Evidence-based sepsis therapy: a hospitalist perspective

Severe sepsis and septic shock are common and associated with a 30-50% mortality rate. Evidence-based therapies for severe sepsis supported by international critical care and infectious disease societies exist, but are inconsistently employed.

The epidemiology and definitions of sepsis syndromes are reviewed; sepsis therapies supported by definitive studies in the field, along with the supporting literature, are summarized and presented from a hospitalist perspective.

Compelling observational data supports the importance of early, effective antibiotics. Well-designed randomized controlled trials and/or meta-analyses demonstrate the impact of activated protein C, early goal-directed therapy, stress-dose steroids, and intensive insulin in well-defined subgroups of patients. These therapies reduce the absolute mortality risk associated with severe sepsis by 9.5-16%; the corresponding numbers needed to treat to save one life are 6.25-10.5. While major trials are ongoing and the evidence for several sepsis therapies are limited to single trials, the available evidence indicates that appropriate use of these treatments can substantially reduce mortality from severe sepsis.