Renaissance Master Caravaggio Didn’t Die of Syphilis, but of Sepsis,

Assignment: Learn everything you can about sepsis than make sure your local hospital uses Artificial Intelligence to diagnose (and even recommend treatment for) sepsis?

Less than one day after burying his beloved wife Barbara, former President George H.W. Bush was hospitalized in the intensive care unit with sepsis.

He recovered and left the hospital, but too often this potentially deadly condition takes lives.  In 2017 alone, 1 in 3 people who died in a hospital had sepsis.

The Centers for Disease Control tracks the disease and its complications.  Last year, it found at least 1.7 million cases diagnosed in the United States.

What is sepsis?  Sepsis is the body’s extreme response to common bacterial infections.  Things as simple as an infected skin cut, a urinary tract infection or illness affecting your lungs can trigger it. If you don’t get proper medical attention quickly, it can lead to tissue damage, organ failure and death.

It can strike anyone, but children, the elderly and those with chronic health problems are most at risk.

To help you know your risk and to avoid putting yourself or your family at risk, check out the CDC’s fact sheets on how to protect yourself. (W)

“Do not take that slight cut on your knee or a bruise on your elbow lightly for they can land your health in a complicated state called sepsis. Sepsis occurs when an existing infection causes the immune system to flare up intensely. As a result, your body swells up severely blocking the blood flow to your organs. While the symptoms take 24 -48 hours to manifest, do watch out for signs of fever, shortness of breath, unbearable pain, and a racy heart. Although bacterial infections are said to be the major cause of the disease, there are other culprits to watch out for.” (A)

Physicians will accept pathogen coverage of 80% to 90% from their preferred empiric antibiotic regimen when managing patients with mild and severe sepsis, respectively, from bacterial infections, survey results showed.

The survey of internal medicine physicians in Canada also showed that physicians perceived that their preferred empiric antibiotic regimen would cover 90% of the offending pathogens in each clinical scenario of sepsis.

Researchers said the findings could be used to inform clinical guidelines and improve prescribing practices.

According to Alex M. Cressman, MD, MSc, from the University of Toronto and Sunnybrook Health Sciences Center, and colleagues, prescribers must balance “early empiric antibiotic coverage and the antimicrobial stewardship goal of minimizing unnecessary broad-spectrum treatment” when choosing an antibiotic regimen. They suggested a need for treatment thresholds to aid physicians in choosing empiric antibiotic regimens for patients with serious bacterial infections.

 “Using a scenario-based survey of general internists and infectious disease specialists across Canada, we characterized physicians’ perceived likelihood of adequate coverage achieved by their preferred empiric antibiotic regimens for patients with mild and severe sepsis,” Cressman and colleagues wrote. “We also identified physicians’ minimum acceptable thresholds of adequate coverage for these patients.”..

According to Kollef and Burnham, treatment bundles can overlook important factors. Specifically, treatment bundles for sepsis tend not to assess antibiotic necessity, dosing strategies and antibiotic duration, and the in vitro activity of the antibiotic regimen. They highlighted the success that rapid molecular diagnostics has had in expediting patient evaluation for sepsis, ensuring effective, early antibiotic therapy and reducing the unnecessary use of broad-spectrum agents.

“Further work is needed to understand their work in a broader context that includes other front-line antibiotic prescribers,” Burnham and Kollef wrote. “Empiric antibiotic prescribing will continue to be a moving target, but with advances in [rapid molecular diagnostics], the ideal scenario of minimizing antibiotic use while maximizing excellent patient outcomes moves closer to realization, including in critically ill patients.” (B)

Hospitals have a hard time meeting the CMS’ sepsis treatment requirements.

The national average compliance rate for the Severe Sepsis and Septic Shock Early Management Bundle is barely 50%, according to the most recent data on Hospital Compare. The measure was adopted in July 2015 to improve hospitals’ identification and treatment of the life-threatening condition. More than 200,000 people die each year from sepsis.

