Entries in Sepsis (2)


Sepsis: How Doctors Miss Signs of Dangerous Infection

iStockphoto/Thinkstock(NEW YORK) -- A child gets a minor scrape while playing sports at school.  The child and parents ignore it, but the next day he is vomiting and has pain in his leg.  The parents take their child to the emergency room.

Remarkably, decisions made by doctors at this point could mean the difference between life and death.  And right now, the case of Rory Staunton, a 12-year-old boy who died after showing symptoms exactly as described above, has hospitals all over the country focusing on ways to make sure these cases don't end tragically.

In an episode first reported by The New York Times last week, Staunton died at NYU Langone Medical Center of a deadly condition known as sepsis.  Such cases are rare, but not unheard of.

Sepsis, which affects at least 750,000 adults a year, can and does affect children.  In 2007, a 13-year-old in Chicago named Tony Love almost died after experiencing nearly the same symptoms.  Love's story is told at the beginning of Maryn McKenna's 2010 book Superbug about the dangers of antibiotic-resistant bacteria.

For doctors, the problem is recognizing what's wrong before it's too late.

Sepsis is the result of a body's overwhelming response to an infection.  When bacteria get into the bloodstream, the body's immune system mobilizes to fight them.  But if the infection is left unchecked, the body's own defenses can rage out of control.

"The body says, 'Hey, we have some attackers here, let's go fight them,'" says Dr. Nathan Shapiro, an emergency medicine physician at Beth Israel Deaconess Medical Center.  "It makes chemicals called cytokines and other factors as part of the inflammatory response."

But as Shapiro explains it, if the underlying infection is not treated, the response itself can cause organ damage and death.

The problem is that, in its early stages, sepsis causes symptoms that aren't much different from those of a viral infection that will go away on its own.  Consequently, sorting out who can go home from the emergency department and who needs quick hospitalization can be tough.

"The thing that people are always looking for is the crystal ball that will tell whether this kid who doesn't look all that sick really is," says Dr. David Gaieski, assistant professor of emergency medicine at the Hospital of the University of Pennsylvania.  "Right now there's nothing that is 100 percent able to do that."

Shapiro agrees: "The tricky part is discriminating between someone who has an infection and is going to recover by themselves, and someone who is going to become really sick."

The stakes involved in this decision could not be higher, since treating septic patients early is the single most important element in their care.

"When the person shows up, the clock starts ticking," says Gaieski.  "Those first six hours mean a lot."

Complicating matters further is the fact that guidelines developed to tip off physicians when they should suspect sepsis and start early treatment are most often geared toward adults.  In children, these same rules may not apply.

"It's hard to apply sepsis criteria mentioned in there to pediatric patients," says Dr. Abhi Mehrotra of the University of North Carolina at Chapel Hill.  "Vital sign criteria are age-appropriate.  It's difficult to take criteria out of the clinical population in which they were developed and apply them to another."

Copyright 2012 ABC News Radio


Sepsis: Blood Poisoning Kills Thousands, But No Drugs to Help

iStockphoto/Thinkstock(NEW YORK) -- Rory Staunton's death started with a simple cut on his arm.

Rory, a 12-year-old New Yorker, cut himself when he dove for a basketball at his school gym in late March, according to The New York Times.  Two days later, he was vomiting, feverish and had a pain in his leg.  A few days later, on April 1, Rory died at NYU-Langone Medical Center of a kind of blood poisoning known as sepsis.

His death, and others, point to a major problem in treating sepsis -- there are currently no drugs approved to fight it.  The only drug developed for it, called Xigris, was withdrawn from the market in 2011, when the drug failed rigorous testing required to maintain regulatory approval.  The drug's fall from grace highlights just how difficult fighting sepsis is, and leaves doctors wondering whether developing a drug will ever be possible.

About 750,000 people in the U.S. each year get sepsis, and about 225,000 of them die from it.  The condition is an infection of the bloodstream, and it can arise from any number of infectious bugs that attack the body, such as meningitis, pneumonia and infections of the skin or bladder, to name a few.  The blood poisoning is caused not by the germs themselves, but by the body's hyper-response to those germs, when it releases a barrage of chemicals that can lead to organ failure.

Those chemicals cause the body to go into shock, and patients have symptoms such as chills, fever, confusion, rapid heartbeat, headache and skin rashes.

The best shot patients have is for doctors to treat them early, ideally giving a patient antibiotics and fluids within the first hour that they show symptoms.  Dr. Andre Kalil, an associate professor of medicine at the University of Nebraska Medical Center, said even in the best-case scenario, antibiotics don't always help.

"Unfortunately even with the best antibiotics and supportive care, a third of these patients will die," Kalil said.  "We don't have other drugs that actually can act in the body in response to the infection.  We just don't."

That wasn't always in the case.  In 2001 when the U.S. Food and Drug Administration approved Xigris, made by the pharmaceutical company Eli Lilly, hopes were high that it would keep thousands of patients from dying.  The company's initial clinical trials of the drug showed that it reduced the chances of dying by 20 percent in patients at risk of developing sepsis.

But the drug's initial performance was somewhat disappointing.  Some patients benefited from the drug, others did not, and doctors had trouble defining which type of patient would benefit the most.  The drug was also very expensive, so many hospitals put protocols in place that strictly limited when the drug could be given -- usually when all other methods had failed.

Questions about the drug's safety also began to surface.  Patients getting Xigris had a slightly increased risk of bleeding.  Increasingly skeptical that the expensive drug was actually effective, European regulators asked Eli Lilly to conduct a second clinical trial.  The results were the nail in Xigris' coffin -- the trial showed that the drug was little better than placebo.  Based on those results, Eli Lilly voluntarily pulled the drug from the market in October 2011.

Copyright 2012 ABC News Radio

ABC News Radio