Updated Surviving Sepsis Campaign Guidelines Not Endorsed by IDSA

Sepsis is never simple, which is why the Infectious Diseases Society of America’s (IDSA) decision to not endorse the 2016 Surviving Sepsis Campaign Guidelines because of fundamental disagreements with the Society of Critical Care Medicine (SCCM) over recommendations pertaining to the diagnosis and treatment of the disease should come as no surprise to anyone who has been following its presence in public health-related headlines for much of 2017.

As noted in a position statement published by the IDSA on November 22, 2017, and authored by members of the Society’s Sepsis Task Force, the infectious disease representatives on the guideline working group “had different perspectives… regarding the interpretation of the major studies that informed the guidelines’ recommendations… [and] thus different conclusions and different perspectives on [them].” The Surviving Sepsis Campaign, under the auspices of the SCCM and the European Society of Intensive Care Medicine, has published the guidelines—for the fourth edition—even without the IDSA’s endorsement. IDSA was among the sponsoring society’s listed on the 2012 (third) edition of the guidelines.

A spokesperson for the SCCM told Contagion^® by email, on December 16, 2017, that the Society had no statement in response to the IDSA’s decision.

The IDSA’s position statement emphasizes that the society’s “major concern” rests with the guidelines’ “failure to acknowledge the practical difficulties clinicians often face when trying to diagnose sepsis.” The guidelines strongly recommend the initiation of intravenous (IV) antibiotic therapy in cases of suspected sepsis and suspected septic shock within 1 hour of evaluation; while the IDSA agrees with the need for “STAT” therapy for those with severe infections, it argues that “stipulating an aggressive, fixed time period” may result in the overuse of broad-spectrum antibiotics in patients who don’t actually need them.

Because of the concerns of the IDSA and others regarding the over-prescribing of antibiotics—and the related issue of increased resistance, this proved to be a major sticking point. In the position statement, the IDSA authors cited recent research suggesting that as many as 2 of every 5 patients admitted to ICUs with a sepsis diagnosis “do not have an infection and thus do not actually have sepsis.”

In addition, the IDSA has also expressed concerns regarding what they say is a lack of clarity in terms of how the Surviving Sepsis Campaign Guidelines refer to “empiric,” “targeted,” “multidrug,” and/or “combination” antibiotic therapy. The Society also takes issue with the guidelines for the recommendation to continue therapy with 2 active agents “until… clinical improvement and/or… infection resolution,” irrespective of the availability of susceptibility data.

Henry Masur, MD a member of the IDSA’s Sepsis Task Force and Chief, Critical Care Medicine Department, National Institutes of Health (NIH) told Contagion^® that the Society’s leadership felt the need to withhold its endorsement of the 2016 guidelines, as opposed to continuing discussions on their substance, because there were “deadlines [the other stakeholders] wanted to meet and we couldn’t come to a consensus” in that timeframe. Unlike, for example, the hepatitis C guidelines, which the IDSA develops in conjunction with the American Association for the Study of Liver Diseases (AASLD) and updates online and in “real time” as needed when new research is published, Dr. Masur said, the Surviving Sepsis Campaign Guidelines have, to date, only been revised every 4 years since the first edition was published in 2004.

As new data on sepsis is being published more frequently, he would like to see the guidelines for the disease adopt the same approach as that of the hepatitis C recommendations—although he admits that may not be financially feasible for the professional societies involved.

“The IDSA has reached this irrevocable decision on this guideline, although we certainly would be willing and interested in talking to them again on a future guideline,” Dr. Masur said of the 2016 edition. “We were in fundamental agreement with most of the societies involved on most of the science, but when [the authors] got into the aspect of most interest to IDSA, the diagnosis and management of the microbial etiology of the disease, that’s where we had the most disagreement.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.