The burden of sepsis: a call to action in support of World Sepsis Day 2013

Worldwide, sepsis is one of the most common deadly diseases. It is one of the few conditions to strike with equal ferocity in resource-poor areas and in the developed world. Globally, 20 to 30 million patients are estimated to be afflicted every year. Every hour, about 1,000 people and each day around 24,000 people die from sepsis worldwide. Despite accounting for over 8 million lives lost annually, sepsis it is one of the least well known diseases. In the developing world, sepsis accounts for 60-80% of lost lives in childhood, with more than 6 million neonates and children affected by sepsis annually. Sepsis is responsible for >100,000 cases of maternal sepsis each year, and in some countries is now a greater threat in pregnancy than bleeding or thromboembolism.(1) In high income countries sepsis is increasing at an alarming annual rate of 8-13%.(2) Reasons are diverse, and include the aging population, increasing use of high-risk interventions in all age groups, and the development of drug-resistant and more virulent varieties of pathogens. In the developing world, malnutrition, poverty, and lack of access to vaccines and timely treatment all contribute to death. A considerable percentage of sepsis cases could be prevented through the widespread adoption of practices in good general hygiene and hand washing, cleaner obstetric deliveries, and through improvements in sanitation and nutrition (especially among children under 5 years of age), provision of clean water in resource poor areas(3) and vaccination programs for at risk patient populations.(4,5) Sepsis mortality can be reduced considerably through the adoption of early recognition systems and standardized emergency treatment.(6-8) However, these interventions are currently delivered to fewer than 1 in 7 patients in a timely fashion.(7,9,10) Sepsis is often diagnosed too late. Patients and health care professionals do not suspect sepsis, and the clinical symptoms and laboratory signs that are currently used for the diagnosis, such as raised temperature, increased pulse, breathing rate, or white blood cell count, are not specific for sepsis. Low awareness of sepsis as a discrete clinical entity among health professionals is compounded by a lack of reliable systems to aid identification and speed delivery of care. Recognition in neonates and children is even more problematic because the signs and symptoms may be non-specific and subtle but deterioration is usually rapid. The variation in normal physiological parameters with age is a further contributor to difficulties in identifying acute illness early.(11) Despite the fact that a patient with sepsis is around five times more likely to die than a patient who has suffered a heart attack or stroke, the Konrad Reinhart1, Ron Daniels1, Flavia Ribeiro Machado1 “on behalf of the World Sepsis Day Steering Committee and the Global Sepsis Alliance Executive Board”