Sepsis is a condition that can be caused by bacteria, fungi or viruses in the blood and is the result of the body’s response to infection. Approximately 30-35% of cases of severe sepsis are fatal, with mortality exceeding that of prostate cancer, breast cancer and AIDs combined.1 The mortality rate is even higher for fungal infections.2 Septic shock is a complication of sepsis that can lead to organ failure and death in approximately 50% of patients.3
A local infection – e.g. in the lung – overcomes the body’s defense mechanisms. Pathogens and the toxins they produce leave the original site of infection and enter the circulatory system.
A general inflammatory response called SIRS (systemic inflammatory response syndrome) causes an individual organ to deteriorate or fail. Sepsis occurs when more than one organ begins to deteriorate.
Septic shock occurs when multiple organs stop functioning and cardio-circulatory failure leads to a sudden drop in blood pressure.1
With 50M cases worldwide each year, its impact on human life and healthcare systems is staggering.4
Sepsis is most likely to develop in immunocompromised, pediatric, and elderly populations; or those who have an indwelling medical device or catheter. Sepsis rates are on the rise because of a rising elderly population, increased longevity of individuals with chronic diseases such as cancer, technological advances in medicine that lead to more frequent use of invasive medical devices, and the extensive use of antibiotics.4
Challenges in Diagnosis and Delivering Care
Rapid identification of the causative agent(s) of bloodstream infections (BSIs) is critical. Traditional methods can take days to identify the cause of an infection and mortality can increase up to 8% for every hour effective antibiotics are delayed.1 Rapid identification of BSIs, in combination with Antimicrobial Stewardship has been shown to decrease time to targeted therapy by roughly 24 hours, while decreasing hospital length of stay by 2.5 days.5,6
The rapid emergence of resistant microorganisms has led to an antibiotic resistance crisis. Up to 50% of antibiotics prescribed in hospitals are either unnecessary or inappropriate7 and it is estimated that roughly 10 million people will die annually due to antimicrobial resistance by the year 2050.8 Taking antibiotics when not needed can put patients at risk for serious adverse events and lead to the development of resistance. As such, careful and judicious use of antimicrobial agents has become a key component of mitigating the risk posed by resistant organisms.
Fungal pathogens are a growing cause of BSIs and are associated with some of the highest rates of inappropriate therapy and mortality. The hospital mortality rate of invasive candidiasis is estimated between 46%-75%, with costs attributed to candidemia as high as $92,000 per case.1 Non-albicans species of Candida and other emerging fungi are increasing in incidence, with immunocompromised patients at greatest risk. A recent study has shown that a delay in antifungal prescribing of >12 hours from the time of blood sample collection increased mortality by 2.09-fold.9
Blood Culture Contamination
Contaminants in blood cultures are common and can lead to unnecessary use of antibiotics that increase cost and toxicity. These contaminants can represent up to 15-30% of the organisms isolated in some hospitals.10 The optimized identification of pathogens when combined with antibiotic stewardship, has been shown to decrease the duration of antibiotic therapy for blood culture contaminants by 17.8 hours.11
Blood culture contaminants can have a significant impact on hospital costs:
- Length of stay can increase by 2 days12
- Total cost of care per patient has been shown to increase by over $4,70012
- Lab charges and pharmacy costs can increase more than $100013,14
The ePlex® Blood Culture Identification Solution
With the broadest inclusivity of any multiplex molecular BCID panel, more clinically relevant bloodstream infections can be detected earlier. The inclusion of blood culture contaminants allows the ePlex system to detect contaminants that other molecular assays will not, aiding in early de-escalation of antibiotics. In addition, ePlex BCID Panels have broad resistance gene coverage, delivering actionable information faster than antimicrobial susceptibility testing (AST) and helping clinicians make treatment decisions days earlier than waiting for AST results. Finally, the ePlex system is the easiest-to-use platform for multiplex molecular diagnostics, offering several unique solutions, like the Templated Comments Module, designed to accelerate clinical decisions on any shift.
The broadest inclusivity of the organisms that cause sepsis and their resistance genes, combined with the ability to rule-out blood culture contamination and the power of novel ePlex solutions delivered on any shift, makes ePlex BCID Panels the only test for rapid, routine blood culture identification.
This information is provided as an educational resource only.
1. Fact Sheet Sepsis. V2_Sepsis Fact Sheet. World Sepsis Day. Global Sepsis Alliance. Center for Sepsis Control & Care.
2. Pfaller MA, et al. (2007) Clin Microbiol Rev;20(1):133-63.
3. Sutton, et. al., Trends in Septicemia Hospitalizations and Readmissions in Selected HCUP States, 2005 and 2010. HCUP Statistical Brief #161. September 2013.
5. Box, et. al., (2015) Pharmacotherapy, 35 (3): 269-276.
6. Timbrook, et al. (2017) Clin Infect Dis. 64 (1): 15-23.
7. Antibiotic Resistance Threats in the United States, 2013. U.S. Dept. of Health & Human Services, Centers for Disease Control and Prevention
8. The Review on Antimicrobial Resistance, Chaired by Jim O’Neill, December 2014.
9. Fraser, et. al. (2005) Antimicrobial Agents. 49:3640-5
10. Murray, P. et. al. (2012), Crit Care Med, Current Approaches to the Diagnosis of Bacterial and Fungal Bloodstream Infections for the ICU
11. Box, M. et. al., (2016), Pharmacotherapy, Outcomes of Rapid ID for Gram-Positive Bacteremia in Combination with Antibiotic Stewardship at a Community-Based Hospital System
12. Skoglund E, et al. (2019), JCM; 57(1): 1105-18.
13. Bates, D. et. al. (1991), JAMA, Contaminant Blood Cultures and Resource Utilization: The True Consequences of False-Positive Results
14. Hall, K. et. al. (2006), Clinical Microbiology Reviews, Updated Review of Blood Culture Contamination.