As health care systems look to lower costs and improve patient outcomes, controlling sepsis is a great place to start. Ignoring that opportunity is a huge mistake.
Sepsis is caused by the body’s exuberant response to an infection. It is the No. 1 inpatient hospital expense in the United States, with costs tripling over the last decade to $27 billion. Nearly half of all hospital deaths are caused by sepsis. And the problem is growing — it’s now one of the top five causes of hospitalization in age groups over 18. This is why a comprehensive plan to detect, treat, and prevent sepsis must be an essential pillar of any serious effort to improve care and drive down costs.
When a patient spikes a fever for an unknown reason, doctors usually send blood samples to be cultured. But it can take an enormously long time — up to six days — to get the results. In addition, these cultures miss 35 percent to 50 percent of infections.
Given the possible delay and uncertainty of blood cultures, if a patient is at high risk for sepsis, his or her clinician will immediately prescribe antibiotics. Doctors know that this represents overtreatment, since sepsis can be indistinguishable from other less-serious health concerns. But you can’t guess wrong if you suspect sepsis, because a patient’s risk of dying rises as much as 8 percent per hour if the infection is improperly treated.
If the patient does not respond to the antibiotic and the fever does not break after 12 to 24 hours, clinicians usually switch to a different antibiotic, and then maybe another, and then possibly to an antifungal drug.
Hospitals are getting better at combating sepsis. Doctors and nurses across the country have done incredible work to improve sepsis awareness. They are preventing more sepsis-causing infections before they ever occur, and they are reaching for antibiotics quicker when sepsis is suspected.
Yet advances in sepsis treatment protocols are fueling another massive health care issue: the rise of drug resistance and superbugs. On the individual level, even one exposure to an antimicrobial drug can reduce the therapy’s effectiveness for that same patient later on. The overuse of antibiotics and other antimicrobial drugs also kills beneficial bacteria and microbes, which can weaken the immune system and lead to hospital readmission. On the global level, drug-resistant infections are predicted to kill more than 10 million people per year by 2050.
To solve the sepsis problem, we need a three-pronged solution: continued improvements in hospital processes to prevent sepsis; improved diagnostics to get patients on targeted treatment faster; and development of new antibiotics.
Hospitals need to aggressively pursue sepsis initiatives. Huntsville Hospital in Alabama is one of many hospitals on the leading edge of refining their processes around sepsis. Clinicians at Huntsville went on the offense, catching suspected sepsis cases early, improving protocols and education, and creating clinical teams focused on sepsis. The result was a reduction of sepsis mortality by more than 50 percent and a significant decrease in hospital readmissions.
Improving the detection of sepsis is bounded by the limitations of current diagnostic tools. The current standard of care for diagnosing sepsis has remained the same since the 1930s — the lengthy process of culturing blood to detect infection-causing organisms. Diagnostic companies must provide new breakthrough technologies to minimize the one- to six-day dark period in which clinicians work without strong diagnostic information. Without better diagnostic tools, solutions to improve sepsis care and fight drug resistance will remain on a collision course.
Our team at T2 Biosystems is one of many trying to support hospitals in this effort by developing blood tests that can detect the microbes that cause sepsis within hours, not days, and with more than 90 percent sensitivity. Instead of culturing blood, our tests use magnetic resonance technology to identify microbes directly in blood, a much faster approach.
Finally, we need to develop new drugs to combat sepsis. While antimicrobial resistance limits the effectiveness of many existing drugs, the number of new ones to address this problem have dwindled in recent years. We must accelerate clinical trials to develop and release antimicrobial drugs faster and help clinicians apply the best one to the right patient at the right time.
For too long, combating sepsis has been an unspoken problem in health care, taking lives and driving up costs. With thousands of lives and billions of dollars at stake, it is time to place a greater emphasis on new models for sepsis prevention, detection, and treatment.
John McDonough is the CEO of T2 Biosystems, a company that develops innovative medical diagnostic products.
A cure for Sepsis was published last Spring, and is called the Marik IV Protocol, where vitamin C, and other natural metabolites are given to the patient through IV injection. Although the study was small, the results were dramatic, and there is no risk involved in the administration of natural metabolites. Why this highly successful protocol is not immediate made available is the question. The conservative mentality of mainstream medicine is killing people who would otherwise survive Sepsis if the Marik Protocol was put into use.
The relationship of money and monied interests is a serious problem in medical research, from which that report doesn’t suffer. It is nevertheless a low quality study and I personally do not like to experiment on my patients. More attention has been given to the replication crisis in psychology but it is a serious problem in clinical research. I have come to the conclusion that my practice should virtually never be swayed by a single study.
