Antimicrobial Stewardship in the Management of Sepsis argues that the problem with the rapid initiation of broad-spectrum antibiotics begins with the issue of how to diagnose sepsis. The article notes that current sepsis guidelines may be too general, noting, “It is not uncommon for patients with otherwise uncomplicated cases of common infections (e.g., influenza, pneumonia, or pyelonephritis) to meet this widely used definition of sepsis.”

According to the authors of an article in The BMJ, “the combination of inadequate diagnostic criteria for sepsis with the extraordinary time pressure to provide broad-spectrum antimicrobial therapy is troubling from a stewardship perspective.” Research supports the need for more effective sepsis management guidelines that better align with the goals of AMS programs. Increasing awareness about the relationship between the two efforts may be a step in the right direction.

Sepsis and AMR have a significant relationship. If the sepsis patient’s underlying infection is resistant to antimicrobials, treatment may be difficult or impossible. However, media reporting and/or public health campaigns for sepsis and AMR are rarely presented together, resulting in a lack of understanding of how the issues are related.

Sepsis media reports tend to share personal narratives and identify immediate solutions that are within the power of individual health professionals and the public. This makes them effective in achieving awareness and positive actions. Reports on antimicrobial resistance are often different.

AMR is frequently framed as a health threat affecting future patients and involving multiple factors. “Given human decision makers’ tendency to prefer short-term rewards over delayed rewards…this aspect of media reporting does little to encourage individual responsibility or motivation to optimize antimicrobial use,” the authors of the BMJ article write. Moreover, individual responsibility can become diffused because AMR messaging calls on everyone at the same time and may not provide concrete steps for a person to take. These aspects each contribute to difficulties in raising awareness and eliciting action around AMR.

Certain AMS strategies can help align sepsis protocols and stewardship goals. Specifically, safely de-escalating and shortening therapy duration can help reduce the likelihood of C. difficile infections and other adverse side effects resulting from prolonged antimicrobial therapy, along with reducing the development of resistant microorganisms. The clinical laboratory and diagnostics are at the center of such strategies.

Around 70% of clinical decisions for patient management are based on laboratory results. Therefore, tools that reduce the time required to detect and identify infection can be especially beneficial. Correctly used, diagnostics can assist clinical decision making and contribute to improved outcomes for patients with sepsis, as well as strengthening AMS practices.

Finally, reframing the current AMR message could have an impact on the understanding of the relationship between sepsis and AMR. AMR is an immediate issue with consequences for individual clinicians and patients. It is critical to address AMR in areas like sepsis management, where providing the best patient care is contingent on access to effective antimicrobials.