Dr Ron Daniels
Founder & Joint CEO, UK Sepsis Trust
UK Sepsis Trust Founder & Joint CEO Dr Ron Daniels calls for a new approach to Infections Management, to tackle sepsis deaths and threat of antimicrobial resistance (AMR).
Sepsis is the final common pathway to death from most infectious diseases worldwide according to the WHO – the agency which also report that in 2019 an estimated 5 million deaths worldwide were attributed to antimicrobial resistance (AMR). Sepsis most commonly complicates bacterial infections such as UTIs and pneumonia, but can also complicate viral infections including COVID-19 and Ebola.
A complex interrelationship
Sepsis is a life-threatening condition in which the body’s response to an infection causes organ damage. In 2020, it was reported to claim an estimated 11 million lives globally among 49 million people affected every year – for context (and without diminishing the impact of the pandemic), in the more than three years to March 2023, COVID-19 claimed 6.9 million lives.
Antimicrobial resistance is causing harm to patients in our hospitals including in developed countries today, rather than it being a perceived future threat. However, it is not antimicrobial resistance in and of itself which brings about harm, but rather the infections which are rendered untreatable. The final common pathway to death, whether an infection is readily treated with antibiotics or not, is sepsis.
Therefore as the spectre of antimicrobial resistance grows, so will the death toll of sepsis. Simple infections which do not respond to antimicrobials will become life-threatening. Perhaps perversely, efforts to improve outcomes from sepsis which centre around heightening public awareness, resilient healthcare systems and health professional education might increase consumption of antimicrobials which might itself fuel AMR – thankfully data from the UK, Ireland and the USA suggest that this unintended harm of large-scale sepsis improvement efforts is not the reality.
Sepsis most commonly complicates bacterial infections such as UTIs and pneumonia, but can also complicate viral infections including COVID-19 and Ebola.
A new approach to Infections Management
Several governments around the world have initiated, and to varying degrees acted upon, national action plans regarding AMR. Whilst this progress is important, it isolates but one facet of the problem of infections management. We must improve the way in which we use antimicrobials in humans to treat and prevent disease, as well as in agriculture.
Dame Sally Davies has reminded us that AMR presents a more immediate threat to humanity than climate change. Addressing this existential threat requires a similarly coordinated approach.
If we are to envisage a future in which we can reasonably expect that our infections remain treatable, we have to change the paradigm with which we approach infection. Infections Management must address with equal figure four pillars: outbreak surveillance and pandemic preparedness, infection prevention and control, antimicrobial stewardship and the rapid recognition and treatment of sepsis. Until we do so robustly, we risk our existence.