Roberts wants people to know the signs of sepsis, the body’s overwhelming response to a blood infection, which can lead to organ failure and even death. If he had known the signs and insisted that his fiancee was treated appropriately, he believes she’d still be alive.
Sepsis kills over 250,000 people a year in the United States — more than any cause other than cancer and heart disease. But still, many people have never heard of it. And hospitals often fail to notice the warning signs when a patient is spiraling downward.
It’s a complex condition, and researchers are pursuing various avenues to reduce deaths. Last month, for instance, the Food and Drug Administration gave market clearance to a new test that will more rapidly identify the bug triggering a patient’s infection, potentially allowing doctors to give more targeted antibiotics.
The detector, from T2 Biosystems, of Lexington, Mass., finds and identifies the extremely rare bacterial cells in blood samples, rather than having to culture bacteria in a lab dish, which can take days.
While such technologies can help, the biggest problem, say some sepsis experts, is that many doctors, nurses, and family members don’t recognize sepsis until it’s too late, delaying treatment until a life-threatening cascade of inflammation and organ failure has begun.
Roberts’ fiancee, Dorice Broughton, 42, of Gloucester, Mass., showed classic signs of the infection as her condition declined three years ago. She had an open wound that wouldn’t heal and spots of discolored skin, her eyes were glazed over, and she was barely urinating, suggesting that her kidneys were failing. But the signs were missed, and she wasn’t started on antibiotics in time.
Quick treatment makes big difference
Hospitals have been working on the problem for years, and their initiatives — including faster diagnosis and treatment, and removing catheters before infections set in — have led to some dramatic improvements.
Dr. James Weinstein was CEO of New Hampshire’s Dartmouth-Hitchcock Medical Center in 2014 when he launched a hospital-wide effort to bring down the death rate from sepsis. “Over half who were diagnosed never went home. That’s an awesome, scary thing,” said Weinstein, now a visiting professor at the Kellogg School of Management at Northwestern University in Evanston, Ill.
The hospital started patients on antibiotics and fluids immediately after a sepsis diagnosis — and death rates plummeted. They have remained steady at about 12 percent to 15 percent since, he said.
In Pennsylvania, Geisinger Health System has streamlined the process of getting antibiotics to patients with sepsis. That used to take an hour or more, but now a clinician’s “sepsis alert” triggers an automatic page to a phlebotomist to draw blood for analysis and a call to the pharmacy to deliver antibiotics in less than 15 minutes, said Dr. Benjamin Hohmuth, who took over this week as chief medical informatics officer for the health care system.
Seeking to diagnose sepsis more rapidly, the chain of 11 hospitals also launched a system last month to analyze more than 100 variables in patients’ electronic medical records to predict which patients are most vulnerable to sepsis.
Diagnosis can be tricky, said Dr. Karin Molander, a board member of the advocacy group the Sepsis Alliance, which seeks to raise awareness about the condition. Many of the symptoms, such as feeling lousy, are vague and could have many causes, said Molander, a doctor with Mills Peninsula Emergency Medicine Associates in Burlingame, Calif.
It’s the combination of symptoms that should make people think “sepsis,” she said.
For instance, if someone is extremely confused or disoriented and their leg is bright red and warm to the touch, she said, sepsis should immediately come to mind. If a paramedic calls in a sepsis alert to the hospital, studies show that the patient mortality rate drops from 27 percent to 13 percent, Molander said.
The Sepsis Alliance launched an advertising campaign last week that uses “TIME” as an acronym to help people remember to immediately seek medical attention if they experience: temperature above or below normal, infection, mental decline including confusion or sleepiness, and extreme illness with severe pain or discomfort.
Although sepsis is often thought of as a disease of older people with multiple health conditions, it’s important for caregivers to consider sepsis with younger patients, too, several experts said. Broughton was just 42 and relatively healthy when she developed the blood infection; Angelica Hale was just 4 years old.
Hale, now 10 and a spokesperson for the Sepsis Alliance’s awareness campaign, said her parents brought her to the pediatrician’s office three times in one week six years ago. She had a horrible headache, her breaths were shallow, and her blood pressure kept rising. Finally, her parents ignored the doctor’s reassurances that it was just a virus and brought her to the hospital.
They saved her life, but sepsis had already destroyed her kidneys. Hale, who was a finalist on “America’s Got Talent” last year, received a kidney transplant from her mother and still needs to take immunosuppressive drugs to avoid rejecting the organ.
“She’s living with consequences for the rest of her life,” said her father, James Hale, of Atlanta. “And we’re the lucky ones. Losing our 4-year-old daughter was a very, very real possibility.”
Improvements are harder to come by
Despite all these efforts, improvements in sepsis care have leveled off, said Dr. Allan Walkey, an associate professor at the Boston University School of Medicine and co-director of the Evans Center for Implementation and Improvement Sciences.
“The big gains of the prior decades have slowed,” he said, adding that technological advancements like getting better at figuring out which bug is triggering sepsis could make a difference going forward.
Usually, a sepsis patient is immediately started on a broad-spectrum antibiotic. But those drugs can have dangerous and unpleasant side effects, including causing persistent C. difficile infections, which can cause chronic diarrhea and life-threatening inflammation of the colon. And the antibiotics can miss certain bugs. If doctors could tell right away what was causing the infection, they could better target therapy, Walkey said.
That’s the premise behind the T2Bacteria Panel, said John McDonough, president and chief executive officer of T2 Biosystems. Even if sepsis is suspected early, he said, it can take three to five days to grow out the bacteria from a patient’s blood sample and hopefully identify the bug behind the infection. In contrast, T2’s $150 test yields a more precise analysis in five hours by detecting five of the most common sepsis-causing species of bacteria.
“The way we’ve designed this panel is to identify 95 percent of infections not covered by broad-spectrum antibiotics,” McDonough said.
The idea sounds simple, but the process of developing it was not. It’s taken 11 years, 40 patents, and a lot of ingenuity to be able to detect as few as one to 10 bacterial and fungal cells per milliliter of blood, McDonough said.
Such rapid detection could make a big difference for patients who don’t respond to a first-line antibiotic, said Dr. W. Frank Peacock, a professor and research director in the emergency medicine department at Baylor College of Medicine in Houston.
“We’ve maximized what we can do operationally, and the next piece is dropping in these rapid diagnostics, and that will be another step forward,” he said. “Can we decrease mortality another 5 percent by diagnosing people accurately within three to four hours instead of two days?”
Unfortunately, these advances are coming too late for Dorice Broughton, who died in 2015, less than a month after her son graduated from high school.
“Some days it’s tough,” said her fiance, Roberts, who works the meat counter at a Gloucester grocery store. The 63-year-old wakes up alone, makes himself a sandwich for dinner — “I don’t like cooking for one,” he said —and struggles to stay positive.
But then he pays another $300 to buy 1,000 brochures from the Sepsis Alliance, hoping to save some other family from what he’s gone through.