Severe sepsis and septic shock

In 2004, an Australia-wide study reported that hospital admissions associated with life-threatening infection “septic shock” may have a mortality of 37.5%.

The hospital care of this group alone costs > $60 million annually (1), and the added yearly load of deaths from severe sepsis and septic shock exceeds that attributable to breast and colo-rectal cancer (2) and is three times higher than the national road toll (3).

Reduction of mortality in severe sepsis is dependent on early appropriate antibiotic treatment
figure 1

Available data suggest a critical 6-12 hour window for maximum impact of antibiotic therapy on survival.

CRE researchers are now studying the impact of bacterial load on outcomes in septic shock (the BLISS study), in research linked to the Australasian Resuscitation in Sepsis Evaluation (ARISE) study of patients presenting to hospital with severe sepsis.

At the moment, even with the best available treatment, identification of the pathogen takes about 12 hours and antibiotic susceptibility results can take another 24 hours.

Can we predict antibiotic resistance when a patient first develops septic shock

We have recently shown that the resistance gene pool is naturally limited in Sydney, and that we can accurately predict susceptibility to aminoglycosides and third generation cephalosporins (NPV for resistance >99.5% in E. coli and K pneumoniae). An international consortium is now examining this in other parts of the world.