Sepsis 2019: What Surgeons Need to Know

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Surgical Practice

Background:

• Sepsis definitions and management strategies are continuously evolving.
• Sepsis-3 criteria, utilizing the Sequential Organ Failure Assessment (SOFA) score, have replaced SIRS-based diagnoses for prognosis.
• Antimicrobial resistance, particularly carbapenem-resistance in gram-negative organisms and ESKAPE pathogens, poses a significant challenge.

Purpose of the Study:

• To review current and emerging strategies in sepsis diagnosis and management.
• To highlight the evolving role of surgeons in sepsis care, including source control and antibiotic stewardship.
• To discuss advancements in diagnostics, therapeutics, and the impact of artificial intelligence in sepsis management.

Main Methods:

• Review of current literature and clinical trial data on sepsis management.
• Analysis of evolving diagnostic criteria and prognostic tools (e.g., SOFA score).
• Discussion of novel antimicrobial agents, diagnostic tests, and therapeutic interventions.

Main Results:

• Sepsis-3 and SOFA scores improve prognostic accuracy.
• Rapid diagnostics and multidisciplinary alerts aid in identifying multidrug-resistant organisms.
• New antibiotic agents and therapies are emerging, with trials like STOP-IT challenging treatment paradigms.

Conclusions:

• Surgeons are integral to sepsis management, focusing on source control and antibiotic stewardship.
• Personalized therapy using biomarkers (e.g., procalcitonin) and novel agents is advancing.
• A broader understanding of sepsis as an acute and chronic condition, coupled with AI and public health initiatives, is crucial for combating resistance and improving outcomes.