WellSpan Health, an integrated delivery system based in York, Pa., has blown past that average, recently boasting an 85% compliance rate for the bundle. WellSpan executives credit a year-old quality improvement initiative that involves leveraging the electronic health record and a remote patient monitoring team to identify and treat patients with sepsis early…

To address alert fatigue, WellSpan established a remote surveillance team to monitor sepsis alerts and patients’ vital signs 24/7. The Central Alert Team operates much like air traffic controllers do, with the nurses monitoring patients at five hospitals, allowing them to review and intervene when necessary.

“The idea of the alert team is to facilitate early recognition and communication with the care team at the bedside, so they launch appropriate interventions,” Delaveris said.

Alerts go to the Clinical Alert Team rather than nurses at the bedside. Using patient record data on hand, nurses on the alert team will determine if an alert should be elevated to the next level. If so, they contact the patient’s physician or nurse directly to let them know the sepsis bundle should be activated.

Because the nurses only reach out to the bedside team when they see something amiss, the clinicians take their alerts seriously, Delaveris said. WellSpan also introduced the nurses to the clinicians they’d be working with so “it’s not just someone calling from the sky. We wanted to build a relationship and trust,” he added.

At least one registered nurse with intensive-care and emergency department experience is on duty at any given time monitoring patients for sepsis.

The nurses also continuously monitor the patients they see as at risk for sepsis to ensure the clinical team is following all of the bundle’s steps. WellSpan opted to use the bundle from the Surviving Sepsis Campaign, which is closely aligned with the CMS requirements. The bundle has multiple steps that need to be accomplished within designated time periods.” (C)

“Know the risks. Spot the signs. Act fast. Merit Health Wesley has worked for the past few years to integrate evidence-based clinical practices into the medical management of sepsis and reduce risk in the community by educating the public about the illness.

Merit Health Wesley is the first in Mississippi to achieve The Joint Commission’s Gold Seal of Approval for Sepsis Care.

“This achievement is a symbol of quality that reflects our hospital’s ongoing commitment to providing safe and effective patient care,” said Debbie Johnson, vice president of quality and clinical transformation and patient safety officer. “We endeavor to provide the highest quality of sepsis care through a comprehensive, multi-disciplinary approach to sepsis management and long term recovery.”

The sepsis management team at Merit Health Wesley has reduced the risk of sepsis by limiting the progression of sepsis. They are focusing on early diagnosis and rapid, efficient and effective treatment. Key elements of the hospital’s process are medical staff-approved sepsis protocols, a team approach with focused patient handoffs, regular reviews of designed process compliance, and accountability meetings to review outcomes. Merit Health Wesley chose to authenticate their best practices and process improvements by pursuing certification.

Since as many as 87 percent of sepsis cases start in the community, Merit Health Wesley has also implemented a community outreach and education plan. Patients and their families, nursing homes, emergency management staff and other care providers are educated to increase their awareness of sepsis and common early warning signs, as well as, evidenced based standards of care for rapid treatment, all key to improved outcomes and survival.” (D)

“Massachusetts Institute of Technology researchers have developed a machine-learning system that could help clinicians decide when to treat patients for sepsis in the emergency room.

Sepsis is one of the most common reasons for readmission to the hospital and one of the most common causes of death in the ICU. The researchers suggest that most of the ICU patients are admitted through the emergency room.

Treatment typically begins with antibiotics and IV fluids at a couple liters at a time, according to the researchers. Sepsis shock can happen if a patient’s body doesn’t respond well to treatment, which results in blood pressure dropping dangerously low with organ failure. Once that happens, the patient goes to ICU where clinicians can reduce and stop fluids to start vasopressor medications to raise and maintain blood pressure.

However, giving a patient fluids for too long could cause more organ damage. The researchers say that vasopressor intervention could be helpful and has previously been linked to improved mortality in septic shock. But administering vasopressors too early can cause heart arrhythmias and cell damage, leaving clinicians with an unclear answer on when to administer treatment.

MIT researchers have developed a model to alleviate that problem. The model learns from health data on emergency-care sepsis patients and can predict if a patient will need vasopressors within the next few hours.

In a study, the researchers compiled a dataset for ER sepsis patients. When they tested the algorithm, the model was able to predict the need for a vasopressor more than 80% of the time…

The machine-learning system could be used in a bedside monitor to track patients and send alerts to clinicians in the ER about when to start vasopressors and reduce fluids.

