Sepsis: the Achilles’ heel of health care

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.