Modern aspects in the diagnosis and treatment of sepsis
Keywords:
sepsis, diagnosis, treatmentAbstract
Sepsis is a global public health problem and one of the most common causes of death worldwide. Despite intensive studies on pathogenetic mechanisms and progress in therapeutic approach in septic patients, the global mortality rate is about 20%. The definitions used in the field of sepsis are developing dynamically. As a result of multicenter studies due to the recognized need for strategic changes in the diagnostic and therapeutic approaches to sepsis, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were approved in 2016, which were published by the European Society of Intensive Care Medicine and the Society of Resuscitation Medicine. This literature review is focused on contemporary aspects in the diagnosis and treatment of sepsis.
References
Fleischmann-Struzek C, Rudd K. Challenges of assessing the burden of sepsis. Med Klin Intensivmed Notfmed, 2023, 118(Suppl 2):68-74.
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219):200-211.
Arefian H, Heublein S, Scherag A, et al. Hospital-related cost of sepsis: A systematic review. J Infect, 2017, 74(2):107-117.
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [published correction appears in JAMA. 2016; 315(20): 2237]. JAMA, 2016, 315(8): 762-774.
Gupta S, Sakhuja A, Kumar G, et al. Culture-negative severe sepsis: nationwide trends and outcomes. Chest, 2016, 150(6):1251-1259.
Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence, 2014, 5(1):4-11.
Angus DC, van der Poll T. Severe sepsis and septic shock [published correction appears in N Engl J Med, 2013, 369(21):2069]. N Engl J Med. 2013; 369(9):840-851.
Nannan Panday RS, Lammers EMJ, Alam N, et al. An overview of positive cultures and clinical outcomes in septic patients. Crit Care, 2019, 23(1):182.
Pakov I. Immune reconstitution in late-presenting HIV-positive case with idiopathic liver cirrhosis and ischemic brain stroke. JBCR, 2023, 16(1):66-73.
Паков И, Дойчинова Ц. HIV-асоциирана смъртност и причини за настъпването ѝ при късно представящи се пациенти. Мединфо, 2020, (3), 58-62. [Pakov I, Doychinova T. HIV-associated mortality and causes of its occurrence in late-presenting patients. Medinfo, 2020, (3), 58-62.]
Cecconi M, Evans L, Levy M, et al. Sepsis and septic shock. Lancet, 2018, 392(10141):75-87.
Gotts JE, Matthay MA. Sepsis: pathophysiology and clinical management. BMJ, 2016, 23:353:i1585.
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 2022, 399(10325):629-655.
Fleischmann C, Scherag A, Adhikari NK, et al. International Forum of Acute Care Trialists. Assessment of global incidence and mortality of hospital-treated sepsis. Am J Respir Crit Care Med, 2016, 193(3):259-272.
Cunha BA. Sepsis and septic shock: selection of empiric antimicrobial therapy. Crit Care Clin, 2008, 24(2):313-334, ix.
Dongkwan H, Seung HK, Young WU, et al. Temperature trajectories and mortality in hypothermic sepsis patients. Am J Emerg Med, 2024, 84:18-24.
National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023, 388(6):499-510.
Rumbus Z, Matics R, Hegyi P, et al. Fever is associated with reduced, hypothermia with increased mortality in septic patients: a meta-analysis of clinical trials. PLoS One, 2017, 12(1):e0170152.
White HD, Vazquez-Sandoval A, Quiroga PF, et al. Utility of venous blood gases in severe sepsis and septic shock. Proc (Bayl Univ Med Cent), 2018, 31(3):269-275.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med, 2017, 45(3):486-552.
Vijayan AL, Vanimaya, Ravindran S, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care, 2017, 5:51.
Yunus I, Fasih A, Wang Y. The use of procalcitonin in the determination of severity of sepsis, patient outcomes and infection characteristics. PLoS One, 2018, 13(11):e0206527.
Velissaris D, Zareifopoulos N, Lagadinou M, et al. Procalcitonin and sepsis in the Emergency Department: an update. Eur Rev Med Pharmacol Sci, 2021, 25(1):466-479.
Weinberger J, Klompas M, Rhee C. What Is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock? Semin Respir Crit Care Med, 2021, 42(5):650-661.
Ryoo SM, Lee J, Lee YS, et al. Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by Sepsis-3. Crit Care Med, 2018, 46(6):e489-e495.