“This model would be a vigilance or surveillance system working in the background,” Thomas Heldt, the study’s co-author, said. “There are many cases of sepsis that [clinicians] clearly understand, or don’t need any support with. The patients might be so sick at initial presentation that the physicians know exactly what to do. But there’s also a ‘gray zone,’ where these kinds of tools become very important.”

Other models have been built to predict who is at risk of developing sepsis or when to administer vasopressors in the ICU. The MIT-developed model is the first one to be trained on data from the ER.

“[The ICU] is a later stage for most sepsis patients. The ER is the first point of patient contact, where you can make important decisions that can make a difference in outcome,” Heldt said…

 “The model basically takes a set of current vital signs, and a little bit of what the trajectory looks like, and determines that this current observation suggests this patient might need vasopressors, or this set of variables suggests this patient would not need them,” Prasad said.

The researchers hope to expand their work to make more tools that can predict in real-time if patients in the ER would initially be at risk for sepsis or septic shock.

“The idea is to integrate all these tools into one pipeline that will help manage care from when they first come into the ER,” said Prasad.

The researchers also say that the system could help clinicians in emergency room departments in major hospitals focus on patients who are most at-risk of developing sepsis.

“The problem with sepsis is the presentation of the patient often belies the seriousness of the underlying disease process,” Heldt said. “If someone comes in with weakness and doesn’t feel right, a little bit of fluids may often do the trick. But, in some cases, they have underlying sepsis and can deteriorate very quickly. We want to be able to tell which patients have become better and which are on a critical path if left untreated.” (E)

Jonathan Perlin, MD, president of clinical services and chief medical officer at HCA Healthcare, calls sepsis an “overwhelming infection” that can lead to severe organ failure and even death. He says the key to survival is early recognition and aggressive treatment.

“It’s a medical emergency that should be treated as aggressively as a heart attack or stroke,” Dr. Perlin said. “At HCA, we’re pleased to be able to rally the data of more than 28 million patients every year to help control sepsis, one of the most challenging diagnoses inflicted on patients, and ultimately, better inform patient improvements and outcomes.”..

For every hour of a delayed sepsis diagnosis, it increases the chance of death between 4 and 7 percent…

How does SPOT work?

Hospital computers, through “machine learning”, are trained by ingesting millions of data points on which patients do and do not develop sepsis. Those computers monitor clinical data every second of a patient’s hospitalization.  When a pattern of data consistent with sepsis risk occurs, it will signal with an alert to trained technicians who call a “code sepsis.”

The bedside nurse responds, begins evaluating the patient, and if sepsis is not “ruled out,” treatment begins immediately.

“SPOT is operating with 100 percent sensitivity, that is, all true sepsis positives have been identified,” he said, “allowing caregivers to fully focus on those patients who need intensive monitoring and support.”

More than 5,500 lives have been saved over the last three years as a result of the stop severe sepsis program, the national standard that relies on detecting sepsis at the cusp of deterioration, and HCA’s new technology SPOT.

“The doctors and nurses tell us there were some patients SPOT detected that we would’ve known about,” Perlin said. “More importantly, it told us time and again those patients we didn’t appreciate that were headed towards sepsis.”

HCA celebrated in August 1 million patients followed by SPOT. (F)

“Durham, N.C.-based Duke University Hospital in November will launch Sepsis Watch, a system that uses artificial intelligence to help identify patients in the early stages of sepsis, according to IEEE Spectrum.

Duke University Hospital will deploy the system in its emergency department before extending it to the general hospital floor and intensive care unit.

“The most important thing is to catch cases early, before they get to the ICU,” Suresh Balu, project lead and director of the Duke Institute for Health Innovation, told IEEE Spectrum.

The Sepsis Watch system can identify cases based on numerous variables, including vital signs, lab test results and medical histories. The AI’s training data consists of 50,000 patient records and more than 32 million data points. While operating, the system pulls information from medical records every five minutes to evaluate patients’ conditions, which offers real-time analytics physicians can’t provide.

