Abstract
International guidelines concerning the management of patients with sepsis, septic shock and multiple organ failure make no reference to the nature of the infecting organism. Indeed, most clinical signs of sepsis are nonspecific. In contrast, in vitro data suggest that there are mechanistic differences between bacterial, viral and fungal sepsis, and imply that pathogenetic differences may exist between subclasses such as Gram-negative and Gram-positive bacteria. These differences are reflected in different cytokine profiles and mortality rates associated with Gram-positive and Gram-negative sepsis in humans. They also suggest that putative anti-mediator therapies may act differently according to the nature of an infecting organism. Data from some clinical trials conducted in severe sepsis support this hypothesis. It is likely that potential new therapies targeting, for example, Toll-like receptor pathways will require knowledge of the infecting organism. The advent of new technologies that accelerate the identification of infectious agents and their antimicrobial sensitivities may allow better tailored anti-mediator therapies and administration of antibiotics with narrow spectra and known efficacy.
Highlights
Sepsis and its sequelae, namely severe sepsis, septic shock and multiple organ failure, dominate the case load of noncoronary intensive care units (ICUs)
Despite a fall in mortality, deaths attributable to sepsis have risen in developed countries as the incidence increases in an ageing population [1,2]
Sepsis is the focus of many quality improvement initiatives
Summary
Namely severe sepsis, septic shock and multiple organ failure, dominate the case load of noncoronary intensive care units (ICUs). In around 40% of cases no organism is identified as the cause of sepsis [30], possibly because of lack of samples, previous antibiotic therapy, or deficiencies in microbiological techniques It is not known how the different microbial groups are represented within this important subgroup [35]. Being directed at TLR4, these therapies may be efficacious only in bacterial Gram-negative sepsis, and their effectiveness will be critically dependent on the nature of the infecting organism. No system has been evaluated extensively in clinical practice, but they offer considerable potential advantages They may facilitate the use of antibiotics with narrower spectra but known efficacy against a particular organism; this may minimize the development of multidrug resistant bacteria and infections such as Clostridium difficile diarrhoea. Other articles in the series can be found online at http://ccforum.com/articles/
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
