7th Weimar Sepsis Congress of the German Sepsis Society (DSG) - "Precision Medicine for Sepsis"

Two patients share a room on your ICU: A 78 year old patient, 60 kg, suffering from chronic lymphocytic leukemia, chronic renal dysfunction, pulmonary hypertension in COPD and permanent atrial fibrillation, and a 36 year old woman, 120 kg, without any pre-existing diseases. Both are diagnosed with septic shock, acute renal failure requiring dialysis, acute respiratory failure and a platelet count below 20.000 mm/3. Both have developed bacteremic sepsis: the 78 year old patient has a device associated Staphylococcus aureus sepsis, and the 36 year old woman a pneumococcal pneumonia and associated Purpura fulminans.

Both patients meet the inclusion criteria of a placebo-controlled phase II clinical trial for a new monoclonal antibody that blocks a biologically plausible inflammatory pathway. Although the active agent has shown a high effectiveness in pre-clinical murine models, results of the study are rather disappointing: No difference could be observed – as is so often the case.

What are your standards of treatment?

According to the guidelines, of course. But is this really true? You use the same hemodynamic monitoring, the same ventilator settings and types of dialysis, the same dosage of anti-infective therapy and equal substitution of thrombocytes? Of course you don’t. You wouldn’t stick blindly to the guidelines and this might be the reason why you do everything right.

The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

Are pre-clinical hypotheses and models, endpoints of clinical trials and our tools in clinical routine insufficient? Do we need more precise clinical definitions and a new staging model for sepsis in order to achieve better results when treating organ failure in this heterogeneous disease? Do we lack better diagnostic markers that allow for a specific, personalized therapy? And – last but not least – do we always control the source of infection adequately?

The German Sepsis Society (DSG) will address these questions at its 7th Weimar Sepsis Congress entitled “Precision Medicine for Sepsis”. Differential therapy of very old patients, therapeutic drug monitoring of anti-infectives and empirical treatment for multi-resistant pathogens are just a few examples.

One of the highlights will be the presentation of the new sepsis definitions that are being developed on the initiative of the Society of Critical Care Medicine (SCCM) by an international Consensus Committee with the involvement of the DSG.

For more information: http://sepsis-2015.com/