When the AI system detects a patient who may be in the early stages of sepsis, it alerts a nurse on the hospital’s rapid-response team who will either dismiss the alert, place the patient on a watch list or contact a physician about starting treatment. The system will also walk staff through a sepsis treatment checklist using protocols outlined by the Surviving Sepsis Campaign.

“The model detects sepsis,” Mark Sendak, MD, physician and data scientist, told IEEE Spectrum. “But most of the application is focused on completing treatment.”

Electronic health records can help identify hospitalized patients at risk of death, according to a new study in The American Journal of Medicine.

Inpatients’ conditions can deteriorate quickly; the faster the intervention, the better the patient’s chances of survival. The researchers, from Arizona based Banner Health, created an algorithm that looked for at least two out of four systemic inflammatory response syndrome (SIRS) criteria, plus at least one of 14 acute organ dysfunction parameters. The algorithm continually sampled the EHR data in real time of 312,214 patients in 24 Banner Health hospitals, and contained an alert to notify the physician of the risk of death when a patient triggered it.

The alert identified a majority of the high risk patients within 48 hours of admission and enabled early and targeted medical intervention. The patients who triggered the alert had a “significantly high” chance of dying in that hospital stay compared to patients who didn’t trigger the alarm.” (G)

“.. the technology that goes by the name AI Clinician, described today in a paper in Nature Medicine, doesn’t diagnose—it makes decisions. It takes all the information about a patient with sepsis and recommends a course of treatment.

“It’s not mimicking the perceptual ability of the doctor, where the doctor sees certain symptoms and says the patient is going into septic shock,” says Aldo Faisal, an associate professor of bioengineering and computing at Imperial College London and one of the paper’s authors. “It’s really cognition that is captured here. We’re not just making the AI see like a doctor, we’re making it act like a doctor.”

The researchers didn’t try out their system on real patients; the technology isn’t ready for the clinic yet. Instead, they trained and tested AI Clinician on medical record databases from intensive care units (ICUs) in the United States. They first used 17,000 cases to teach the model about sepsis treatment, and then had it issue recommendations for 79,000 cases.

Overall, the treatments that the AI recommended were more likely to keep patients alive than those administered by the human doctors… 

Part of the treatment is to give patients intravenous fluids and drugs called vasopressors that constrict the blood vessels and increase blood pressure: These actions ensure that blood is reaching the organs. However, there’s considerable debate about how much to give, and when.

The researchers trained AI Clinician to issue recommendations on fluids and vasopressors. Gordon says these basic recommendations are just a start, and that the team has already been working on a model that includes more treatment factors…

Theoretically, an AI could control electronic pumps that deliver IV fluids and medications. “It would be the most personal doctor you can imagine, relentlessly watching over you,” Faisal says…

Essentially, reinforcement learning comes down to trial and error. The trainers establish a goal—such as winning a game, achieving a high score, or keeping a sepsis patient alive—and link it to a reward. (In this case, the AI was programmed to maximize credits, and it earned credits for each patient that stayed alive and lost credits for those that died.) The AI tries out a sequence of actions at random, and if it achieves its goal, it gets the payoff. Over many repetitions, it learns which combinations of actions are most likely to result in the reward.” (H)

“After finding inefficiencies and a high potential for error in their sepsis treatment process, University of Utah Health, a four-hospital system based in Salt Lake City, partnered with clinical communication solutions provider Spok to help improve sepsis response…

Dr. Horton began to identify problems in sepsis response while evaluating patients with fevers. “When I was consulting for a fever, I’d go see a patient, get into their chart and find they had abnormal vital signs that had been there for several days,” he said. “Our EHR imports those notes every day, but there were no discussions about those vital signs.”

At patient bedsides, nurses would take vital signs and continue this process for four or five other patients, making the first vital signs up to an hour old by the time they were entered into the computer. “If this was an emergent case, we’d already lost an hour,” Dr. Horton said. “There may not be communication about those vital signs, they may just sit in the computer waiting for the nurse to see them and a provider may not get back to them quickly.”

