Better, quicker and more effective treatment for patients with sepsis
Sepsis kills five people every hour and accounts for about 50,000 deaths per year in the UK alone. To mark World Sepsis Day, Professor Anthony Gordon, Chief Investigator of the SepTiC study, who is also a consultant in intensive care medicine, NIHR Senior Investigator and head of the division of anaesthetics, pain medicine and intensive care (APMIC), sheds light on how the study aims to find more effective treatment for sepsis patients.
Sepsis is one of the most serious conditions medical teams deal with. It’s life threatening and always considered a medical emergency. We don’t fully understand why it effects some people at different times but we do know it is caused by the immune system having an extreme response to an infection, most commonly due to an infection caused by bacteria. This causes organs to stop working properly and the body to damage itself because of that immune response, sometimes leading to multiple organ failure.
Patients with sepsis can deteriorate rapidly and this can sometimes be difficult to spot because the symptoms, such as fever, pain and breathlessness, are common to many other diseases. Anything we can do to improve care for these patients is vital to improving outcomes.
For patients receiving critical care in the intensive care unit, this can be even more challenging because they aren’t always able to tell us how they are feeling. But these patients are also at the highest risk because they are already so unwell.
This is why research to refine and improve treatments for sepsis is so vital - so we can respond as quickly as possible, in the most effective way, to help more patients make a full recovery, without lasting side effects.
We’re now recruiting to a new study – SepTiC – which aims to answer three key questions about sepsis treatment. We hope that by examining these questions side by side, we can efficiently find ways to provide more effective treatment, which improves quality of life and survival rates.
Does rapid testing help patients by allowing us to give them antibiotics which are more specific to their infection?
Currently, doctors who think a patient has sepsis initially prescribe very powerful antibiotics, known to be able to treat a large range of infections effectively. Once we know more about the type of infection leading to the sepsis, we can give a more specific antibiotic. These tests currently take several days but our study is using rapid PCR testing, similar to that used during the pandemic, to help more quickly work out what the infection is and therefore know which specific antibiotic is most likely to work.
This has two potential benefits – firstly that patients get the targeted treatment they need more quickly, but secondly it could reduce the use of very powerful, wide-ranging antibiotics, which contribute to the issue of anti-microbial resistance and, in turn, the increase of drug-resistant infections which often lead to sepsis in the first place.
Could some patients with sepsis benefit from having less fluid?
Currently, doctors give all patients with sepsis additional fluid via a drip. This is known to help maintain blood flow to the organs initially and is the gold standard of care. But doctors don’t know exactly how much to give and evidence suggests some patients may benefit from a reduction in fluids once their condition begins to improve. This is because additional fluid may later impair the blood flow to the organs, meaning they can’t recover and work properly. Our study will look at whether removing the excess fluid (using medicines such as water tablets or an injection) after it has done its job may help organs recover more quickly.
Can we safely give the sickest patients a medication to boost their immune system?
Patients who have had sepsis are often at higher risk of getting further infections due to the impact on their immune system. We are also looking at whether an immune stimulating medicine called GM-CSF, also known as Sargramostim, could help reduce the risk of further infections and improve recovery.
We know that anti-microbial resistance is a major contributor to the prevalence of sepsis. An increase in infections that do not respond to the usual antibiotics used to treat them means more patients are at risk of developing sepsis because they have been unable to clear an infection from their body. However, the overuse of antibiotics is also known to cause anti-microbial resistance so any research that can lead to a reduction in the use of antibiotics, especially the most powerful ones, could also have a significant effect on the global fight against AMR.
The SepTiC study is funded by the National Institute for Health & Care Research (NIHR). We are recruiting patients now from across Imperial College Healthcare NHS Trust hospitals, alongside our partners and plan to open up to 60 sites in the UK over the next 9 months.
Find out more about the SepTiC study.
Research at Imperial College Healthcare is supported by funding from the National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre (BRC), a translational research partnership between Imperial College Healthcare NHS Trust and Imperial College London, which was awarded £95m in 2022 to continue developing new experimental treatments and diagnostics for patients.
The SepTiC study is now open for recruitment at St Mary’s Hospital, Charing Cross Hospital, Hammersmith Hospital, King’s Mill Hospital, Queen Alexandra Portsmouth, Bristol Royal Infirmary, Kettering General Hospital, St George’s Hospital, James Cook University Hospital and Russells Hall Hospital.
