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April 12, 2016

Immunosuppression and Secondary Infection in Sepsis: Part, Not All, of the Story

Author Affiliations
  • 1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Pittsburgh, Pennsylvania
  • 3Associate Editor, JAMA
  • 4Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University School of Medicine, Providence, Rhode Island
JAMA. 2016;315(14):1457-1459. doi:10.1001/jama.2016.2762

Despite considerable efforts to promote early identification and treatment of sepsis, each year several million individuals worldwide develop sepsis-induced multiple organ dysfunction, requiring admission to intensive care and institution of life support, and frequently progressing to death or protracted illness and incomplete recovery. Sepsis is now the leading cause of death in US hospitals and is projected to account for more than 5 million deaths globally each year.1,2 The question is why. More specifically, why do patients with sepsis who receive appropriate antibiotics and prompt institution of life support still die? Certainly, there are instances when life support is inadequate, such as overwhelming shock unresponsive to fluids and vasopressors or severe hypoxia despite advanced mechanical ventilatory support. However, many critically ill patients simply lie in an ICU bed receiving life support while the team monitors for complications, titrates life support treatment, and waits to see what transpires.