Some of the health system’s providers couldn’t put the pieces together to say it was sepsis, Dr. Horton said. “And as we started looking into it, we realized we had no real process in place at our institution to address sepsis as a leading cause of death.”

If there was a way to get the vital signs in the notes sent to a provider who knows what to do with them, the hospital could ensure patients aren’t slipping through the cracks, Dr. Horton said.

To address this issue, University of Utah Health leveraged their EHR system with Spok Care Connect, which takes the EHR’s sepsis alert or a critical test result and sends it to the right clinicians’ mobile device automatically.

The alert contains the information clinicians need to act right away, including who the patient is, their room number and their modified early warning score, or MEWS. MEWS is a physiological test that prevents delays in the intervention or transfer of critically ill patients. The alert is sent in seconds, allowing the care team to respond faster.

University of Utah Health’s EHR automatically uses vital signs entered to calculate the MEWS score. If the MEWS is sufficiently high, Spok sends that MEWS alert as a message to either the charge nurse or the rapid response team. When vitals are outside normal range, the recipients get a notification to begin intervention on that patient right away.

“What was helpful for us was having all our sepsis data in one place — we can look at the data and take it back to our providers to tell them what we’re seeing,” Dr. Horton said. “If you have an EHR-based algorithm, patients’ illness can be detected earlier on and resuscitated earlier on.”

The data University of Utah Health collected also allowed them to look at the odds of septic patients getting antibiotics within the first 24 hours, Dr. Horton said.

“For all sepsis patients, we saw a length of stay that was decreased by 10 percent and because of that our total direct cost decreased by 10 percent.”

“We can have the best hospital in the world, but if you don’t know what vital signs are, and if the vital signs aren’t entered into the computer in real time, then that patient is losing, and the institution is losing,” Dr. Horton said.” (I)

“.. a new alert system, pioneered by doctors at Cambridge University Hospitals and part of a two-year pilot, has led to a seven-fold increase in the number of patients getting life-saving drugs.

The alert system works by constantly analysing patients’ observations, as recorded by staff on handheld devices.

This includes temperature, pulse, blood pressure and level of consciousness taken at various stages as patients are assessed in A&E.

If the observations suggest a patient might have sepsis, a text message appears on the hand-held device and doctors can treat the patient.

The alert system was introduced at Addenbrookes Hospital in 2016. In July 2015, only 11 per cent of patients with possible sepsis were given antibiotics within an hour of arriving at A&E. This increased to 76 per cent by August 2016.” (J)

“New York state hospitals’ adherence to sepsis protocols increased and sepsis mortality declined after reporting became mandatory, researchers said.

The analysis of sepsis reporting data from 185 New York hospitals from April 2014 through June 2016 found that sepsis protocols were initiated in 81.3% of eligible patients, most often in emergency care settings.

Risk-adjusted deaths declined from 28.8% to 24.4% (P<0.001) among patients for whom a sepsis protocol was initiated, reported Mitchel M. Levy, MD, of Brown University/Rhode Island Hospital in Providence, and colleagues in the American Journal of Respiratory and Critical Care Medicine…

While hospitals have some flexibility in developing their sepsis protocols, the law requires:

•             Blood cultures followed by antibiotics and measurement of blood lactate levels within 3 hours of presentation in patients with severe sepsis (“3-hour bundle”)

•             Administration of intravenous fluids (30 cc/kg), vasopressors and re-measurement of lactate within 6 hours in patients with septic shock, defined as systolic pressure <90 mm Hg or lactate level ≥4 mmol/L (“6-hour bundle”)..

Greater hospital compliance with 3-hour and 6-hour bundles was associated with shorter length of hospital stay as well as with increased survival…(K)

“Despite the controversy, the proof in the literature is overwhelming,” he said. “The question I have when I debate this is, ‘Where would you want your loved one to be treated — at a hospital that is known to be continuously working toward meeting these measures or at a hospital that doesn’t agree with them?'”

Twenty-seven states fall below the national average for appropriate sepsis care, according to sepsis performance data added to CMS’ Hospital Compare website in July.

Nationally, the average percentage of patients who received appropriate care for severe sepsis and septic shock is 49 percent, according to Hospital Compare.

