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Clin Microbiol Infect. 2018 Dec;24(12):1264-1272. doi: 10.1016/j.cmi.2018.03.011. Epub 2018 Mar 24.

Towards precision medicine in sepsis: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.

Author information

1
CIBERES, Vall d'Hebron Barcelona Campus Hospital, European Study Group of Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain. Electronic address: jrello@crips.es.
2
Centre for Experimental Molecular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
3
Department of Infectious Diseases, Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
4
Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
5
University Hospital of Rennes, Department of Clinical Microbiology, Rennes, France and National Reference Center for Antimicrobial Resistance (lab Enterococci), Rennes, France.
6
Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Centre, Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany; Executive Committee of ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS), The Netherlands.
7
Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania.
8
Faculté de Médecine, University of Lille and Centre de Réanimation, CHU Lille, Lille, France.
9
Brown University, Infectious Diseases, Providence, RI, USA.
10
Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
11
Department of Microbiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK.
12
Centre for Experimental Molecular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Executive Committee of ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS), The Netherlands. Electronic address: w.j.wiersinga@amc.uva.nl.

Abstract

BACKGROUND:

Our current understanding of the pathophysiology and management of sepsis is associated with a lack of progress in clinical trials, which partly reflects insufficient appreciation of the heterogeneity of this syndrome. Consequently, more patient-specific approaches to treatment should be explored.

AIMS:

To summarize the current evidence on precision medicine in sepsis, with an emphasis on translation from theory to clinical practice. A secondary objective is to develop a framework enclosing recommendations on management and priorities for further research.

SOURCES:

A global search strategy was performed in the MEDLINE database through the PubMed search engine (last search December 2017). No restrictions of study design, time, or language were imposed.

CONTENT:

The focus of this Position Paper is on the interplay between therapies, pathogens, and the host. Regarding the pathogen, microbiologic diagnostic approaches (such as blood cultures (BCs) and rapid diagnostic tests (RDTs)) are discussed, as well as targeted antibiotic treatment. Other topics include the disruption of host immune system and the use of biomarkers in sepsis management, patient stratification, and future clinical trial design. Lastly, personalized antibiotic treatment and stewardship are addressed (Fig. 1).

IMPLICATIONS:

A road map provides recommendations and future perspectives. RDTs and identifying drug-response phenotypes are clear challenges. The next step will be the implementation of precision medicine to sepsis management, based on theranostic methodology. This highly individualized approach will be essential for the design of novel clinical trials and improvement of care pathways.

KEYWORDS:

Big data; Biomarkers; Host defence; Low- and middle-income countries; Microbiome; Personalized medicine; Precision medicine; Rapid diagnostic test (RDT); Theranostics; Treatment

PMID:
29581049
DOI:
10.1016/j.cmi.2018.03.011
[Indexed for MEDLINE]
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