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Updated: Oct 22, 2025
Design of Cecal Ligation and Puncture and Intranasal Infection Dual Model of Sepsis-Induced Immunosuppression
Published on: June 15, 2019
Initial antimicrobial management of sepsis
Michael S Niederman1, Rebecca M Baron2, Lila Bouadma3
1Pulmonary and Critical Care Medicine, New York Presbyterian/Weill Cornell Medical Center, 425 East 61st St, New York, NY, 10065, USA. msn9004@med.cornell.edu.
Abstract:
Sepsis is a common consequence of infection, associated with a mortality rate > 25%. Although community-acquired sepsis is more common, hospital-acquired infection is more lethal. The most common site of infection is the lung, followed by abdominal infection, catheter-associated blood steam infection and urinary tract infection. Gram-negative sepsis is more common than gram-positive infection, but sepsis can also be due to fungal and viral pathogens. To reduce mortality, it is necessary to give immediate, empiric, broad-spectrum therapy to those with severe sepsis and/or shock, but this approach can drive antimicrobial overuse and resistance and should be accompanied by a commitment to de-escalation and antimicrobial stewardship. Biomarkers such a procalcitonin can provide decision support for antibiotic use, and may identify patients with a low likelihood of infection, and in some settings, can guide duration of antibiotic therapy. Sepsis can involve drug-resistant pathogens, and this often necessitates consideration of newer antimicrobial agents.
Insights
Sepsis, a severe infection response, has a high mortality rate. Prompt treatment with broad-spectrum antibiotics is crucial but requires careful antimicrobial stewardship and de-escalation to combat resistance.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
- It is a common complication of infections, particularly hospital-acquired infections, with a mortality rate exceeding 25%.
- Common infection sites include the lungs, abdomen, and bloodstream, with Gram-negative pathogens being frequent culprits.
Purpose of the Study:
- To review the epidemiology, clinical presentation, and management strategies for sepsis.
- To highlight the challenges posed by antimicrobial resistance in sepsis treatment.
- To discuss the role of biomarkers and antimicrobial stewardship in optimizing sepsis care.
Main Methods:
- Literature review of sepsis epidemiology, risk factors, and treatment guidelines.
- Analysis of current therapeutic approaches, including empiric broad-spectrum antibiotic therapy.
- Evaluation of diagnostic and prognostic biomarkers, such as procalcitonin.
Main Results:
- Hospital-acquired sepsis is more lethal than community-acquired sepsis.
- Effective management necessitates immediate, empiric, broad-spectrum antibiotic therapy for severe sepsis and shock.
- Antimicrobial stewardship, de-escalation, and the use of biomarkers like procalcitonin are essential to mitigate resistance and guide therapy.
Conclusions:
- Sepsis management requires a balance between rapid intervention and judicious antibiotic use.
- Antimicrobial stewardship programs are critical to combat the rise of drug-resistant pathogens in sepsis.
- Biomarkers can aid in decision-making for antibiotic initiation and duration, improving patient outcomes and reducing resistance pressure.
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