Sepsis hysteria: excess hype and unrealistic expectations

Abstract

In a point prevalence study in Welsh hospitals including 521 patients with sepsis and 136 deaths, only 40 deaths were directly or possibly attributable to sepsis.6 Of these 40 deaths, 77·5% were in patients who had substantial frailty, and 70% were in patients who were not for cardiopulmonary resuscitation in the event of cardiac arrest. Evidence for the benefits of this recommendation is solely from retrospective analyses of databases with inherent residual confounding and biases, and questionable plausibility.11 No prospective study to our knowledge, including a large randomised trial12 and multicentre quality improvement programmes,13,14 has shown outcome benefit. Antibiotic use in emergency departments in English hospitals has doubled since 2015 (Howard P, Rx-Info Define, personal communication), coinciding with the introduction of the Commissioning for Quality and Innovation quality improvement initiative mandating antibiotic prescription within 1 h of presentation, yet no clear effect on mortality has been shown.