The burden of sepsis: All must be informed

September 13 is World Sepsis Day, declared by the Global Sepsis Alliance. This day is celebrated by health workers across the world. Even though sepsis is a major contributor to mortality, paucity of its awareness is deafening. Sepsis has prematurely taken lives of so many people, including celebrities. Everybody must be educated about the devastating consequence of the condition across the nation and the world.

What is sepsis?
Sepsis, also referred to as septicaemia, is a life-threatening illness that arises when the body is overcome by infection. In lay terms, it occurs when infection from any part of the body (skin, urinary tract, lungs) spreads to the bloodstream and produces toxins that poison the body. This leads to abnormal organ function that consequently leads to high morbidity and mortality. The problem of sepsis has been buried in the heap of burden of infection and as a result has not and is not being addressed properly at the individual, governmental and institutional level.

It is estimated that 60 to 80 per cent of deaths occurring in the developing world is as a result of sepsis. Conservatively, it kills more than six million newborns and children alone every year. Whichever way one may look at these numbers, it’s scary enough to sit and not do anything. It may be contracted within the community we live in or from the hospital.

It ranks among the top three causes of death in the newborns, maternal deaths and is also a major complication following surgery. Conditions that may lead to sepsis include pneumonia, typhoid fever, skin infections, including any kind of boils, urinary tract infection and infections following surgery and child birth.

In the United States of America (USA) where good data exist, sepsis has surpassed heart attack as the number one cause of death and also kills more people than heart attack, prostate cancer, breast cancer and HIV combined. This is the magnitude of the problem of sepsis. It follows that we as resource-poor country may have a much higher burden than the USA.

Who can be infected?
Sepsis does not discriminate between age or sex, meaning it can affect anyone irrespective of lifestyle. People at increased risk are newborns, young children and the elderly. Certain diseases also increases the risk and severity of the condition. It may be seen more in the healthcare settings where eventually most sick patients are diagnosed and treated; it could also be acquired within the community.

How does one know that one has sepsis?

There are a host of non-specific symptoms and signs that the healthcare worker may pick during the hospital visit interaction. A combination of these, with laboratory investigations cardinal of which is blood culture, may assist in confirming the diagnosis.

Suspect sepsis if you (or a relative or a patient) “feel severely sick”, “that something is wrong”, or “are not yourself” and have any of the following symptoms: weakness, loss of appetite, fever and chills, unusual thirst and signs of worsening organ function such as difficult rapid breathing, rapid heartbeat, low blood pressure and reduced urine flow. Some of these symptoms may also pass for malaria so you need a trained health worker to put things together.

Once a diagnosis of sepsis is made and the abnormal function of any of the body systems such as brain, circulation, clotting abnormalities, urine production and others is detected, the patient is admitted to the hospital to receive treatment.

The treatment of sepsis cannot be taken lightly as the cost of inadequate treatment can be costly to life. Studies have shown that recognising sepsis early is the key to survival and all efforts must be made by health workers to update their knowledge and keep abreast of modern ways of diagnosis.

It is known also that any delays in administering appropriate antibiotics can cost the life of the patient or cause severe morbidity that may include the amputation of limbs. Institutions and bodies that need to ensure proper and potent drugs are on the market must be encouraged to ensure that we have genuine drugs to treat patients; failure of which carries dire consequences for the patient.

Role of antibiotics in sepsis
While talking about the use of antibiotics, it is important to discourage the indiscriminate prescribing and use of antibiotics. Billions of dollars spent on antibiotics annually are unnecessary. In fact, close to half of all antibiotics prescribed are not indicated. In Ghana, most dispensary shops sell these drugs without prescription, which is against the Food and Drugs Authority’s guidelines. Drugs such as amoxicillin, penicillin and others can be freely purchased even at car stations.

Frequent and prolonged exposure to antibiotics lead to the scourge of antibiotic resistance, which is a major contributory factor in treatment failures in our hospitals. Everybody is at risk from the indiscriminate use of antibiotics. We are all guilty one way or the other. The problem of resistance does not discriminate between the one who abused it or not, rich or poor. The World Health Organisation and Ministry of Health frown upon the indiscriminate use of this class of medication.

Is there any economic cost to sepsis?
Aside from saving lives, early identification and treatment of sepsis can save the nation huge sums of money that can be used for other development projects. The cost involved in treating late stages of infection is massive. This includes the huge cost of high care, an intensive care unit stay, complex adjunct therapies needed such as mechanical ventilation and drugs.

The Agency for Healthcare Research and Quality (in USA) lists sepsis as the most expensive condition treated in US hospitals, costing more than $20 billion in 2011 increasing on average annually by 11.9 per cent.

The World Sepsis Day noted that the costs related to long-term impact of sepsis have not been quantified but are likely very substantial, including subsequent medical care: the true fiscal burden, considering delayed return to work, the need for families to adjust lifestyles to support and rehabilitation cost is likely to be huge.

What can be done to reduce the risk of acquiring infection? Sepsis is always caused by an infection, with most being bacteria but other micro-organisms such as viruses also cause sepsis.

Simple preventive measures such as hand-washing, vaccination and avoiding indiscriminate antibiotic use have been proven to reduce incidence of sepsis. Good hygiene, sanitation and water supply improvement will help reduce incidence of sepsis.

There is a move by the  Sepsis Alliance (a non-governmental organisation) to get the United Nations Assembly to declare every September 13 as World Sepsis Day.

I am entreating many Ghanaians to support this organisation by visiting their website and signing the World Sepsis Declaration calling everybody to work to reduce sepsis deaths.

The writer is a Paediatric Critical Care Senior Specialist, Komfo Anokye Teaching Hospital (KATH)  and a Member of the Global Sepsis Alliance, Little Steps Foundation - KATH and Paediatric Society of Ghana.