The sepsis performance measure is based on data from the first quarter of 2017 through the third quarter of 2017. The preview period for this change spanned from May 4 to June 2. The first full year of sepsis data will be available by October.

Here are the states ranked by the percentage of patients who received appropriate care for severe sepsis and septic shock, ordered from highest to lowest: • New York: 45 (L)

“Sepsis is a major cause of death in U.S. hospitals, yet timely and effective sepsis care can reduce the risk of death,” Chanu Rhee, MD, MPH, assistant professor of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, said during a presentation.

Previously, Infectious Disease News spoke with Konrad Reinhart, MD, chair of the Global Sepsis Alliance, about the global rise of sepsis. Although he said there have been improvements in coding standards in the last 5 years, before that “the medical system was not doing a good job of accounting for cases of sepsis.”

Rhee and colleagues found that the reliance on claims data may be hindering sepsis surveillance, research and quality improvement. Likewise, Rhee said variations in hospital diagnosis, documentation and coding practices may make it difficult to benchmark hospital sepsis outcomes using claims data.

“Administrative claims data have important limitations,” Rhee said. “We know they have low-to-moderate sensitivity when identifying sepsis and, more importantly, recent analyses have suggested that claims-based trends are biased by changing diagnosis and coding practices over time.”..

Rhee explained that varying claims data between hospitals limits its use when comparing sepsis rates and outcomes.

“I would be the first to acknowledge that there is no true gold standard for sepsis,” Rhee said. “However, the EHR clinical criteria, I believe, are more objective and consistent.” (M)

“The Sepsis Alliance is using the month of September to educate the public and care providers about the dangers of sepsis and the need to take quick action. By using the TIME acronym, it serves as a reminder to seek medical attention as soon as symptoms are present.

Temperature – Higher or lower than normal.

Infection – May have signs and symptoms of an infection.

Mental decline – Confused, sleepy, difficult to rouse.

Extremely ill – “I feel like I might die,” severe pain or discomfort.

If you have a combination of any of these symptoms, see your medical professional immediately, call 911, or go to a hospital with an advocate and mention concerns about sepsis.” (N)

“A local hospital is using a lighter approach to educate staff on a critical problem.

Nurses and doctors at Penn Presbyterian had to solve clues, just like an escape room game, to properly diagnose and treat a mock patient with sepsis – a life-threatening response to an infection. And to save him, they had an hour to complete all the tasks.

A nurse developed the exercise to make colleagues more aware of how to detect and treat sepsis.

And some of the equipment in the room was just used as a decoy – trying to make staffers more attentive and think as they would have to in a real-life situation. No doubt this will help them and their patients in the future. (O)

“I have been on active surveillance (AS) for prostate cancer since December 2010. But though I generally am a compliant patient, I increasingly have become resistant to MRIs and biopsies.

I have had five biopsies since 2010. Only a single core out of 60 has revealed any cancer — less than one millimeter back in 2010. It was never seen again.

In the beginning, I had annual biopsies; lately, I have been on a biopsy vacation.

When I heard about potential sepsis, I became uncertain about being needled.

I worry about the potential, though rare, for deadly infections. My hospital takes steps to prevent infections (they have a low rate in prostate biopsies, one infection in 6,000 patients vs one in 1,500 nationally), but sepsis is a killer.” (P)

“When someone is admitted to the hospital, they expect to get better. Instead, nearly 100,000 people in the United States are dying each year because of healthcare-associated infections (HAI), which is more than breast and prostate cancer fatalities combined.

Those who acquire HAIs but survive are forced to stay in the hospital for significantly longer than those who do not receive an infection, racking up medical bills that likely could have been avoided.

According to the Center for Disease Control (CDC), there are four common types of HACs:

Catheter-associated urinary tract infection (CAUTI): This is a type of infection that can occur in any part of the urinary system. The biggest risk factor for a CAUTI is using a catheter for too long. Doctors should remove them as soon as they are no longer needed to minimize this risk.

Central line-associated bloodstream infection (CLABSI): CLABSI is a serious infection that occurs when germs enter the bloodstream through a central line, which is a tube that doctors place near large veins to give medications or fluids or collect blood for testing.

