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Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 15 October 2026 | Viewed by 13340

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Special Issue Editor

Dr. Alice Dragoescu

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Guest Editor

Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
Interests: sepsis; septic shock; prognosis; presepsin; neutrophil to lymphocyte ratio (NLR); agenesis of ductus venosus; portal venous system anomalies
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Special Issue Information

Dear Colleagues,

Sepsis, a life-threatening condition resulting from a dysregulated host response to infection, has been a significant global health concern for decades. Despite advances in medicine, sepsis continues to cause substantial morbidity and mortality worldwide, particularly in low- and middle-income countries. The condition has complex etiologies, making it difficult to diagnose and treat, especially in resource-limited settings. Historical milestones in understanding sepsis include the early recognition of its systemic inflammatory nature and the development of protocols such as the "Surviving Sepsis Campaign." However, the increasing prevalence of antimicrobial resistance and disparities in healthcare delivery have added new dimensions to this age-old challenge, necessitating renewed focus and collaborative global strategies.

This Special Issue, Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies, will provide a comprehensive platform for discussing the latest developments in sepsis research, prevention, and management. By integrating insights from epidemiological studies, clinical advancements, and public health efforts, this Special Issue will address global disparities in sepsis outcomes and resource allocation. It emphasizes the importance of innovative diagnostic tools, effective treatment protocols, and global awareness campaigns for reducing the burden of sepsis. This Special Issue will serve as a multidisciplinary forum for advancing understanding, fostering collaboration, and shaping policies to improve sepsis care globally.

This Special Issue will feature cutting-edge research that explores novel approaches to diagnosing, treating, and managing sepsis. Topics of interest include the following:

Development and implementation of biomarkers and rapid diagnostic tools;
Artificial intelligence and machine learning applications in sepsis prediction and management;
Innovations in antimicrobial therapies and strategies to combat resistance;
Insights into the immunopathology and molecular mechanisms of sepsis;
Advances in personalized medicine, such as precision therapeutics tailored to individual patient profiles;
Global epidemiological trends, highlighting disparities in incidence, outcomes, and resource availability;
Evaluation of awareness campaigns and their impacts on early detection and treatment;
Health systems approaches for improving sepsis care in low-resource settings.

We invite original research articles, reviews, meta-analyses, clinical case studies, and commentaries that align with the following themes:

Epidemiological studies examining the global and regional burden of sepsis;
Research on diagnostic innovations, including biomarkers and imaging techniques;
Studies on treatment protocols, including the use of advanced therapies and supportive care;
Investigations into the role of antimicrobial resistance in sepsis outcomes;
Papers highlighting the challenges and successes of awareness campaigns;
Research on healthcare disparities and access to sepsis care in different regions;
Contributions on public health policies and interventions for improving sepsis outcomes;
Translational research bridging basic science findings with clinical applications;
Perspectives on sepsis management in specialized populations, such as neonates, the elderly, and immunocompromised patients.

Dr. Alice Dragoescu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

sepsis
global health
treatment strategies
early diagnosis
personalized medicine
immunopathology
awareness campaigns

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Published Papers (6 papers)

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Research

15 pages, 605 KB

Open AccessArticle

Cumulative Vulnerability in Cardiac Critical Care: A Framework for Understanding Healthcare-Associated Infections and Their Progression to Severe Infection and Sepsis

by Daniela Mirela Vîrtosu, Angela Dragomir, Simina Crișan, Silvia Luca, Oana Pătru, Ruxandra-Maria Băghină, Mihai-Andrei Lazăr, Alina-Ramona Cozlac, Stela Iurciuc and Constantin Tudor Luca

