Deaths Rise From Blood Infection

Experts say 20-year increase is public health concern

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By
HealthDay Reporter

TUESDAY, Nov. 6, 2001 (HealthDayNews) -- Deaths from sepsis, a dangerous bacterial blood infection, have doubled in the last 20 years, a trend that alarms a group of critical-care doctors.

Though the percentage of deaths among sepsis patients has decreased since 1979, the number of deaths sepsis causes has made it the 11th leading cause of death in America, report the researchers.

Sepsis, or septic shock, is the body's response to an overwhelming bacterial infection. Symptoms include fever, pale extremities, confusion, skin rash, rapid heartbeat and decreased urine output. The condition can affect nearly every body system and cause multiple organ failures and death.

Sepsis is more common in men than in women, and it occurs more frequently in blacks than in whites. Newborns and people over 55 also are more vulnerable to sepsis.

The findings were presented yesterday at CHEST 2001, the annual assembly of the American College of Chest Physicians in Philadelphia, Pa.

"We wanted to get an idea of whether sepsis truly is changing in the United States, and, if so, how. We were surprised by the magnitude of the change," says lead research author Dr. Gregory Martin, assistant professor of pulmonary and critical care at Emory University in Atlanta, Ga.

Using data from the National Hospital Discharge Survey, the researchers found the national incidence of sepsis jumped from 469,596 cases to 684,035, an increase of 23.3 percent, between 1988 and 1998. Martin says the HIV epidemic that accelerated during the 1980s may have played a role, since HIV patients are more susceptible to infection.

More aggressive chemotherapy in cancer patients also may factor into the increase, since anti-cancer drugs can compromise a patient's immune system. Invasive procedures such as cardiac catheterization and major surgeries also make sepsis more likely.

Finally, Martin says doctors may simply be getting better at recognizing sepsis, which also could account for the increased numbers.

While the mortality rate from sepsis fell from 20.6 percent to 17.4 percent, the total number of patients who died rose from 96,665 in 1988 to 119,125 in 1998.

The most common cause of sepsis, accounting for 52.9 percent of cases, was gram-positive bacteria, such as Staphylococcus and Streptococcus.

"The increases really are quite dramatic," which may point to changes in the organisms responsible for sepsis, says Martin.

"As incidence gets greater, we're going to have a much larger health care burden," Martin says, pointing to data showing that treating sepsis costs $20,000 to $40,000 per patient.

"It's a huge public health problem," says Dr. Gordon Bernard, director of allergy, pulmonary and critical care medicine at Vanderbilt University, in Nashville, Tenn.

Bernard says doctors fight sepsis by treating the underlying infection with antibiotics and with support for failing organs, including lungs, heart and kidneys.

But Martin says until recently, some two decades of clinical trials have not produced any real advances in specific treatments for sepsis.

However on Monday, drug manufacturer Eli Lilly and Company, based in Indianapolis, Ind., received preliminary approval from the Food and Drug Administration (FDA) for the anti-sepsis drug Xigris, or drotrecogin alfa. Xigris is designed to counter excessive blood clotting typical of the disease.

Before the drug can be marketed, the FDA still must approve the manufacturing plant for the drug, and post-marketing studies must be planned and an advisory committee must agree on the drug's safety.

Bernard estimates that Xigris could be available in about a month or two.

Martin is optimistic about other, future treatments. "It wouldn't surprise me if in the next five or 10 years, we'll start to see more effective therapies."

What To Do: For more information on sepsis, check HealthCentral (caution: this site contains some disturbing images), Sepsis.com, a Web site published by Eli Lilly and Company, or FindArticles.com.

SOURCES: Interviews with Gregory S. Martin, M.D., assistant professor, division of pulmonary and critical care medicine, department of medicine, Emory University, Atlanta, Ga.; Gordon R. Bernard, M.D., professor, director, division of allergy, pulmonary and critical care medicine, Vanderbilt University, Nashville, Tenn.; Nov. 5, 2001, abstract, American College of Chest Physicians annual assembly

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