Surgical site infection (SSI): An SSI is an infection that occurs after a surgical procedure at the part of the body where the surgery took place.

Ventilator-associated pneumonia (VAP): VAP is lung infection that develops in individuals while they are on ventilators to help them breathe.

Many HAIs are a result of a doctor failing to follow proper medical procedures. Making errors during surgery, using poor hand hygiene, using materials that are not sterile, improper insertion of a catheter or central line, and failure to remove devices in a timely manner are just some of the ways medical providers can cause HAIs.” (Q)

“Early Recognition of Sepsis across the Continuum. “To facilitate timely diagnosis and management, healthcare organizations across the continuum should have protocols for response when sepsis is suspected, much as they do for chest pain.”” (R)

“In a recent national survey of more than 1,300 EMS providers, the National Association of Emergency Medical Technicians (NAEMT) in association with the Sepsis Alliance found that although nearly all respondents (98%) consider sepsis a medical emergency, only about half (51%) feel very confident in their ability to recognize symptoms of sepsis—the body’s life-threatening response to an infection…

Unfortunately, more than one third of EMS providers surveyed say that sepsis isn’t a key priority within their organization, and 33% say their organization isn’t well prepared for patients with sepsis. Furthermore, 25% state that while they know patients have sepsis, physicians don’t like to diagnose them with it, and 58% say when patients are showing signs of sepsis, not all hospitals initiate a sepsis protocol.” (S)

“UK researchers have developed a test they say might quickly identify sepsis, a potentially fatal complication from an infection.

Scientists at Scotland’s University of Strathclyde developed an experimental microelectrode device that analyzes a patient’s blood and provides results as quickly as 2.5 minutes. Current testing methods for sepsis can take up to 72 hours.

This is important given that every hour without diagnosis and treatment increases the chance of dying.” (T)

Can You Really Get Sepsis from Trying on Shoes Without Socks?  (U)

Famed Renaissance painter Caravaggio didn’t die of syphilis, as some historians long thought.

Instead, it appears that the talented Italian artist — who had a reputation for gambling, drinking, sleeping with prostitutes and even murder — died of a sword wound that developed a nasty infection, leading to deadly condition called sepsis, a new study finds. Sepsis is the body’s overwhelming and life-threatening response to an infection.

A team of French and Italian scientists made the discovery by digging up and analyzing what they believe are the skeletal remains of the revolutionary painter, who died at age 39 in 1610. [Photos: Renaissance Husband’s Heart Buried with Wife]..

Over the years, historians have speculated how the artist died. Caravaggio had a fever at the time his death, prompting some to guess that he had malaria or even brucellosis, an infection that people can get from eating unpasteurized dairy products.

To investigate, the researchers searched the cemetery reported to hold Caravaggio’s remains. They looked for a skeleton that was about 5 feet, 4 inches (1.65 meters) tall and between 35 and 40 years of age.

Nine skeletons in the cemetery met these criteria, but only one dated to the beginning of the 17th century, according to radiocarbon dating, the researchers said. Even more revealing were the high levels of lead in the bones, “which was a discovery of great importance since Caravaggio was known to be careless when using lead for painting,” the researchers wrote in the study, published online Sept. 17 in the journal The Lancet.

The research team also analyzed the individual’s DNA and found that it matched the genetic profile of other men with the name Merisi or Merisio, who are believed to be Caravaggio’s relatives.

Satisfied they had Caravaggio’s remains, the researchers next analyzed his teeth and found the bacteria Staphylococcus aureus hiding within the remaining blood vessels of the artist’s teeth. This bacterial infection likely led to Caravaggio’s sepsis, the researchers said.

“[The cause of death] resulted from sepsis secondary to superinfection of wounds after a fight in Naples, a few days before the onset of symptoms,” they wrote in the study.” (V)

“The cost of treating patients who develop sepsis in the hospital rose by 20% in just three years, with hospitals spending $1.5 billion more last year than in 2015, according to a new analysis.” (X)


“…of the 1.5 million Americans who develop sepsis each year, nearly 260,000 die from it.”