Explore the relationship between Coronavirus disease, Sepsis and the potential rise in antimicrobial resistance
Since the coronavirus outbreak, clinicians and scientists have been desperately trying to understand the complex disease. From where the virus originated to how it manifests within the human body, the race to answer these questions has been a phenomenal challenge.
The unpredictable nature of coronavirus has already taken over 1 million lives and witnessed more than 35 million cases worldwide1. As we continue to adapt to the ever-changing obstacles that this new pandemic brings, there is overwhelming evidence connecting coronavirus cases to other life-threatening illnesses.
Sepsis is one of these illnesses. The Global Sepsis Alliance suggests sepsis occurs in 2-5% of patients infected with coronavirus, from which many will die due to its complications. Sepsis results from the body’s overwhelming and life-threatening response to an infection that can lead to organ damage and death. Many types of infections can cause sepsis, but the most common cause is pneumonia. Pneumonia is severe lung inflammation that occurs in response to a bacterial, viral or fungal infection in which the alveoli (air sacs) fill with pus, making it difficult to breathe.
Research indicates that coronavirus infections may lead to sepsis due to several factors, including direct viral invasion, the presence of a superinfection (bacterial, fungal or viral that follows coronavirus) or a co-infection (an existing bacterial, fungal or viral infection with coronavirus), and/or the age of the patient.
Differentiating sepsis from coronavirus infections can be difficult as both share similar symptoms such as fever spikes, breathlessness and muscle pain. Furthermore, symptoms of a coronavirus infection may also be difficult to distinguish from hospital-acquired and ventilator-associated pneumonia in hospital inpatients. This together with documented evidence that secondary bacterial pneumonia was a major cause of death in past viral pandemics (influenza) could explain the surge in empirical broad spectrum antimicrobial use e.g. co-amoxiclav plus a macrolide or the combination of azithromycin and hydroxychloroquine, which is currently undergoing clinical trials. Indeed, as many as 75% of coronavirus infected patients received an antimicrobial. With growing evidence that secondary bacterial infections are not as prevalent as anticipated, the consequence has been an increased exposure to infections in healthcare settings and invasive procedures, along with expanded antibiotic use, all of which has the potential to promote the emergence and spread of resistant pathogens.
What’s new in the world of Sepsis diagnosis and treatment?
Advances in phenotypic antimicrobial susceptibility testing (AST) have come on leaps and bounds, seeing the introduction of rapid automated systems in recent years. This rapid-AST space will soon see the launch of some truly novel and exciting fully automated systems reducing the time to targeted therapy from days, as seen in traditional AST methods, to hours. These systems have the potential to make dramatic improvements in the management of sepsis where time is critical and often a question of life or death.
With bacterial infections being the main cause of sepsis and the growing prevalence of multidrug resistant organisms (MDRO) on a global scale, targeted therapy is now more critical than ever before because sepsis patients do not have the luxury of time. The latest antimicrobials available to treat infections before they lead to sepsis include, but are not limited to, cefidericol, ceftolozane/tazobactam, imipenem/relebactam and meropenem/vaborbactam. These drugs are available to test using sensitive broth microdilution plates producing accurate minimum inhibitory concentrations (MIC) to guide the treatment of these critically ill patients.
Sepsis test could cut diagnosis time from days to minutes as reported by the British Broadcasting Corporation (BBC), highlighting the work done by the “Project Sepsis” group to develop a quick finger-prick test to determine whether an infection is likely to lead to sepsis. This work may have the potential to dramatically assist the early detection of this life-threatening disease.
Awareness is key. Thermo Scientific™ Antimicrobial Sensitivity Testing products are designed with healthcare teams in mind, with the aim of delivering additional insights that can support improved decision making in cases like sepsis, where the right decisions can save lives and reduce hospital length of stay.
A safer, smarter world where we reduce coronavirus/sepsis cases is on the horizon. Join us as we discover it.
1. WHO Coronavirus Disease (COVID-19) Dashboard covid19.who.int/ Figures as of 5 October, 2020