“By 2050, the number of deaths from sepsis is likely to triple due to the aging of the population”predicts Professor Djillali Annane (intensive medicine-resuscitation department at the Raymond-Poincaré hospital in Garches, AP-HP). Already today, according to the World Health Organization (WHO), sepsis affects 50 million people each year (including 45% of children under 5 years old) and is responsible for one in four deaths worldwide. (600,000 in Europe), not to mention the serious psychological and motor after-effects in one in two survivors.
To better understand this complication of infections, marked by a loss of control of inflammation leading to the impairment of vital functions, the Prometheus university hospital institute (IHU) was launched on September 17, 2024 by the University of Paris- Saclay, CEA, AP-HP, Inserm and their partners. This first world center, financed to the tune of 40 million euros as part of France 2030, combines research, training and care. The ambition: to halve, within ten years, mortality and after-effects caused by sepsis.
The IHU, which brings together more than 60 research teams, aims to better understand the molecular and cellular interactions between the host and pathogens. To shed light on the long-term repercussions, including social and economic, it should set up a longitudinal cohort of 10,000 patients followed over ten years. Furthermore, the IHU intends to validate and market a rapid diagnostic test platform to finely characterize the host response to infection on an individual scale. Digital twins should make it possible to anticipate the response of each subject to different treatments. Finally, the IHU wants to develop new treatments (innovative small molecules, nanomedicines, biotherapies, vaccines) and strategies modulating microbiota.
Towards harmonization of practices on a European scale
At the same time, Professor Djillali Annane participated with the Sepsis Stronger Together consortium in the writing of an article published in the Lancet (1) calling for a European action plan to harmonize practices with those of Northern countries. “The English are five to ten years ahead of us, the Swedes and the Germans have also put in place measures which are starting to influence things favorably”explains Professor Annane. These national initiatives remain compartmentalized, with the countries of southern and eastern Europe being, on the contrary, far behind. According to street microphone surveys, 95% of British people, who have benefited from national communication campaigns, know what sepsis is, compared to 7% of French people.
Primary care professionals must be better trained in the symptoms and first signs that should encourage treatment of the patient before the pathology is too advanced, asks Professor Annane. The High Authority for Health must also publish recommendations at the beginning of 2025 on the diagnosis and management of sepsis by primary care doctors. “General practitioners have the impression that sepsis is a problem of intensive care, which is false: 80% of sepsis begins in the city”says the director of the IHU.
And to recall the symptoms that should alert you: a drop in systolic blood pressure below 100 mmHg, an increase in respiratory rate above 22 cycles per minute and a state of obtundation or confusion. When at least two of these three criteria exist in a patient with an infection, he or she may be considered at very high risk of developing sepsis. You should then quickly contact Samu.
Future recommendations should also focus on the management of after-effects. Among the disabilities resulting from sepsis, the most common are severe cognitive disorders, musculoskeletal damage, paralysis and respiratory problems or even kidney failure with dialysis. “The recommendations to be published include a section on structured early rehabilitation programs which would make it possible to reduce these after-effects in duration and intensity”specifies Professor Annane.
Hopes are finally focused on vaccines, while in 85% of cases, sepsis is linked to one of these five bacteria, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus or Streptococcus pneumoniae. Vaccination is already possible against pneumococcus and a vaccine against Escherichia coli should be available soon. Not forgetting the flu and RSV vaccines, the cause of a lot of preventable sepsis.
(1) K. Bracke et al., The Lancet, 2024, volume 404, n° 10462 p1517-1518