McIntyre L, Rowe BH, Walsh TS, et al.; Canadian Critical Care Trials Group. Multicountry survey of emergency and critical care medicine physicians’ fluid resuscitation practices for adult patients with early septic shock. BMJ Open, 2016, 6(7):e010041.
Semler MW, Self WH, Wanderer JP, et al.; SMART Investigators and the Pragmatic Critical Care Research Group. Balanced crystalloids versus saline in critically ill adults. N Engl J Med, 2018, 378(9):829-839.
Long B, Koyfman A, Modisett KL, et al. Practical considerations in sepsis resuscitation. J Emerg Med. 2017; 52(4): 472-483.
Brown RM, Semler MW. Fluid management in sepsis. J Intensive Care Med, 2019, 34(5):364-373.
Sherwin R, Winters ME, Vilke GM, et al. Does early and appropriate antibiotic administration improve mortality in emergency department patients with severe sepsis or septic shock? J Emerg Med, 2017, 53(4):588-595.
Rhee C, Chen T, Kadri SS, et al.; CDC Prevention Epicenters Program. Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals. JAMA Netw Open. 2024, 7(6):e2418923.
Whiles BB, Deis AS, Simpson SQ. Increased time to initial antimicrobial administration is associated with progression to septic shock in severe sepsis patients. Crit Care Med, 2017, 45(4):623-629.
Seymour CW, Kahn JM, Martin-Gill C, et al. Delays from first medical contact to antibiotic administration for sepsis. Crit Care Med. 2017, 45(5):759-765.
Levy MM, Rhodes A, Evans LE. Steering and Executive Committee of the Surviving Sepsis Campaign. Counterpoint: should the surviving sepsis campaign guidelines be retired? No. Chest, 2019, 155(1):14-17.
Sterling SA, Miller WR, Pryor J, et al. The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Crit Care Med. 2015; 43(9): 1907-1915.
Peltan ID, Brown SM, Bledsoe JR, et al. ED door-to-antibiotic time and long-term mortality in sepsis. Chest, 2019,155(5):938-946.
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious
Diseases Society of America and the American Thoracic Society [published corrections appear in Clin Infect Dis. 2017; 64(9): 1298, Clin Infect Dis. 2017; 65(8): 1435, and Clin Infect Dis. 2017; 65(12): 2161]. Clin Infect Dis, 2016, 63(5):e61-e111.
Rhee C, Kadri SS, Dekker JP, et al.; CDC Prevention Epicenters Program. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use. JAMA Netw Open, 2020, 3(4):e202899.
Kollef MH, Shorr AF, Bassetti M, et al. Timing of antibiotic therapy in the ICU. Crit Care, 2021, 25(1):360.
Coggins SA, Glaser K. Updates in Late-Onset Sepsis: Risk Assessment, Therapy, and Outcomes. Neoreviews, 2022, 23(11):738-755.
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med, 2018, 44(6):925-928.
Bai X, Yu W, Ji W, et al. Early versus delayed administration of norepinephrine in patients with septic shock. Crit Care, 2014, 18(5): 532.
Kalimouttou A, Kennedy JN, Feng J, et al. Optimal Vasopressin Initiation in Septic Shock: The OVISS Reinforcement Learning Study. JAMA, 2025, 333(19):1688-1698. Erratum in: JAMA. 2025 May 6;333(17):1549.
Permpikul C, Tongyoo S, Viarasilpa T, et al. Early use of norepinephrine in septic shock resuscitation (CENSER): a randomized trial. Am J Respir Crit Care Med, 2019, 199(9):1097-1105.
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 2021, 49(11):p e1063-e1143.
Chaudhuri D, Nei A, Rochwerg B, et al. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Critical Care Medicine, 2024, 52(5):e219-e233.
Marik PE, Khangoora V, Rivera R, et al. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest, 2017, 151(6):1229-1238.
Rubin R. Wide interest in a vitamin C drug cocktail for sepsis despite lagging evidence. JAMA, 2019, 322(4):291-293.
Seymour CW, Kennedy JN, Wang S, et al. Derivation, validation, and potential treatment implications of novel clinical phenotypes for sepsis. JAMA, 2019, 321(20):2003-2017.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 G. Gancheva (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
You are free to share, copy and redistribute the material in any medium or format under these terms.
Journal Bulgarian Medical Journal (Български медицински журнал / Bulgarian Medical Journal)
