Sepsis: syndrome or disease?

Intensivists consider sepsis (the systematic response of the body to severe infection) as the 3rd cause of death due to infection (after pulmonary infections and AIDS). The increasing trend of sepsis incidence and its complications may make it as the most prevalent cause of death in Intensive Care Units. In the late 80 decade, sepsis used to be the 13th cause of death in US and more than about ten billion dollars was spent annually for the cost of its therapy. Estimates reveal that more than 400,000 new cases of sepsis and 200,000 new cases of consequent septic shock were occurred annually in US in which 100,000 of them are unfortunately resulted to death. Many factors are considered for the increasing rate of sepsis and septic shock incidence in which immune system suppressive therapy, raising use of different vascular catheters, increase of life expectance and also increasing rate of resistant infections are more remarkable amongst them. Despite the proposing of new theories on pathogenesis and pathophysiology of sepsis and the introduction of new and potent antimicrobial and antifungal drugs, it seems that there is not sign of clinically significant decrease in the mortality of this syndrome. This mortality rate is still considered unpredictable and for example for gram negative sepsis within the range of 20 to 80%. Though this special clinical situation deserves to be considered and further investigated by scientist from a 360° general point of view. General practitioners whom are the main target population for this review article are not supposed to confront routinely the cases of septic shock and this misleading statement may keep them happily far from the facts mentioned above. The aim of this article is to review the current information on the definitions, etiology, pathogenesis, pathophysiology and pharmacotherapy of sepsis in a teaching and educational basis.