Sepsis: A Deadly Disease

It started innocently enough. It was just a little cough. But by the time Jim went to bed that night, he had developed fever and chills, and then became too weak and dizzy to walk to the bathroom. He was lightheaded and confused. His wife called an ambulance, and by the time he arrived in the emergency room, his blood pressure was so low, his organs weren’t getting enough blood and oxygen. Jim was diagnosed with pneumonia, but this had evolved into septic shock. Jim and his family certainly knew pneumonia, but like most people, they had never heard of “severe sepsis” or “septic shock.”

This disease has quietly and surreptitiously become the most important disease hospitals face in the 21st century. Sepsis, the body’s response to severe and at times overwhelming infection, is now the number one disease in terms of hospital costs in the United States. More people will die of sepsis this year than breast cancer, prostate cancer, and HIV/AIDS combined. We are truly in the midst of a sepsis epidemic, with the number of patients admitted to the hospital with sepsis rising 10 percent per year, since 2000, more than doubling in seven years.

In spite of advances in treatment, due to the rapidly rising number of cases, there are now more people dying of this disease than ever before. There are many causes for this increase. Although sepsis can strike at any age, from newborns to adults, the elderly are at the highest risk, and they are also a rapidly growing segment of the population. Additionally, more and more treatments for various diseases involve immunologic, biologic, and chemotherapeutic agents, all of which suppress the immune system and increase the risk of infection. The “bugs” themselves are becoming more virulent and aggressive, and more resistant to antibiotics.

More than 10 years ago we sought to improve the recognition and management of this disease at Cottage hospital by developing protocols and instituting improvements in processes of care. With constant vigilance and continued refinements in how we treat them, the survival of patients like Jim has improved from only 50 percent to 85 percent. Yet we have reached a plateau in what we can accomplish with improvements in these processes and overall management. We need new treatments for sepsis.

The cornerstone of treatment for sepsis is antibiotic therapy. Between 1940 and 1962, 20 different classes of antibiotics were introduced. Unfortunately, in the 50 years since, only two new classes have been brought to market. We need a better understanding of the basic physiology of how sepsis causes patients to suffer and sometimes die. Yet, in spite of the importance of this disease, there is very little being spent on research. The National Institutes of Health budget for sepsis research in 2014 was $100 million. Spending was more than three times greater for strokes, 20 times more for heart disease, and 12 times more on the combination of breast, lung, and prostate cancers.

The great diseases of the late 20th century (cardiovascular disease, strokes, and the top three cancers listed above), are now on the decline. The cost and number of hospitalizations from these diseases, and their mortality, have decreased significantly in the past decade. These real and dramatic improvements are the result of major advances in treatment: advances made possible by both public and private funding of research and development. At the same time, the amount of funding going to sepsis research has been stagnant. Why is there so little public awareness and so few resources devoted to treating sepsis?

Sepsis is a disease without a constituency. Most people don’t realize the urinary tract infection they just had, or the pneumonia their parent or grandparent or niece died from last year, was a form of sepsis. Most who survive serious, life-threatening infections never make the connection between their infection and “sepsis.”

Like it or not, funding for health-care research is political. Without a well-identified constituency, lobbying efforts on behalf of sepsis research are fruitless. While the press likes to publicize hospital-acquired infections, such as the recent infections connected to specialized endoscopes, these infections account for only a very small fraction of the infections from which people are dying. The vast majority of severe infections treated in the hospital are acquired in the community, not in the hospital.

Sunday, September 13 is World Sepsis Day. So what can we do about sepsis? If you or a family member has ever had a serious infection caused by pneumonia, kidney infection, skin or joint infections, appendicitis, gall bladder infections, diverticulitis or bowel infections, meningitis, or an infection of any organ, you’ve had sepsis. Urge your elected officials to increase the funding for sepsis research. Give to the Sepsis Alliance or other organizations combating sepsis. Find out what your hospital is doing to treat sepsis and to prevent hospital-acquired infections. If they have not put programs in place to aggressively treat sepsis, urge them to do so now.

While sepsis is a huge and growing problem in adults, particularly the elderly, many children also die of sepsis every day. Get the influenza vaccine each year, and the pneumonia and other vaccines for yourself and your children, as your physician recommends.

In 1896, Sir William Osler, widely considered the father of 20th-century medicine, said, “Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever … ” Today, 120 years later, it is still true. As a nation, if we put the same energy and resources into combating sepsis as we have other diseases, we can finally recognize, and defeat this greatest of enemies.

Jeffrey C. Fried, MD, FCCM, FCCP, practices and teaches critical care medicine at Santa Barbara Cottage Hospital. He is also associate program director of the hospital’s Internal Medicine Residency program and is adjunct clinical professor of medicine at USC’s Keck School of Medicine.