Current Clinical Controversies in the Management of Sepsis

Abstract

Sepsis remains a challenging clinical problem requiring prompt diagnosis and optimal clinical management if the continuing high mortality is to be contained. In this brief review I consider four specific questions that are the subject of ongoing controversy. First, whether the new 'Sepsis-3' definitions will be helpful, in particular in improving diagnosis, or whether the rapid move towards precision medicine will make the definition redundant. Second, should we routinely use combinations of antibiotics for the empiric treatment of sepsis. Third, whether there is any clinical benefit in continuous rather than bolus administration of ß-lactam antibiotics. Finally, whether there is good evidence that biomarkers such as procalcitonin can help reduce the duration of antibiotic therapy.

Biomarkers and Newer Laboratory Investigations in the Diagnosis of Sepsis

“…34 PCT values help in deciding about the need for antibiotics and duration of antibiotic therapy. 35 It was also found that use of PCT helps in reduction of antibiotic prescription between 11% and 74%, and reduction of days of antibiotic therapy by between 13% and 55%. 36 In patients admitted to ICU use of PCT-based algorithm resulted in the reduction of antibiotic therapy for the initial infection by 2 days and the total duration of antibiotic therapy by 4 days.…”