CLINICAL24: Microbiologist's near-fatal battle with sepsis highlights urgent need for improvements

Guest editorial by Terri Somers, Senior Manager, Global PR and StoryLab, published as part of the global CLINICAL24 conversation.

What Jeroen Bursens thought would be a routine surgery to remove a nodule from his thyroid, almost cost him his life.

He never anticipated the one-two punch of developing a hospital-acquired bacterial infection, which triggered sepsis, a violent overreaction of the body’s immune system that kills about one-third of the 49 million people it inflicts worldwide each year.

Jeroen, a microbiologist in Thermo Fisher Scientific’s specialty diagnostics business which develops tools to detect infections and sepsis, now has an intimate appreciation for them and the need to better educate the healthcare community and public about the signs of sepsis and strategies to prevent it.

“Having experienced this first-hand, I understand better the importance of what Thermo Fisher does as a company and how important it is to enable physicians to have more information sooner, and better options to combat infections with the right antibiotics at the right time,” Jeroen said.

Know the signs

Three days after his surgery, Jeroen was discharged from the hospital and decided to cook dinner for his extended family, However, he cut short the gathering in the late afternoon because he felt exhausted.

A couple of hours later, he was shivering uncontrollably, and his urine was black.

His husband, Bram Bruniel, a nurse, recognized these could be signs of sepsis and rushed Jeroen back to the small community hospital where he’d had his surgery.

In less than 24 hours, Jeroen was transferred to a larger university hospital with much more experience with serious infections and sepsis. There, he was put into an induced coma, as doctors tried to control a rapidly spreading bacterial infection called necrotizing fasciitis, commonly known as flesh-eating disease, which had taken hold in the soft tissue of his neck, shoulder and arm. He had three surgeries to remove dead tissue.

When Jeroen was brought out of the coma a week later, he learned the infection had spread to his abdomen. And then doctors told him very frankly about the sepsis and his dire prognosis.

“I had a very difficult conversation with my parents and my husband’s parents,” Jeroen said. “I was mentally, psychologically, and intellectually aware of what was happening, and I was ready to go,” he said.

Then the antibiotics kicked in.

Fortunately, Jeroen’s infection was susceptible to the broad-spectrum antibiotic that was given to him immediately to try to combat the infection.

A week later, Jeroen was discharged.

Pushing for increased awareness

Jeroen was lucky. He survived what experts have called “the number one cause of preventable death in the world.”

Medical records from 195 nations show that there are 49 million cases of sepsis around the world each year (1.7 million adults in the U.S.) and an estimated 11 million people die from it – more than those who die from cancer, said Konrad Reinhart, a member of the German National Academy of Science Leopoldina and founding president of the Global Sepsis Alliance (GSA).

The Alliance is the initiator of World Sepsis Day (Sept. 13), World Sepsis Awareness Month, which is September, and the annual World Sepsis Congress. Each aim to increase awareness of the signs of sepsis and earlier and better diagnosis of the condition.

Sepsis has a real PR problem, Konrad said. It’s evident when you compare the public perception, concern and investment in sepsis to cancer, he said.

More research is needed to understand what triggers sepsis in some people who have an infection and not others, he said. Meanwhile, more awareness is needed within the healthcare community so that clinicians and caregivers recognize the sepsis warning signs early and adjust treatment accordingly, he said. Healthcare systems around the world need to make sepsis awareness and treatment protocols a priority, he said.

The international Surviving Sepsis Campaign (SSC), launched in 2000, has provided guidelines for healthcare facilities in the management of sepsis with the aim of creating a standard of care and increasing awareness among healthcare professional and the general public. The guidelines, which seek to reduce morbidity and mortality from sepsis worldwide, were last updated in 2021.

Adherence has been suboptimal, particularly regarding the microbiological work-up and administration of appropriate antibiotics, according to an article in the journal Critical Care in 2022. To boost adoption of sepsis guidelines, individual hospitals have introduced sepsis performance improvement programs.

The consensus, underscored by the endorsements from 35 international medical societies, is that these programs have a positive impact, the article states. One 7.5-year study noted in the article, which involved 29,000 patients in 280 hospitals across Europe, South America and the United States, showed overall mortality was significantly lower in high-compliance hospitals (29%) compared with low-compliance hospitals (38.6%).

This slow adoption of anti-sepsis measures frustrates Konrad, who points out that there are now reliable tools that better enable clinicians to do so, such as determining procalcitonin (PCT) levels with a biomarker test from Thermo Fisher that can help guide treatment by showing a patient’s infection level.

