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Current aspects in sepsis approach. Turning things around.

F J Candel1, M Borges Sá, S Belda

  • 1Francisco Javier Candel González, Department of Clinical Microbiology. Hospital Clínico San Carlos. IdISSC Health Research Institute Universidad Complutense. Madrid. Spain. Avda Profesor Martín Lagos s/n. 28040. fj.candel@gmail.com.

Revista Espanola De Quimioterapia : Publicacion Oficial De La Sociedad Espanola De Quimioterapia
|June 26, 2018
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Summary

Sepsis diagnosis and treatment can be improved by using validated biomarkers like procalcitonin and advanced molecular methods. Early detection and appropriate fluid resuscitation are crucial for better patient outcomes in sepsis care.

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Biomarkers

Background:

  • Sepsis incidence and prevalence may be underestimated due to varying definitions and diagnostic challenges.
  • Delayed detection, particularly in vulnerable populations, and ambiguous presentations complicate sepsis management.
  • Microbiological information is obtained in only 30-60% of cases, highlighting the need for improved diagnostic tools.

Purpose of the Study:

  • To review current understanding and advancements in sepsis diagnosis, treatment, and research.
  • To emphasize the role of biomarkers and novel diagnostic technologies in improving sepsis care.
  • To discuss the importance of early detection, appropriate fluid resuscitation, and future research directions in sepsis.

Main Methods:

  • Review of current literature on sepsis biomarkers, diagnostic methods, and fluid resuscitation strategies.
  • Discussion of advancements in molecular diagnostics, including MALDI-TOF and omics technologies.
  • Analysis of hemodynamic differences in sepsis between neonates, children, and adults.

Main Results:

  • Procalcitonin is a validated biomarker for bacterial sepsis, while presepsin and pro-adrenomedullin aid in early diagnosis and prognosis.
  • Combining biomarkers offers greater clarity for infectious causes than individual markers.
  • Crystalloids and balanced solutions are preferred over artificial colloids for resuscitation, especially in renal insufficiency.
  • Modern molecular methods and MALDI-TOF shorten diagnostic times and optimize antibiotic treatment.
  • Neonatal and pediatric sepsis present unique hemodynamic challenges compared to adults.

Conclusions:

  • Optimizing sepsis diagnosis and treatment involves validated biomarkers, advanced molecular techniques, and appropriate fluid management.
  • Future research focuses on ultra-fast Point-of-Care tests, omics technologies, big data, and microbiome restoration.
  • Establishing a sepsis code improves organization, unifies criteria, and reduces diagnosis and treatment times, leading to better outcomes and cost reduction.