Who Owns Sepsis?

Ideas and Opinions4 February 2020Who Owns Sepsis?Michael Klompas, MD, MPH, Tiffany M. Osborn, MD, MPH, and Chanu Rhee, MD, MPHMichael Klompas, MD, MPHHarvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R.), Tiffany M. Osborn, MD, MPHWashington University, St. Louis, Missouri (T.M.O.), and Chanu Rhee, MD, MPHHarvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2966 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To their great credit, critical care physicians founded the Surviving Sepsis Campaign, promulgated the Surviving Sepsis Campaign guidelines (for which 2 of us are committee members), popularized the principles of early recognition and bundled care, and spearheaded the latest overhaul of sepsis definitions. There is much to acknowledge and celebrate in critical care's leadership of sepsis. One underappreciated consequence, however, is that the critical care perspective, borne of their experiences treating the sickest subset of patients, dominates the popular conception of sepsis.The common perception is that sepsis is always a dire emergency: Patients present in extremis, and failure to ...References1. Rhee C, Dantes R, Epstein L, et al; CDC Prevention Epicenter Program. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. JAMA. 2017;318:1241-9. [PMID: 28903154] doi:10.1001/jama.2017.13836 CrossrefMedlineGoogle Scholar2. Wang HE, Jones AR, Donnelly JP. Revised national estimates of emergency department visits for sepsis in the United States. Crit Care Med. 2017;45:1443-9. [PMID: 28817480] doi:10.1097/CCM.0000000000002538 CrossrefMedlineGoogle Scholar3. Simpson SQ. New sepsis criteria: a change we should not make [Editorial]. Chest. 2016;149:1117-8. [PMID: 26927525] doi:10.1016/j.chest.2016.02.653 CrossrefMedlineGoogle Scholar4. Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care. 2015;19:319. [PMID: 26346055] doi:10.1186/s13054-015-1035-1 CrossrefMedlineGoogle Scholar5. Sterling SA, Miller WR, Pryor J, et al. The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Crit Care Med. 2015;43:1907-15. [PMID: 26121073] doi:10.1097/CCM.0000000000001142 CrossrefMedlineGoogle Scholar6. Lodise TP, Patel N, Kwa A, et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection. Antimicrob Agents Chemother. 2007;51:3510-5. [PMID: 17646415] CrossrefMedlineGoogle Scholar7. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589-96. [PMID: 16625125] CrossrefMedlineGoogle Scholar8. Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014;42:1749-55. [PMID: 24717459] doi:10.1097/CCM.0000000000000330 CrossrefMedlineGoogle Scholar9. Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med. 2017;376:2235-44. [PMID: 28528569] doi:10.1056/NEJMoa1703058 CrossrefMedlineGoogle Scholar10. Liu VX, Fielding-Singh V, Greene JD, et al. The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med. 2017;196:856-63. [PMID: 28345952] doi:10.1164/rccm.201609-1848OC CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Harvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R.)Washington University, St. Louis, Missouri (T.M.O.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2966.Corresponding Author: Michael Klompas, MD, MPH, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215; e-mail, [email protected]harvard.edu.Current Author Addresses: Drs. Klompas and Rhee: Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215.Dr. Osborn: Department of Surgery, Division of Acute and Critical Care Surgery, Washington University, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO 63110-1093.Author Contributions: Conception and design: M. Klompas, T.M. Osborn.Analysis and interpretation of the data: T.M. Osborn.Drafting of the article: M. Klompas, T.M. Osborn, C. Rhee.Critical revision of the article for important intellectual content: T.M. Osborn, C. Rhee.Final approval of the article: M. Klompas, T.M. Osborn, C. Rhee.This article was published at Annals.org on 28 January 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPatient Heterogeneity and the J-Curve Relationship Between Time-to-Antibiotics and the Outcomes of Patients Admitted With Bacterial Infection*Heterogeneity in Clinical Presentations of Sepsis: Challenges and Implications for "One-Size-Fits-All" Time-to-Antibiotic Measures*Elucidating the Spectrum of Disease Severity Encompassed by SepsisAssociation Between Implementation of the Severe Sepsis and Septic Shock Early Management Bundle Performance Measure and Outcomes in Patients With Suspected Sepsis in US HospitalsAntecedent treat-and-release diagnoses prior to sepsis hospitalization among adult emergency department patients: a look-back analysis employing insurance claims data using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) methodologyLikelihood of Bacterial Infection in Patients Treated With Broad-Spectrum IV Antibiotics in the Emergency Department*Prevalence and Clinical Characteristics of Patients With Sepsis Discharge Diagnosis Codes and Short Lengths of Stay in U.S. HospitalsStandardized Care Is Better Than Individualized Care for the Majority of Critically Ill Patients 4 February 2020Volume 172, Issue 3Page: 210-211KeywordsAntibioticsCritical careDiagnostic techniquesIntensive care unitsMyocardial infarctionPatientsSepsisShockSurgeryTreatment guidelines ePublished: 28 January 2020 Issue Published: 4 February 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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