change in coagulation parameters, Confusion or delirium, Hyperbilirubinemia
Increase in insulin demand

Cause of Sepsis
Bacterial infections are the most common cause of sepsis. Sepsis can also be caused by fungal, parasitic, or viral infections. When analyzed the test results of patients being already diagnosed with sepsis using the blood culture method, 70% of patients have either Gram (+) or Gram (-) and the rest is infected with fungi or co-infected with both fungi and bacteria.

Diagnosis of Sepsis
Sepsis is first suspected when a patient shows several vital signs, such as high or low body temperature, raised heart and breathing rate, and elevated white blood cell count. X-ray, hemoptysis, or blood culture is used to confirm whether a patient has sepsis.

The blood culture system is currently the most important diagnostic method for diagnosing blood infection. However, this method takes long time to diagnose a patient and bacteria may not always grow in a blood culture, particularly if the person is taking antibiotics.

PCR method can detect bacteria and fungi from blood without culturing by amplifying their DNA. The advantages of PCR are being able to detect pathogens in the early stage and discriminate antibiotic resistance. However, the conventional PCR method has difficulties in reproducibility and specificity.

Limitation of Current Diagnostic Method
The common diagnostic method for detecting sepsis causing microbes is blood culturing. A few problems, however, exist. Blood sample used in this method is already pretreated with antibiotics and some microbes do not grow in the culture system. Besides, sepsis causing fungi cannot be detected using blood culture.

The main disadvantage of blood culture is time-consuming because it usually takes 3 to 8 days to find the cause of sepsis. Given the fact that early diagnosis and prompt prescription of adequate antibiotics is the most important factor of cure for sepsis, delaying in the identification of pathogen is a major setback.

Necessity of Molecular Diagnostics
One of the recently developed methods to diagnose sepsis is application of PCR. Several studies have proved that using PCR to diagnose sepsis has benefits over blood culture, such as being able to detect both dead and live pathogens and very little amount of pathogens in blood. Additionally, Pathogen DNA detection by PCR identifies different types of pathogen including bacteria- and fungi-causing sepsis. However, there are problems of sensitivity and specificity in the conventional PCR method.

Seeplex^® Sepsis DNA Test solves sensitivity and specificity issues that the conventional PCR method had by applying Seegene's DPO™ technology. Seegene's human diagnostic products utilize DPO™ Multiplex PCR Test and thus all our products guarantee excellent, trustworthy results.

Treatment
The first step to cure sepsis is early diagnosis followed by prompt administration of antibiotics. and patients must stay on the antibiotic regimens until they are completely cured. Delayed diagnosis in sepsis leads to inappropriate antimicrobial treatment increasing dramatically patients’ mortality rate and the emergence of resistance bacterial strains such methicillin-resistant S. aureus end vancomycin-resistant enterococci. Therefore, it is critical to treat sepsis with rapid and appropriate antibiotics treatment.