Educational Article

Rate of Sepsis Increases in the US

By Dr. Robert Martin

One of the greatest medical discoveries of the last century, one that has saved countless lives and is integral to the practice of medicine as we know it today is also a major contributing factor in a significant rise in life threatening infections. The incidence of sepsis – which is defined as an infection that affects more than one organ system in the body with increased temperature and white blood cell count – is increasing by an average of 16% a year in the United States, according to research by investigators at Emory University School of Medicine and the Centers for Disease Control and Prevention.

During the 20-year period from 1979 to 1999, the incidence of sepsis increased by more than 329%, from 78 cases to 259 cases per 100,000 people. Sepsis is a major public health problem consuming more than $15 billion in health care costs annually in this country.

Emory pulmonologist and intensive medicine specialist Greg Martin, MD, presented an analysis of data from the U.S. National Hospital Discharge Survey at the annual meeting of the American Thoracic Society in Atlanta recently. The study is the most comprehensive survey of sepsis epidemiology to date because it includes statistics from the entire country over a long period of time.

The scientists used selected groupings of clinical disease classification codes to identify patients with sepsis and fount that the incidence increased in both children and adults during the 20-year period. Males, blacks and other non-white patients had the highest rates of hospitalization due to sepsis, although the incidence of females and Caucasians increased more rapidly.

The study also indicated an increase in the incidence of a particular class of bacteria resulting in gram-positive infections - typically infection resulting in sepsis has been related to gram-negative bacteria. Results showed gram-positive infections were increasing each year, which by 1999 represented the majority of cases of sepsis (56%), while gram-negative infections, as well as other classes of infections – anaerobic, fungal and viral – were less common. Although relatively uncommon, the greatest increase was in sepsis cases with fungal infections as their source.

Although there has been no scientific study to identify the reasons for the increase in sepsis in the study several explanations were offered. The most prominent reason for this trend seems to be the overuse of antibiotics resulting in the development of resistant organisms. In an era when we rely so heavily on antibiotics on medicine, that reliance is putting us behind the eight ball. Resistance to antibiotics develops because antibiotics typically do not kill all the bacteria just most of them. The ones that survive are resistant to the antibiotic, they continue to reproduce with the non resistant bacteria eventually mutating the entire strain of bacteria making them all resistant. For most healthy adults our bodies natural defenses against infection protect us, however for people with poor immune systems, the elderly and young children their risk increases.

Antibiotic resistant bacteria most disturbingly are not limited to minor bacterial strains but to the most common and serious. Recently a case of infection involving staph aureus, the most common bacteria to cause orthopaedic infection was found to be resistant to the powerful IV antibiotic vancomycin. Awareness of this trend can help us all combat its progression. Don’t use antibiotics unless necessary and always consult your doctor regarding their use.

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