American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Sepsis: Past, present, and future

OCTOBER 24, 2018
Clinical Congress Daily Highlights, Wednesday Second Edition


Sepsis is a major public health burden. Worldwide, it is estimated to affect more than 30 million people and cause six million deaths annually. A Wednesday panel considered how the management and treatment of septic patients has changed, and continues to evolve.

Vanessa Ho, MD, MPH, FACS, MetroHealth, Cleveland, OH, explained how the definition of sepsis has recently changed. Prior to 2016, sepsis was considered to consist of systemic inflammatory response syndrome (SIRS) plus infection. With the publication of the Third International Consensus Definitions for Sepsis and Septic Shock, sepsis is now described as “a life-threatening organ dysfunction caused by a dysregulated host response to infection”. Dr. Ho went on to explain how this new definition makes sepsis a more severe disease than it was as previously described.

The panel next discussed current strategies and guidelines for treating sepsis. Dr. Ho recommended first giving patients fluids (mostly balanced salt solution) if they are fluid responsive, and then treating with vasopressors, with norepinephrine being the first choice. If the patient remains in septic shock after these treatments, Dr. Ho said that steroids can be used, but cautioned that there is conflicting data on the efficacy of steroids in sepsis.

Antibiotics were also a hot topic of discussion. Tanya Zakrison, MD, FACS, FRCS(C), University of Miami Health System, Miami, FL, and Rishi Rattan, MD, University of Miami Health System, Miami, FL, discussed the role of antibiotics for treating multi drug-resistant organisms (MDROs).

Dr. Zakrison said that surgeons can prevent MDROs by identifying risk factors, limiting antibiotic prophylaxis, implementing rapid molecular diagnostic testing, removing the source of infection, using the serum procalcitonin biomarker to guide source control, and finally reducing antibiotic therapy as early as possible.

Dr. Rattan followed up by sharing recent studies that suggest the possibility of using shorter antibiotic durations in septic patients.

“We are entering an era of individual antimicrobial therapy, where we don’t just need to use guidelines to inform treatment,” said Dr. Rattan. “Recent studies have shown that we can use procalcitonin to inform antibiotic duration and reduce mortality.”

The panel closed with discussion on how best to treat sepsis in geriatric patients. Dr. Ho argued that geriatric patients are an entirely different patient population, and thus need to be treated differently.

“Long-term outcomes with older sepsis patients are largely unknown, but we do know that functional outcomes aren’t great at one year,” said Dr. Ho. “We need to set expectations with families for what reasonable outcomes are. For medical therapies, we need to do cardiac output monitoring – our older patients won’t respond the same way to vasopressors or fluid therapy compared to younger patients.”

Dr. Zakrison agreed, and said that doctors don’t always spend the time they need to with elderly patients. She suggested that there should be a geriatric-specific sepsis score, to which the panel and the audience enthusiastically agreed.

Additional information

The panel session, Sepsis Update 2018, was held October 24, at the 2018 Clinical Congress of the American College of Surgeons in Boston, MA. Program, webcast and audio information is available online at facs.org/clincon2018.

Return to index