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Sepsis Matters 2018

posted 22 Mar 2019, 03:20 by Joy Allen   [ updated 28 Mar 2019, 03:36 by Rachel Dickinson ]

On the 3rd October 2018 the NIHR Newcastle In Vitro Diagnostics Co-operative (NIHR Newcastle MIC) held a “Sepsis Matters” event for the Valuing Our Intellectual Capital & Experience (VOICE) research support group, a group of research engaged citizens.  The event was a collaboration between the NIHR Newcastle MIC, The UK Sepsis Trust charity, Newcastle upon Tyne Hospitals NHS Foundation Trust and Anasyst Ltd., a local company based in the North East, who are developing a medical device for diagnosing Sepsis more efficiently and effectively.  This was an opportunity to educate the group about this life threatening condition but also involve the group in the research and development of a new medical test for Sepsis.  By the end of the session the group had increased their knowledge of Sepsis and appropriate use of antibiotics as we demonstrated with a before and after survey. 


The UK Sepsis Trust set the scene with some interesting and worrying facts and figures.  The group learnt that not only is Sepsis more common than heart attacks but it is a leading cause of death:  each year 44,000 – 68,000 people die of Sepsis, this is around the capacity of St. James’ Park football stadium.  The group learnt how the UK Sepsis Trust aims to reduce the impact of sepsis and save lives through: raising public awareness; running training workshops for healthcare professionals; lobbying politicians and supporting people who have been affected by this condition.

Ewan Hunter, infectious lead at the Royal Victoria Infirmary, then explained what Sepsis is.  It is caused by our immune system going into overdrive to combat a spreading severe bacterial infection.  This uncontrolled inflammatory response damages the blood vessels, making them leaky, which causes our blood pressure to dangerously drop leading to organ failure. 

The group learnt that currently diagnosing individuals with a severe infection who might be at risk of developing Sepsis is not trivial.  For example current hospital bedside methods involve taking a set of observations which are time consuming and not specific for Sepsis.  Blood tests for markers of bacterial infection tend to be sent to laboratories as the equipment requires specialised training which could lead to delays in healthcare professionals receiving the test results and starting treatment. 

This is problematic because the key to recovery from Sepsis is early recognition and treatment with the most appropriate antibiotic.  Once patients enter a septic state they deteriorate rapidly.  If patients receive antibiotics within 30 minutes of low blood pressure being noted they have 90% likelihood of survival; the survival rate drops to 50% if antibiotics are started after 4-5 hours.  The group also learnt that even a large amount of antibiotics will fail to rescue a patient if they are left too long in a Septic state without treatment.  Therefore there is an aim to start antibiotic treatment within the first “golden hour” of the Sepsis response. 

The group asked whether all patients with suspected infections could be treated with antibiotics.  They learnt that the symptoms of a severe bacterial infection are also similar to infections caused by other pathogens such as viruses which would not be treated effectively by antibiotics.  In fact inappropriate use of antibiotics for a viral infection could even contribute to an individual being more susceptible to Sepsis triggered from a future bacterial infection.  The group also learnt about the global threat of antimicrobial resistance due to misuse and overuse of antibiotics.  They learnt how routine medical procedures such as hip replacements, minor operations and chemotherapy would be impossible to deliver without the use of antibiotics but these antibiotics would be ineffective if bacteria became resistant. Ewan stated that the “holy grail” would be a new test which would quickly, reliably and cheaply inform a healthcare professional that bacteria were definitely present so they would know whether to start antibiotic treatment.

Zulf Ali, CEO of Anasyst, then spoke about working with the Newcastle MIC to build a map and get a detailed understanding of the journey of a patient with suspected Sepsis within the healthcare system.  This is shaping the creation of Anasyst’s new test for diagnosing Sepsis.  They are developing a small portable diagnostic device which does not require the assistance of skilled technical staff.  It is also more sensitive than other instruments and may only require a finger prick of blood.  This will potentially allow Sepsis markers that are not currently analysed, or ones that are usually only measured in specialised laboratories, to be assessed at the bedside in the hospital or even in a GP surgery or walk in centre. 

With the Newcastle MIC, Anasyst have been canvassing the opinion of healthcare professionals on the use of the test and which markers to include.  They also asked VOICE for their opinion.  The group wondered whether they would be expected to request the test based on the type of infection they had and their overall health.  Ewan, Zulf and the MIC explained that they would not be expected to make a self-assessment as Sepsis can triggered by any type of bacterial infection in any part of the body.  They also explained that while there are certain individuals who are more in danger including people who are: very young; very old; have long term health conditions; receiving medical treatment that weakens their immune system and genetically prone to infections, anyone of any age is potentially at risk of Sepsis. The group liked the idea of the test only needing a finger prick of blood and being conducted in either a walk in centre or at a GP surgery after the sample had been collected at a home visit.  There was a concern around the availability of appointments if the test was to be used in a GP practice.   Zulf explained that the technology could be adapted to produce a quicker result and asked the group’s view regarding how long they would be prepared to wait for the results of the test.  The group were happy to wait for as long as it takes to get an accurate result but they were concerned whether they would have access to treatment quickly enough. 

Ewan, Zulf and the MIC talked through the process and potential advantages of the test.  A healthcare professional would make an initial assessment and conduct the test.  This would enable a patient, if they were quickly declining, to receive an intravenous dose of broad spectrum antibiotics in the ambulance on the way to hospital during the “golden hour”, increasing the patient’s chance of survival.  This would potentially result in a shortened streamlined process when the patient arrives in hospital too as the test could be conducted again to identify the specific bacterial infection driving the Sepsis response.  This would enable the patient treatment to be switched to a more specific antibiotic increasing the chances of a speedier recovery and stopping the overuse of inappropriate antibiotics and issues associated with that such as antimicrobial resistance. 

 

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