On April 21-22, 2021, World Sepsis Congress will return. Over the course of two days and 15 diverse and highly relevant sessions, over 90 speakers from more than 30 countries will give trenchant talks on all aspects of sepsis, from the impact of policy, the role of artificial intelligence and big data, patient safety, and long-term sequelae through to novel trial design, the latest research, and much more.
A Nevada woman has died from an infection resistant to all available antibiotics in the United States, public health officials report.
According to the Centers for Disease Control and Prevention, the woman’s condition was deemed incurable after being tested against 26 different antibiotics.
Though this isn’t the first case of pan-resistant bacteria in the U.S., at this time it is still uncommon. Still, experts note that antibiotic resistance is a growing health concern globally and call the newly reported case “a wake up call.”
“This is the latest reminder that yes, antibiotic resistance is real,” Dr. James Johnson, a professor specializing in infectious diseases at the University of Minnesota Medical School, told CBS News. “This is not some future, fantasized armageddon threat that maybe will happen after our lifetime. This is now, it’s real, and it’s here.”
According to the report, the woman from Washoe County was in her 70s and had recently returned to America after an extended trip to India. She had been hospitalized there several times before being admitted to an acute care hospital in Nevada in mid-August.
Doctors discovered the woman was infected with carbapenem-resistant Enterobacteriaceae(CRE), which is a family of germs that CDC director Dr. Tom Frieden has called “nightmare bacteria” due to the danger it poses for spreading antibiotic resistance.
The woman had a specific type of CRE, called Klebsiella pneumoniae, which can lead to a number of illnesses, including pneumonia, blood stream infections, and meningitis. In early September, she developed septic shock and died.
The authors of the report say the case highlights the need for doctors and hospitals to ask incoming patients about recent travel and if they have been hospitalized elsewhere.
Other experts say it underscores the need for the medical community, the government and the public to take antibiotic resistance more seriously.
According to the CDC, at least two million people become infected with antibiotic resistant bacteria each year, and at least 23,000 die as a direct result of these infections.
The World Health Organization calls antibiotic resistance “one of the biggest threats to global health.”
A grim report released last year suggests that if bacteria keep evolving at the current rate, by 2050, superbugs will kill 10 million people a year.
While scientists are working to develop new antibiotics, that takes time, and experts encourage doctors and the public to focus on prevention efforts.
One of the most important ways to prevent antibiotic resistance is to only take antibiotics only when they’re necessary.
“Drug resistance like this [case] generally develops from too much exposure to antibiotics,” assistant professor of pediatrics at Johns Hopkins University School of Medicine and director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital, told CBS News. “Every time you’re placed on an antibiotic it’s important to question if it’s absolutely necessary and what’s the shortest amount of time you can take this antibiotic for it to still be effective.”
Johnson notes that medical tourism – the practice of traveling to another country to obtain medical treatment, typically at lower cost – may no longer be worth the risk. “With this [antibiotic] resistance issue, the risk/benefit of this approach really changes and I think that people really need to be aware and seriously consider if it’s a good idea given the possibility of this kind of thing,” he said.
Frequent hand washing, particularly in healthcare settings, is also extremely important in preventing the spread of germs.
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Saving patients from sepsis is a race against time
CDC calls sepsis a medical emergency; encourages prompt action for prevention, early recognition
Sepsis is caused by the body’s overwhelming and life-threatening response to an infection and requires rapid intervention. It begins outside of the hospital for nearly 80 percent of patients. According to a new Vital Signs report released by CDC, about 7 in 10 patients with sepsis had used health care services recently or had chronic diseases that required frequent medical care. These represent opportunities for healthcare providers to prevent, recognize, and treat sepsis long before it can cause life-threatening illness or death.
“When sepsis occurs, it should be treated as a medical emergency,” said CDC Director Tom Frieden, M.D., M.P.H. “Doctors and nurses can prevent sepsis and also the devastating effects of sepsis, and patients and families can watch for sepsis and ask, ‘could this be sepsis?’”
