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Advances in pathogenesis and management of sepsis

Cinel, Ismail; Dellinger, R Phillip

Current Opinion in Infectious Diseases: August 2007 - Volume 20 - Issue 4 - p 345–352
doi: 10.1097/QCO.0b013e32818be70a
Nosocomial and hospital-related infections

Purpose of review: The rationale for therapeutic targets in sepsis has arisen from the concept of pathogenesis. This review focuses on recent advances in pathogenesis of sepsis that can aid in management of sepsis patients.

Recent findings: Cellular survival in sepsis is related to the magnitude of the stimulus, the stage of the cell cycle and the type of microbe. While phenotypic modification of the endothelium (procoagulant and proadhesive properties, increased endothelial permeability, endothelial apoptosis and changes in vasomotor properties) leads to vasoplegia as a direct correlate to septic shock mortality, phenotypic changes in the epithelium cause activation of the virulence of the opportunistic pathogens and loss of mucosal barrier function, the latter causing a vicious circle in severe sepsis. Early identification of sepsis with protocolized screening, triggering evidence-based protocolized care, is anticipated to reduce sepsis morbidity and mortality. Current treatment of sepsis includes early antibiotic therapy, early aggressive goal-directed resuscitation targeting tissue hypoperfusion, steroids (for refractory shock), activated protein C (for high risk of death) and maintaining support of organ systems.

Summary: A better understanding of pathogenesis of sepsis has led to specific proven management tools that are likely to improve clinical outcome once incorporated into protocolized care.

Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, Department of Critical Care Medicine, Cooper University Hospital, Camden, New Jersey, USA

Correspondence to R. Phillip Dellinger, MD, Head, Department of Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, 393 Dorrance, Camden, NJ 08103, USA Tel: +1 856 342 2657; fax: +1 856 968 8306; e-mail: dellinger-phil@cooperhealth.edu

© 2007 Lippincott Williams & Wilkins, Inc.