Sepsis: a major killer facing a new tech challengeHospitals
By Chuck Acquisto, Esq.
Working in the health care industry, I would be the first to admit our nation’s biggest health danger is the public’s lack of health education. You see, until seven weeks ago, I had never heard of sepsis. Sadly, neither had my mother Rosemary, a vivacious, go-go lady who had just celebrated turning 74 years old by leasing a brand-new car.
Today, I now know that my mother joins celebrities Casey Kasem, Christopher Reeve and Muhammad Ali on the long list of people who have died of sepsis. So what is sepsis? It is a rapid, potentially deadly reaction that affects roughly one million Americans each year.
In medical terms, sepsis means the body's own immune system is going into overdrive, trying to kill a blood-borne bacterial infection. My mom’s condition started with a urinary tract infection. While flying across the country, I read how sepsis is a treatable condition. But left untreated, it can kill a person in two days. My own math indicated that my mom had sepsis for at least three days, if not more.
The “Cliff Notes” version is that sepsis is a runaway immune response. The irony is that the body's act of self-preservation can actually be lethal. Sepsis begins with what's called systemic inflammatory response syndrome. This is the body ramping up the immune system to fight the bacteria. That is where I found my mother in a Florida hospital; her system had already progressed into sepsis. The next step often is septic shock, in which blood pressure plummets, organs fail, and eventually, the patient dies.
While detecting sepsis often takes one to two days (as results from a bacterial culture are needed), my mom’s condition had deteriorated so badly that her doctors knew she had it within 12 hours. Her kidney was already in renal failure and her heart rate was dropping so rapidly that an external pacemaker was needed. My head began spinning at the hospital as I met with a parade of physicians: a cardiologist, a kidney doc, a lung specialist and a hematologist.
“If only…” became a phrase I muttered time and time again during a three-week battle.
The good news in today’s battle against sepsis is that Texas Tech University’s Department of Chemistry & Biochemistry discovered a new way to significantly reduce the detection time. That critical time will give doctors a greater window in which to successfully treat the patient.
Currently, the detection period runs parallel with the track to death. The objective of the Texas Tech research was to speed that diagnosis time up significantly, to allow for earlier treatment. Instead of awaiting the bacterial culture results, researchers began looking at the body's immune response to those bacteria. After all, bacteria only cause the infection, but it's the body's response to said infection that causes sepsis.
Texas Tech researchers recently filed a provisional patent for a tiny glass and plastic chip that can confirm a sepsis diagnosis in just four hours. This technology was not available to my mom, who was in such a bad state that every hour passing was critical to her survival.
"It is estimated there are one million new cases of sepsis in hospitalized patients per year in the United States," said Dr. John Griswold, professor and chair emeritus in the Department of Surgery at the Texas Tech University Health Sciences Center. "Sepsis is the leading cause of death in intensive care units in the United States, and patients with the diagnosis of sepsis have a minimum of a 30 percent chance of dying of their disease; if their vital organ systems -- brain, heart, lungs, liver, kidneys -- are affected, they have a 70 percent chance of dying. The elderly have the highest rate and, in some studies, death is over 85 percent in those over the age of 75."
I read those stats on the flight to Florida. My heart sank. After arriving at the hospital, my mom’s heart rate plummeted the next day. Just prior to her external pacemaker procedure, she coded on the operating table. Brought back to life through incubation and modern medicine, my mom began an uphill fight. Her kidney was failing. Still, an internal pacemaker procedure was successfully done. Unfortunately, the dominoes continued to fall. A blood-thinning drug produced a reaction, causing her platelets to decrease at the same time it was discovered that a silent heart attack had produced a small hole in her heart. Unable to operate, my mom’s only peaceful choice was hospice.
My mom met the condition’s worst fate, but sepsis can also result in amputation of limbs as well as prolonged hospitalization. Dr. Griswold noted sepsis is considered one of the most costly diseases in health care, with hospital bills rising to a mind-numbing $22 billion to $25 billion each year. Where education of sepsis is critical is that Dr. Griswold predicts the cost will continue to grow by 11 to 12 percent each year without the better detection methods.
"The way they [physicians] treat sepsis right now is through a massive antibiotic administration," said the Health Sciences Center’s Dimitri Pappas, an associate professor of chemistry. "That's good, actually, but if you do it prophylactically and when it's not needed, you're basically helping create drug-resistant bacteria. So there's a need to detect sepsis and to treat it, but not to over-treat it as well, because over-treating it leads to additional problems."
The patent-pending chips by Texas Tech researchers are designed to look for the activation of certain white blood cells, which would indicate the immune system was going to work to fight the infection. The chip requires less than a drop of blood for an accurate test, so doctors can test multiple times to determine the occurrence of sepsis, as well as retest periodically after administering antibiotics to make sure the body's response is returning to normal.
At this point, all testing has been done with the help of stem cells. Because of the chip's success, the next step is to test with human blood. Professor Pappas has already started enrolling patients in the study.
As our Baby Boomer generation ages, this possible advance in fighting sepsis just might be the best news you read in the coming year.
Sepsis occurs when the body gets overwhelmed with rapidly multiplying and spreading bacteria. Clinicians are well aware of the clinical symptoms which frequently include an infection source, developing fever, falling ill and getting worse. Usually intravenous antibiotics are started early to counteract dangerous bacteria dissemination. Sepsis usually occurs in older age or with a compromised immune system, and yes it is a life threatening condition. Catching infections early with the right antibiotics can definitely help, but in many cases the disease cannot controlled any longer once it has spread through the body and affecting multiple organs. Developing new technologies to exactly get the best early strategies to combat this condition is vital.
Excellent article. Rapid detection is the best chance to identify the pathogen and provide the appropriate antibiotic treatment. testing that takes one to two days could have negative outcomes for the patient. Biofire diagnostics provides an accurate and specific result in one hour guiding appropriate therapy and leading to better outcomes.