Sepsis is one of the conditions most feared by healthcare providers. These bloodstream infections strike with such rapid intensity that treating them requires a combination of clinical skill and luck: recognizing the symptoms early enough and choosing the right medication to tame the culprit bacteria before the germs have overwhelmed the immune system of the patient. Body.
Too often, sepsis wins the race. According to the US Centers for Disease Control and Prevention, at least 1.7 million people in this country develop sepsis annually. About 350,000 die during hospitalization or are discharged for hospice care.
But new research published in Proceedings of the National Academy of Sciences It offers hope that one day doctors will be able to detect and treat sepsis more quickly.
The researchers broke Pure blood and dried it by heating it, resulting in a solid porous structure with the bacterial DNA trapped inside. They then used chemicals (primers and enzymes) to get inside the porous structure and amplify the target DNA.
The team was able to detect four causes of bloodstream infections – the bacteria Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-sensitive Staphylococcus aureus (MSSA), gram negative escherichia coli, and fungal species candida albicans. They validated their method with results from clinical laboratories that used blood cultures and DNA analysis to detect sepsis.
The technique took just 2.5 hours and required about 1 ml of blood, according to the researchers.
“This technique may have broad applications in detecting bacterial infections and the presence of bacteria in large amounts of blood,” said Rashid Bashir, PhD, dean of the Grainger College of Engineering at the University of Illinois at Urbana-Champaign, and co-author. of the study, said Medscape Medical News.
While infection control experts and sepsis prevention advocates said the new study offers no clues about how to treat sepsis once it’s detected, they hope the innovation could eventually save lives.
a quick killer
Sepsis occurs when the body overreacts to an infection. The severe response can lead to tissue damage, organ failure, and death.
Thomas Heymann, MBA, President and CEO of Sepsis Allianceone advocacy group said mortality can increase 8% for every hour of delay in treatment.
Babies born prematurely are particularly vulnerable. Bashir and his colleagues noted that 25% of all babies admitted to the neonatal intensive care unit are diagnosed with sepsis. Of these, up to 35% may die from an infection. Sepsis is the most expensive condition treated in US hospitals, accounting for $23.7 billion in annual costs, they added.
Despite high mortality rates and hospital costs, according to a Sepsis Alliance Survey, only 66% of Americans know the term sepsis. Only 19% can name the four primary signs of the condition: altered body temperature, an infection, mental deterioration and feeling extremely ill, or “TIME”.
Getting appropriate antibiotics quickly to sepsis patients can greatly improve the chances of survival, but Bashir said the current method of confirming the diagnosis is too slow.
Blood cultures too slow
Traditional blood cultures are among the most common methods of determining if a patient has a bloodstream infection. But the process takes about 24 hours for a culture to detect the category of bacteria and an additional day to determine exactly which bacteria is present, according to Cindy Hou, DO, infection control officer and medical director of research at Jefferson Health, Voorhees. Township. , NJ. At 72 hours, Hou said, a blood culture it will ultimately be able to produce a “sensitivity” result, which tells doctors which antibiotics will be most effective against the pathogen.
By then, patients are often past the saving point. The bottom line, according to Bashir and his colleagues: Blood cultures are “too slow and cumbersome to allow initial management of patients and thus contribute to high mortality.”
Hou called the ability to identify the type of infection in just 2.5 hours an “incredible” feat.
“With sepsis, it’s helpful to have quick diagnoses where results come quickly. Fast is never fast enough,” he said. “These researchers are pushing the bar on what fast means.”
The new detection method is not yet commercially available. Bashir said that he and his colleagues plan to expand his study and hope to find a way to avoid lengthy culture steps to identify target pathogens directly from a large volume of blood.
Hou said he thinks a blood culture would still be necessary, since doctors would need sensitivity results to guide specific treatment of infections.
“We need much more, but this document is a call to arms for the field of rapid diagnostics to do Quick as fast as it really needs to be, but we still need to find solutions that are affordable,” Hou said.
Even without a blood culture, Bashir’s technology could improve care. Heymann said the technology could help convince doctors concerned about antibiotic resistance to prescribe the fastest treatment.
“We know we’re overusing antibiotics and that’s creating a big new problem” when it comes to treating sepsis, he said. “Getting a diagnostic reading sooner is a game changer.”
Combined with a blood culture that can then confirm or help adjust the course of treatment, Hou said this new sepsis detection method could improve care, especially in settings where rapid diagnostics are not available, and particularly if combined with educating doctors so they understand what treatment is best for various types of infection.
Heyman agreed. Sepsis Alliance also operates the Sepsis Collaborative Innovationa group that supports public-private innovation in sepsis care.
“We lose someone every 90 seconds in the United States to sepsis,” Heymann said. “There’s a huge opportunity to do better and it’s this kind of innovation that’s really inspiring.”
Hou is Medical Director of the Sepsis Alliance, Medical Advisor to the Sepsis Innovation Collaborative, Advisor to Janssen, and Key Opinion Leader for T2 Biosystems. Bashir and Heymann report no relevant financial relationships.
PNAS. Posted online on September 26, 2022. Summary
Kerrie Rushton is a freelance writer living in Maryland.