An arsenal of knowledge and tools

Changing behaviors in healthcare settings is difficult for multiple reasons, said Michael Broyles, PharmD, who worked as a Director of Hospital Pharmacy and Laboratory for 30 years, before joining Thermo Fisher as Director of Medical Affairs for its biomarkers business.

For instance, the surviving sepsis guidelines advise to start antibiotics on all suspected or confirmed sepsis patients, Michael said.

However, because the current guidelines are screening criteria, up to 40 percent of those started on antibiotics are found later not to need them. This often translates to treatment with powerful broad-spectrum antibiotics on patients who may not require them because clinicians are taught to always “err in favor of caution,” he said.

Additionally, most patients are treated longer than necessary for fear of treatment failure, once again driving higher than necessary antibiotic exposure, he said.

Other recommendations in the guidelines seemed to be overlooked or under appreciated. No. 31 in the Surviving Sepsis Guidelines clearly states that when sepsis is diagnosed and the appropriate duration of treatment is unclear, clinicians should consider using PCT, a biomarker in the blood that shows the amount of bacterial infection in the body, and clinical evaluation to decide when to discontinue antibiotics, rather than using clinical evaluation alone, Michael said.

Thermo Fisher offers clinicians several tools. PCT and other biomarkers can be used to assess the risk of sepsis a patient faces and decision making for antibiotics. The company’s tools also empower clinicians to determine whether the specific antibiotic chosen to combat the infection is working and how long to continue antibiotics.

For the first half of his 30-career in the clinic, Michael said there was no reliable test or biological indicator that measured a patient’s level of infection and the correlating risk of sepsis. Then he saw data about Thermo Fisher’s B·R·A·H·M·S PCT test and he became one of the first adopters.

“It was a no-brainer,” said Michael, who estimates he has now used the test more than 70,000 times in daily clinical practice.

PCT is produced by every cell – except for heart cells - when there is a bacterial infection in the body. It’s never elevated for a viral infection. And it is present regardless of the underlying health of the patient or drugs that are being given, Michael said.

“More than 380 biomarkers were studied before PCT and none of those could differentiate a bacterial infection from a viral one,” he said.

Additionally, none are helpful to determine when to safely stop antibiotics.

Having a clear picture of the severity of an infection, and whether an antibiotic is helping the patient improve, enables clinicians to reduce antibiotic exposure and the toxicities that trigger side effects, including kidney damage, C. difficile infection and resistance to antibiotics, he said.

After PCT use was integrated into patient care where Michael worked, a study of more than 2,100 patients showed that antibiotic use was reduced by 47 percent, mortality was reduced over 54 percent, and 30-day readmissions were reduced by 50 percent, as were adverse events, he said.

Studies have shown, however, that because of the complexity of sepsis response, a single biomarker is unlikely to be sufficient.

Another biomarker that has been reviewed in some countries, Mid-regional proAdrenomedullin (MR-proADM), has been studied in combination with PCT to assess disease severity and predict outcomes, particularly in critical care and infectious diseases. Combined, the results help clinicians make more informed decisions about patient management and treatment escalation.

In Thermo Fisher’s microbiology business, where Jeroen works, antimicrobial susceptibility testing (AST) solutions, a portfolio of instruments and software, enable clinicians to make the right first-time decision for patients suffering from bacterial infections, such as necrotizing fasciitis or sepsis. Finding the right antibiotic for the right patient and the right dose, meaning the infection is susceptible to the drug, is important to stemming its spread, which helps to also reduce the likelihood of sepsis, Jeroen said.

To address global efforts to prevent antibiotic resistance, many clinicians treating infection also want to know what is the lowest concentration of an antibiotic that will stop the growth of a particular bacteria. This measurement, known as minimum inhibitory concentration (MIC), is also critical in patients with sepsis. Thermo Fisher’s Sensititre portfolio helps do that, too.

Jeroen said his life-threatening experience has made him evangelistic about Thermo Fisher’s tools and the impact he and his colleagues can make in driving awareness and better treatment of sepsis.

“Thermo Fisher’s mission is to enable our customers to make the world healthier, cleaner and safer,” he said. “We very directly do so by allowing physicians to make the right decisions and by minimizing overexposure to antibiotics.”

Published as part of the global CLINICAL24 conversation highlighting challenges facing clinical laboratories and exploring the technology solutions to overcome them.

This article may include general information about various medical conditions and their treatments. It is provided solely for informational purposes and is not intended to replace the advice of a doctor or other qualified healthcare professional. Patients are advised to always consult with a doctor or other healthcare professional for medical advice, diagnoses, and treatment options.