How addressing Antimicrobial Resistance is the need of the hour to fight Sepsis

Sepsis is a life-threatening condition characterised by the dysregulated immune response of the host to any bacterial, viral, parasitic or fungal infection in the body. It inadvertently results in disproportionate harm to host tissues and organs while combating an infection resulting in multi-organ failure, intractable shock and, if not promptly remedied during early stages, even demise.

As per the WHO report, in 2017, sepsis accounted for 48.9 million cases and 11 million sepsis-related deaths worldwide, which amounts to almost 20 per cent of all global deaths. While regional disparities in sepsis incidence and mortality exist, approximately 85 per centof sepsis cases and sepsis-related deaths worldwide occurred in low and middle-income countries. A prospective, observational, multicentre, 1-day, cross-sectional study in India by Hammond et al showed a 56.7 per cent prevalence of sepsis across 350 ICUs of the country.

Combating Sepsis

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Early suspicion, effective diagnosis, and prompt and appropriate institution of antibiotics are the mainstay of thwarting infection-related complications and death.

Understanding Antimicrobial Resistance (AMR)

AMR happens when organisms evolve and become resistant to the previously effective antimicrobials commonly called antibiotics. In such a case, the antibiotic ceases to be effective clinically.

Inappropriate and inadvertent use of such antimicrobial agents across industries has resulted in creating selection pressure on organisms leading to the alarming rise of resistance across various classes of organisms to multiple antibiotics so much so that AMR is now an urgent global public health threat, killing at least 1.27 million people worldwide and associated with nearly 5 million deaths in 2019. Coupled with the burden of antimicrobial resistance, deaths due to drug-resistant infections can reach up to 10 million by 2050.

Unraveling the Enigmatic Connection Between AMR and Sepsis

● Undermining the Guardians at the Forefront: Antibiotics embody the vanguard in the battle against infections that can culminate in sepsis. When microbes evolve into formidable foes, impervious to the arsenal of antibiotics, the efficacious treatment of these infections assumes an arduous nature. This can pave the way for the genesis of sepsis.

● Treatment Hindered by Time: Sepsis frequently ensues from neglected or inadequately addressed infections. With the ascension of AMR, the treatment of infections metamorphoses into a race against the clock, as physicians grapple with the quest for potent antibiotics. Protracted delays in treatment can exacerbate the condition, amplifying the jeopardy of sepsis.

● Escalated Mortality: Patients inflicted with sepsis arising from drug-resistant infections bear an elevated mortality risk. The paucity of treatment alternatives implies that, notwithstanding the provision of superlative medical care, certain instances of sepsis culminate in fatality.

The Urgent Need to Address AMR

● Global Health Threat: AMR is not just a problem for one country; it's a global health threat. In a world where people and microbes move freely, resistant infections can quickly spread across borders. This makes it crucial for all nations to work together to address AMR.

● Reduced Effectiveness of Current Treatments: As AMR grows, our current arsenal of antibiotics becomes less effective. This means that even common infections that were once easily treatable can become life-threatening. To preserve our ability to treat infections, we must address AMR.

● Innovative Approaches: Addressing AMR encourages the development of new antibiotics and alternative treatments. Researchers are exploring innovative ways to combat drug-resistant infections, which can benefit sepsis patients by providing more effective treatments.

How Can We Address AMR?

● Prudent Antibiotic Use: Doctors, patients, and industries must use antibiotics responsibly. Addressing the right drug, in the right patient for the right reason in the right dose and duration is essential to mitigate resistance. Over-the-counter sales of antibiotics must be stopped.

● Improved Diagnostics: Faster and more accurate diagnostic tests can help identify the specific cause of an infection and determine the tailored treatment strategy. This reduces the overuse of broad-spectrum antibiotics.

● Genomics-baseddiagnosis: Incorporating genomics-based solutions for routine use in infectious disease diagnostics can translate into a non-linear reduction of the test turnaround time with comprehensiveness for decision-makers to make clinically impactful decision making. It not only strengthens our ability to combat drug-resistant infections but also contributes to the global effort to preserve the effectiveness of antibiotics for future generations.

● Vaccination: Vaccines prevent many infections that can lead to sepsis. Widespread vaccination programs can reduce the need for antibiotics in the first place.

● Sanitation and hygiene: Mass education for the importance of high hygiene standards, resource allocation for the supplies of the same and ensuring compliance for adherence must be undertaken to limit the burden of infections.

● Research and Development: Governments, pharmaceutical companies, and research institutions should invest in the development of new antibiotics and alternative treatments for drug-resistant infections.

[Authored by Dr Mahua Kapoor Dasgupta Director of Medical Affairs (Infectious Diseases), HaystackAnalytics]

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