Surviving sepsis campaign: research priorities for sepsis and septic shock

Abstract

Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

Droplet digital polymerase chain reaction for rapid broad‐spectrum detection of bloodstream infections

“…In combination with retrospectively collected patient data, this could have had impact on the test results as well. Furthermore, we cannot rule out that the PCR assay may have been suppressed in certain patients, for example due to sample matrix components, such as heparin, immunoglobulins, or iron‐associated haemoglobin and lactoferrin (Coopersmith et al , ; Pilecky et al , ). Finally, it is yet unclear how extremely low pathogen DNA loads in the blood circulation (possibly due to previous infections) influence the sensitivity and specificity of the ddPCR (Coopersmith et al , ).…”

“…nuc or eap genes for S. aureus species), but also to allow random access when the system is already running (Hussain et al , ; Wang et al , ). Another limitation is that, in line with most molecular tests, the ddPCR set‐up does not provide information regarding microbial susceptibility to antibiotics (Coopersmith et al , ; Pilecky et al , ). Finally, automation of the ddPCR technique seems desirable for clinical practice, as 1 h hands‐on time requires dedicated personnel, also in the weekends and nights.…”

“…Bloodstream infections (BSIs) are the foremost cause of death due to infections and significantly contribute to morbidity, prolonged hospital stay and increased healthcare expenditures (Kilgore and Brossette, 2008;Goto and Al-Hasan, 2013;Rhee et al, 2017;Coopersmith et al, 2018). Currently, diagnosis of BSIs relies on blood cultures in order to identify the causative pathogen (s).…”

“…This results in a significant time window before a correct diagnosis can be made. Since empirical broadspectrum antibiotic treatment is usually initiated immediately upon admission and later tailored based on culture results, development of microbial resistance is another important issue (Coopersmith et al, 2018). Because of its risk for metastatic infection with a possibly lethal course, a rapid diagnosis of BSIs is crucial to steer treatment and reduce the associated clinical adversities and cost (Kumar et al, 2006;Huang et al, 2013;Seymour et al, 2017;Martin-Loeches et al, 2018).…”

The Effectiveness of Scoring Systems in the Prediction of Diagnosis‐Based Mortality

“…© 2018 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy Ther Apher Dial, Vol. 23, No 5,. 2019 Scores in the Prediction of Diagnosis Mortalite…”