Prospects for the Management of Sepsis in an Era of Personalised Medicine

Abstract

Improving the outcome for patients with sepsis has been an enduring challenge in clinical medicine for at least the past 30 years. It would be wrong, of course, to say that nothing has changed and that there has been little improvement in survival rates. On the contrary, there have been extraordinary developments in our understanding of the basic science, and marked improvement in the clinical management of sick patients in the care of intensivists and infectious diseases physicians. Nevertheless, it is right to acknowledge that those improvements have largely been incremental changes in supportive care, better ventilator and fluid management, infection prevention and control, and microbiological diagnosis [1]. We have not seen the successful introduction of a specific therapeutic agent that targets the pathological processes in sepsis per se, and which can reverse, or at least ameliorate the tissue injury and consequent organ damage that are the clinical hallmarks of sepsis. It is no accident that in 2017 the World Health Organization (WHO) identified sepsis as the final common pathway for most deaths due to infectious disease worldwide, and urged member states to improve the detection, prevention, and treatment of sepsis as a priority [2]. As the statement from the WHO pointed out, much could be achieved by the better use of techniques already well known and widely available, even in less-developed economies, by improving hand hygiene and other infection prevention methods and by better antibiotic stewardship.