Sepsis accounts for 8% of annual United States deaths, with approximately 200,000 sepsis deaths annually. The “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008” (SSC) was published in January 2008. Unfortunately, significant controversy exists regarding these new guidelines.
Studies of implementation have revealed that hospitals are not fully implementing the guidelines. However, studies based on the implementation of the guidelines have demonstrated decreased mortality rates. The use of corticosteroids in septic shock is a controversial subject, with many trials using high-dose corticosteroids failing to demonstrate an improvement of survival rates. However, studies of the use of low-dose corticosteroids have given mixed results. The identification of pathogens must be achieved as quickly and accurately as possible, as treatment delays lead to increases in mortality, morbidity, and cost. Relatively new areas of investigation for the treatment of sepsis include the use of angiotensin-converting enzyme (ACE) inhibitors, such as ramipril, candesartan, captopril, and enalapril, and macrolides, such as azithromycin, roxithromycin, clarithromycin, and telethromycin.