Here is a skeptic’s discussion of this issue- https://sciencebasedmedicine.org/vitamin-c-and-sepsis-all-sound-and-fury-much-ado-about-nothing/ which is balanced in my view.
If you are willing to go down a rabbit hole, follow the link in that article to http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 . Or google John Ioannidis or replication crisis. Vox.com had a couple of very excellent and accessible articles on the latter 2 or 3 years ago. I am all for the skepticism you exhibit and for patients being proactive. Yet please rest assured all our failures do not rest lightly on our shoulders.
One Achilles Heal of healthcare is people who are not practitioners who feel it there obligation to direct, without understanding pathophysiology or their own motivations, like selling something in the guise of information.
The other is “Healthcare” itself.
You sound like a peach. Please explain how John, a leader in the fight against sepsis, with tech that offers us the most viable solution to beating this, is wrong in his efforts. T2 has already saved many lives and could potentially save millions.
Last week my family friend died from sepsis caused by a candida infection. The hospital and the primary facility he visited did not have the T2MR platform and the pathogen could not be identified with blood culture.
Many hospital reps and physicians are not even aware of this tech.
So please enlighten us how John is wrong and this article is a bad thing…
The rise of corporate entities in healthcare including corporate labs now employed by gigantic hospital systems have added to the sepsis problem.
Blood is analyzed by multisystem instruments run by fewer and fewer staff.
Prior to this, the lab staff of reasonably-sized hospitals 100-200 beds took notice of their patient’s results by name or in shared concerns by the phlebotomist who collected the sample(s). Signs of sepsis can be seen by lab staff (Medical Laboratory Scientists ) when changes in Complete Blood Count (CBC) data are noted or flagged for blood-smear preparation, staining and review by competent Lab Scientist.
Today, in a laboratory that processes anywhere from 1,000-5,000 CBCs/day, how many blood-smears do you think can be made and reviewed, and by whom? Bigger does not always save money or lives.
Interesting point of view. Thanks for sharing. Luckily for the patient sake, many of the new systems coming out are fully automated. This is the case with T2 biosystems sepsis solution/ T2MR platform. However, I’m not sure how this will change the plight of the employee stuck working in a understaffed impersonal corporate system. Hopefully it will make it better. I’ve been in that situation myself.
As a hospitalist, I treat sepsis regularly. Though long aware of the gravity of the diagnosis and need for prompt treatment, the Surviving Sepsis campaign has heightened my awareness as well as the aggressiveness of my response. Yet there remain issues of overdiagnosis and more diagnosis in milder cases. Also CMS measures reward more serious diagnoses. Little good data exists, despite the claims of individual hospitals, on the results of the campaign. One retrospective review of hospital claims suggest little improvement- https://jamanetwork.com/journals/jama/fullarticle/2654187 (An opinion piece in the same issue discusses difficulties measuring incidence and outcomes in sepsis). So I’m not sure some of the claims in this article are accurate. A dictum I learned many years ago is that even correct antibiotics make no difference in mortality for the first 24 hours, which I still find quite credible.
There is absolutely need for better guidance from research, and such research has been a very active area for many years; though with very few results that impact survival.
Hi Dr. Carter, can you please clarify what you mean by A dictum I learned many years ago is that even correct antibiotics make no difference in mortality for the first 24 hours, which I still find quite credible.
Josh,
I don’t know of data regarding this, but my program was headed by an ID specialist. If 24 hour mortality in severe sepsis is 3% (an estimate), then even when the correct antibiotics are given as early as possible, 24 hour mortality remains 3%. That is the dictum I was told and I doubt it has changed. Similarly in pneumonia and sepsis (and often pneumonia without sepsis), chest x-rays frequently appear worse after 24 hours despite correct treatment.
Thank you for the explanation. It will be interesting to see the outcome of treating bloodstream infections at an earlier stage with T2, given that it would provide a better picture of organism growth (or lack thereof) at lower levels. I see the conundrum that the lack of patient awareness causes and getting them to present to the hospital in a timely manner. Seems like it could lend further credence to placing T2s desktop sized machines in primary care type facilities.
As a recent sepsis survivor, I believe further education of the public needs to be part of this support as well. Suspect Sepsis and Code Sepsis are both important causes.
Neither myself or my husband knew what Sepsis was before I was admitted with severe septic shock.
I haven’t heard much lately about the hydrocortisone and vitamin C treatment Dr. Paul Marik is using. Have more places adopted it? Have studies shown it not to work? Are there ongoing studies? Based on the initial data it appeared safe, effective, and affordable.