INFECTION CONTROL
antimicrobials, it is much broader than this – it is a problem in farming and community-based healthcare. “Sepsis is not the low-hanging fruit, here,” he argued.
The Academy of Medical Royal Colleges has issued new guidance, in May this year, on the recognition and management of sepsis.
hospitals found an increase during the first 20 months of the COVID-19 pandemic compared with the prior eight months. The research was conducted by Becton, Dickinson, Merck and Pfizer, and was presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases.2 Against this backdrop, antibiotic
prescribing has come under intense scrutiny in recent months and attention has turned to the intrinsic interrelationship between sepsis and AMR. There is an increasing focus on getting the balance right – it is important to administer timely, appropriate antibiotics to save the lives of individuals with sepsis, while preserving our armoury of antibiotics by avoiding unnecessary prescribing.
Getting the balance right With this in mind, the Academy of Medical Royal Colleges issued new guidance, in May this year, on the recognition and management of sepsis – with particular emphasis on the timing of antimicrobial therapy with a view to minimising the impact on AMR.3
The
importance of getting the balance right was a central theme of a recent discussion by Dr Ron Daniels, chief executive at the UK Sepsis Trust, who was invited to give a presentation on ‘What we have
learned from the pandemic’. Speaking at the Infection Prevention and Control Conference, hosted by Knowlex, Dr Daniels opened with some thought-provoking reflections: “We have learned a lot from this pandemic – we have some great things to celebrate, such as accelerated research, including getting answers at scale very, very quickly. We can celebrate the impact of mass vaccination; we’ve learned how to build centres fast, and how to get resources and therapies to people very rapidly. “But I think there is a lot that we have
forgotten. We have forgotten perspective and, to a degree, how we can prioritise people with non-COVID conditions. I also think we have collectively forgotten a bit of respect and that it’s wrong to judge people for their choices. We need to build that back into our healthcare system,” he observed.
He acknowledged that, as we have
emerged from the pandemic, there has been some debate around prioritising sepsis care – specifically the claim that sepsis management has negatively impacted antimicrobial resistance and led to the injudicious prescribing of antimicrobials. Dr Daniels warned against viewing AMR as a ‘sepsis’ problem. Although hospitals do have a problem with injudicious prescribing of
Analysis of antimicrobial resistance at more than 270 US hospitals found an increase during the first 20 months of the COVID-19 pandemic compared with the prior eight months
WWW.PATHOLOGYINPRACTICE.COM SEPTEMBER 2022
Dr Daniels reminded delegates of the scale of the sepsis burden with some startling figures. For dramatic impact, he presented a photo of Aston Villa’s football stadium, enabling delegates to fully visualise the devastating scale of sepsis mortality. The stadium holds around 43,000 people – less than the number of people who die from sepsis each year. He pointed out that sepsis affects 245,000 people in the UK every year, resulting in over 48,000 deaths – more than breast, bowel and prostate cancer combined. “Another thing we have forgotten during the pandemic is the importance of surveillance and monitoring for other conditions – these data are not available at the time of this talk. It’s bigger, of course, than sepsis,” he commented. Dr Daniels explained that sepsis is
a syndrome in response to an infection and, in developed countries, four sorts of infection give rise to 95% of episodes of sepsis – pneumonia, intra-abdominal infection, skin and soft tissue infection, and urinary tract infection.
“A couple of years ago, we set out to identify how many patients were either admitted to hospital with one of these sources of infection or developed one of these infections during their admission. The results will surprise you. “In England, in one year, 1.7 million hospital admissions were complicated by one of those sources of infection or caused by one of those sources of infection. So, to level criticism at sepsis improvement programmes for ‘resulting in increased hospital antimicrobial consumption’ is a little naïve. I would argue that every one of those patients is going to get at least one course of intravenous antimicrobials. It’s around this broader population that we need to seek to improve practice,” he asserted. “While sepsis is a huge problem, no one can argue against the impact of antimicrobial resistance,” he acknowledged. Recently, the Global Antibiotic Research and Development Partnership (GARDP) highlighted the impact of antimicrobial resistance on neonatal sepsis, which accounts for several thousands of lives lost in babies every single month around the world. He went on to highlight the findings of the O’Neill report on AMR,4
which
estimated that there will be an extra 10 million lives lost around the world each year, by 2050, if we don’t act now on AMR.
“I think this was optimistic. Within the 23
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