Certain people with an infection are more likely to get sepsis, including people age 65 years or older, infants less than 1 year old, people who have weakened immune systems, and people who have chronic medical conditions (such as diabetes). While much less common, even healthy children and adults can develop sepsis from an infection, especially when not recognized early. The signs and symptoms of sepsis include: shivering, fever, or feeling very cold; extreme pain or discomfort; clammy or sweaty skin; confusion or disorientation; shortness of breath and a high heart rate.
According to the Vital Signs report, infections of the lung, urinary tract, skin, and gut most often led to sepsis. In most cases, the germ that caused the infection leading to sepsis was not identified. When identified, the most common germs leading to sepsis were Staphylococcus aureus, Escherichia coli (E. coli), and some types of Streptococcus.
Health care providers, patients and their family members can work as a team to prevent sepsis.
Health care providers play a critical role in protecting patients from infections that can lead to sepsis and recognizing sepsis early. Health care providers can:
· Prevent infections. Follow infection control requirements (such as handwashing) and ensure patients to get recommended vaccines (e.g., flu and pneumococcal).
· Educate patients and their families. Stress the need to prevent infections, manage chronic conditions, and, if an infection is not improving, promptly seek care. Don’t delay.
· Think sepsis. Know the signs and symptoms to identify and treat patients earlier.
· Act fast. If sepsis is suspected, order tests to help determine if an infection is present, where it is, and what caused it. Start antibiotics and other recommended medical care immediately.
· Reassess patient management. Check patient progress frequently. Reassess antibiotic therapy 24-48 hours or sooner to change therapy as needed. Determine whether the type of antibiotics, dose, and duration are correct.
CDC is working on five key areas related to sepsis:
· Increasing sepsis awareness by engaging clinical professional organizations and patient advocates.
· Aligning infection prevention, chronic disease management, and appropriate antibiotic use to promote early recognition of sepsis.
· Studying risk factors for sepsis that can guide focused prevention and early recognition.
· Developing tracking for sepsis to measure impact of successful interventions.
· Preventing infections that may lead to sepsis by promoting vaccination programs, chronic disease management, infection prevention, and appropriate antibiotic use.
CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, stem from human error or deliberate attack, CDC is committed to respond to America’s most pressing health challenges.
Norepinephrine has long been the stable pressor agent for sepsis, but new data suggest that vasopressin might offer unique benefits. In this “150 Second Analysis”, MedPage Today clinical reviewer F. Perry Wilson discusses a study pitting the two drugs head-to-head, with an eye on renal failure as the primary outcome.
F. Perry Wilson, MD, MSCE, is an assistant professor of medicine at the Yale School of Medicine. He earned his BA from Harvard University, graduating with honors with a degree in biochemistry. He then attended Columbia College of Physicians and Surgeons in New York City. From there he moved to Philadelphia to complete his internal medicine residency and nephrology fellowship at the Hospital of the University of Pennsylvania. During his post graduate years, he also obtained a Master of Science in Clinical Epidemiology from the University of Pennsylvania. He is an accomplished author of many scientific articles and holds several NIH grants. He is a MedPage Today reviewer, and in addition to his video analyses, he authors a blog, The Methods Man. You can follow @methodsmanmd on Twitter.
Centers for Medicare and Medicaid Services (CMS) Issues Sepsis Measure Update
While many sepsis cases are due to unknown organisms and broad spectrum antibiotic selection is appropriate, Centers for Medicare and Medicaid Services (CMS) is releasing an update to the Severe Sepsis and Septic Shock: Management Bundlemeasure to allow for organism specific antibiotic administration when there is clinician documentation that indicates the causative organism and susceptibility are known.
The specification update also allows for organism specific antibiotic treatment of C. difficile suspected sepsis.
The measure update is included in version 5.2 of the Hospital Inpatient Quality Reporting (IQR) Manual in the section on sepsis.
Version 5.1 becomes effective July 1, 2016, so the changes to the Sepsis measure also affect this version.
CDC and CMS believe that antibiotic stewardship and optimal sepsis management are complimentary efforts that both serve to improve patient care
Resource: CDC Digest Bulletin