Sepsis – a race against time
New antibiotics needed ‘as a matter of urgency’
IT IS every parent’s worse nightmare. Each year, sepsis claims tens of thousands of lives, with tiny, defenceless newborns among those most at risk.
And cases of the lifethreatening condition are rising, with fears that one day the infection may become untreatable.
Last week, Coronation Street viewers were brought to tears by scenes which showed the moment seven-year-old Jack Webster learned the devastating news that his foot had been amputated.
Surgeons were forced to remove his foot and part of his leg after the schoolboy contracted sepsis from a tumble while playing football.
In recent months there have been dozens of harrowing and heartbreaking tales in the media of families who have lost loved ones to the condition.
But why are cases of sepsis increasing?
Dr Ron Daniels is chief executive officer at the charity UK Sepsis Trust.
He says that there are several factors behind the rise, such as an ageing population, advances in treating premature babies and antibiotic resistance.
“Reported cases of sepsis have been increasing around 11 per cent each year over the past decade,” he said.
“What we don’t know is how much of this increase is a true increase in terms of people contracting the disease, how much is more cases being diagnosed and reported and how much is down to antibiotic resistance.
“It’s also highly likely that we are seeing more cases because the population is ageing and we are getting better at saving premature babies – the two age groups most at risk.
“Historically babies born prematurely would have died immediately after birth because of complications with breathing.
“We are now getting them past that hurdle, but they are then more susceptible to sepsis and other infection.
“Very poorly, very premature babies spend typically weeks and months in hospital, they’ll have lines in, undergo multiple procedures and each time they do their risk increases.”
Sepsis is the body’s reaction to infection, meaning that the longer an infection goes untreated, the more risk it has of developing into the life-threatening condition.
Dr Daniels explained that, on average, around 40pc of sepsis cases are caused by ecoli – the same bacteria that cause many urinary tract infections (UTIs). He said that 40pc of ecoli is now resistant to first-line antibiotics, such as penicillin, meaning that if someone was being treated for a UTI with antibiotics which were ineffective, it would increase the risk of the infection developing into sepsis.
A new report from medicines watchdog the National Institute for Health and Care Excellence (Nice) warned that those at high risk of severe illness or death from sepsis must be reviewed by a senior doctor in hospital within an hour and also start on antibiotics.
It comes following previous guidance from Nice which says the condition should be treated as an emergency in the same way as heart attacks.
As well as the elderly and premature babies, there are several other groups who are at a higher risk of contracting sepsis.
They are people with long-term diseases, such as diabetes; people who take steroids, like those with asthma; people who have lung conditions such as COPD (chronic obstructive pulmonary disease) and are more likely to contract pneumonia and people undergoing treatment for cancer, who already have a weakened immune system.
In 2014, Lord Jim O’Neill of Gatley chaired an independent review into Antimicrobial Resistance (AMR) for the Cameron government. He warned that if new antibiotics weren’t developed urgently, by 2050 many infections – like sepsis – could be untreatable. He said that anti microbial resistant infections currently claim at least 50,000 lives each year across Europe and the US.
If no new drugs are created and the rise in resistance continues, Lord O’Neill believes that it could be responsible for the deaths of 10m people each year 30 years from now.
Dr Daniels says that if Lord O’Neill’s findings are right, then by 2050 the country’s population could begin shrinking in size.
“It’s a scary thought,” he said.
“Each year in the UK, there are somewhere between 250,000 to 500,000 cases of sepsis. If we don’t develop new antibiotics as a matter of urgency, many infections like sepsis won’t be treatable.
“That means we could see half a million deaths a year just from sepsis, then there’s several hundred thousand deaths each year from cancer, heart conditions and strokes.
“The birth rate in the UK is 700,000 each year, so there’s a real risk that the population could start decreasing and we will begin to tip the balance between population growth and decline.”
He added: “We now need a concerted effort from philanthropists, policy-makers and the government to attract pharmaceutical companies and researchers to invest significant effort in this issue and develop new antibiotics. It’s also important that we begin using antibiotics more wisely and educate the public that these kind of drugs won’t work for colds.”
Dr Gary Masterson is president of the Intensive Care Society and a consultant in Critical Care Medicine and Anaesthesia at the Royal Liverpool and Broadgreen University Hospitals NHS Trust.
He agrees that more needs to be done to develop new treatments.
“There is a desperate need for funding into research, particularly in terms of developing novel antibiotics or alternative new treatment strategies.
“The big pharmaceuticals aren’t doing this, which is a worry. There needs to be an international governmental and industry joint initiative to develop such treatments.
“However, the things we can change now and which will make a difference rapidly are getting better at recognition, getting better at treating and giving antibiotics early on to patients.
“Moreover, paramedics should be given the freedom to identify and treat sepsis before the patient even reaches hospital, GPs should be educated to do the same and there must be specific training at medical schools, etc.”
A series of harrowing cases have put the spotlight on sepsis in recent months.
Little Alfie ScramblerHolt died just hours after being rushed to Stepping Hill Hospital in Stockport with sepsis last year.
The nine-year-old’s body was ‘overwhelmed’ by the infection and his case demonstrates the devastating speed with which it can claim lives.
The health secretary was notified about Alfie’s case by a coroner who raised concerns about the systems in place across the country for dealing with the bacterial infection.
An inquest at Stockport Coroners Court last month found Alfie died as a consequence of ‘an overwhelming infection on a background of cerebral palsy’.
Doctors tried to save him, but he was not seen by a consultant.
He died 11 hours after being admitted.
Stockport NHS Foundation Trust, which was responsible for his care, has since apologised, admitting it ‘missed important opportunities in his care’.
Earlier this year, a teenager who had to have both his legs amputated died after losing his battle with sepsis.
Ethan Hunt, who was 16, was resuscitated after going into cardiac arrest at Blackburn A&E, where his family rushed him from their home in Burnley.
Doctors discovered he was suffering from an acute form of sepsis, and he was later transferred to Wythenshawe Hospital.
The young man had to have both his legs amputated below the knee after no pulse was found in his feet. He remained in an induced coma and passed away the following month.