Sepsis: A Physician’s Perspective — Matthew Dettmer, MD

Matthew Dettmer, MD, serves as a staff physician in the Critical Care Medicine and Emergency Medicine departments and as co-medical director of the Sepsis Emergency Response Team at the Cleveland Clinic main campus.

BSTQ: How is sepsis typically defined for diagnosis? 

Dr. Dettmer: There are a couple of different ways clinicians define sepsis. Over the last 25 years, especially since the early 2000s, there have been important studies that taught us not only how to define sepsis, but also which interventions help prevent deaths from sepsis. In parallel, the U.S. government became increasingly aware of the risk sepsis poses to patients and worked to standardize care nationally.

As a result, there are now multiple definitions in use. One is the international consensus definition released in 2016, known as Sepsis-3. Another uses SIRS criteria — Systemic Inflammatory Response Syndrome — which informs many regulatory and reporting efforts. These definitions exist for different purposes, which is why clinicians may refer to more than one framework when diagnosing sepsis.

BSTQ: Which patient populations are at higher risk of developing sepsis and/or having worse outcomes?

Dr. Dettmer: Patients with underlying conditions are at higher risk. For example, patients with cancer who are receiving chemotherapy often have suppressed immune systems. If they develop an infection that progresses to sepsis, their outcomes can be worse compared to patients without those underlying conditions.

Another risk factor depends on where sepsis develops and where patients receive their initial care. Most sepsis cases in the U.S. develop in the community, and those patients come to the emergency department for treatment. That’s often referred to as community-onset sepsis or present-on-admission sepsis. In contrast, some patients develop sepsis after they are already hospitalized for another condition, such as heart failure or cancer. This is called hospital-onset sepsis, and while that group is smaller, it carries a higher mortality rate. That makes it a particularly important population for us to understand and target with focused interventions.

BSTQ: Why do patients who develop sepsis in the hospital have a higher mortality rate?

Dr. Dettmer: Even though hospital-onset sepsis represents a smaller proportion of total cases, the higher mortality makes it an especially important group to study. We need to better understand what contributes to those worse outcomes and whether different strategies are needed for that population compared to community-onset sepsis.

BSTQ: Tell us about the Sepsis Emergency Response Team (SERT).

Dr. Dettmer: SERT’s focus is to identify and manage patients who show early signs of sepsis on the regular nursing floors at our main campus. In a hospital of our size, there are large populations of patients receiving care in different settings: the emergency department, the nursing floors and the intensive care unit. Each environment is different, so it’s important to have dedicated workflows that ensure evidence-based sepsis care is delivered effectively in each setting. We primarily use an electronic screening mechanism to identify patients at risk. Our physician assistants and nurse practitioners then evaluate those patients, work with the primary care teams and determine whether symptoms are due to sepsis or another condition. If it is sepsis, we help ensure timely, evidence-based interventions are put into place to improve outcomes.

BSTQ: What is currently being done to improve sepsis identification and care?

Dr. Dettmer: One of the ongoing challenges in sepsis care is balancing sensitivity and specificity — identifying patients early without overwhelming clinicians with alerts that aren’t meaningful. A lot of our current work focuses on improving how we identify patients who truly need intervention. We have teams dedicated to analyzing data, and we are increasingly deploying new technologies, including artificial intelligence, to help screen patients. Rather than relying on single abnormal numbers, these tools help us understand the full context of a patient’s condition and alert providers more intelligently.

BSTQ: Any closing thoughts on sepsis care?

Dr. Dettmer: The struggle against sepsis continues. There are still opportunities to improve outcomes, particularly in specific high-risk populations. Remaining vigilant, innovative and thoughtful about how we approach this disease process is essential as we continue that work.