Medicina 2026, 62(5), 908; https://doi.org/10.3390/medicina62050908 - 8 May 2026

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Abstract

Background and Objectives: Healthcare-associated infections (HAIs) remain a relevant complication in coronary care units (CCUs), particularly among patients with cardiac dysfunction requiring invasive monitoring and prolonged hospitalization. In this setting, infection occurrence may reflect the cumulative interaction between baseline biological vulnerability and care-related exposure. This study aimed to explore whether a simple cumulative framework integrating these components can describe patterns of HAI occurrence and support early identification of patients at risk for severe infectious complications and sepsis. Materials and Methods: The retrospective cohort study included 870 consecutive adult patients admitted to a tertiary-care CCU. A four-component cumulative framework was constructed using reduced left ventricular ejection fraction (LVEF < 40%), diabetes mellitus, urinary catheterization, and CCU length of stay > 5 days. Each component contributed one point (range 0–4). HAIs were defined according to CDC/NHSN criteria and required microbiological confirmation. Associations between cumulative burden and infection occurrence were assessed using trend analysis and exploratory modeling. Results: HAI occurrence increased progressively across cumulative framework levels, demonstrating a stepwise pattern from low to higher vulnerability strata (p for trend < 0.001). A substantial proportion of infections clustered in patients with higher cumulative values, despite representing a minority of the cohort. Increasing cumulative burden was accompanied by higher observed infection occurrence, supporting a graded association between cumulative vulnerability and infection occurrence. Conclusions: In CCU patients, HAI occurrence appears to reflect the accumulation of biological vulnerability and care-related exposure during hospitalization. A simple cumulative framework may support early identification of patients requiring closer preventive attention and contribute to improved awareness of severe infectious complications in cardiac critical care. Prospective validation is warranted. Full article

(This article belongs to the Special Issue Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies)

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10 pages, 347 KB

Open AccessArticle

Impact of Procalcitonin Kinetics on Mortality in Intensive Care Patients with Sepsis

by Yakup Özgüngör, Burak Emre Gilik, Emre Karagöz, Hicret Yeniay, Mensure Çakırgöz, Özlem Melis Korkmaz Özgüngör, İhsan Birol and Sıla Seven

Medicina 2026, 62(3), 487; https://doi.org/10.3390/medicina62030487 - 5 Mar 2026

Viewed by 660

Abstract

Background and Objectives: Procalcitonin (PCT) kinetics are increasingly used as prognostic markers in sepsis, but their interpretation is confounded by dynamic changes in renal function during acute illness. This study evaluated the prognostic value of ΔPCT for 30-day mortality in critically ill patients with either sepsis or septic shock by incorporating serial kinetic eGFR measurements and renal function-adjusted ΔPCT cut-off values based on the mean kinetic eGFR during the first 48–72 h of ICU admission. Materials and Methods: This retrospective cohort study included 106 adult ICU patients with either sepsis or septic shock. Serial procalcitonin measurements were used to calculate ΔPCT as a ratio of follow-up to baseline values, while renal function was assessed using mean kinetic eGFR over the first 72 h of ICU admission. Results: Thirty-day mortality was 43.4%. ΔPCT was a strong independent predictor of mortality across all models. At 48 h, ΔPCT2 was independently associated with 30-day mortality in the overall cohort (AUC 0.793) and demonstrated independent prognostic significance only in patients with preserved renal function (GFR ≥ 30 mL/min/1.73 m²). The optimal ΔPCT2 cut-off corresponded to a 56% reduction in procalcitonin levels. At 72 h, ΔPCT3 emerged as an independent predictor of mortality regardless of renal function. ROC analysis identified an optimal ΔPCT3 cut-off corresponding to 62% procalcitonin reduction in the overall cohort, with renal function-specific thresholds of ~50% for patients with GFR < 30 mL/min/1.73 m² and ~73% for those with preserved renal function. The combination of APACHE II score and ΔPCT3 demonstrated the highest discriminative performance for mortality prediction (AUC 0.948). Conclusions: Procalcitonin kinetics provide clinically meaningful prognostic information in sepsis when interpreted alongside dynamic renal function. While 48 h procalcitonin kinetics offer prognostic value primarily in patients with preserved renal function, 72 h ΔPCT provides renal function-independent and superior mortality discrimination. Integrating serial kinetic eGFR measurements enables renal function-adapted ΔPCT threshold determination and may improve risk stratification in critically ill septic patients. Full article

(This article belongs to the Special Issue Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies)

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17 pages, 1310 KB

Open AccessArticle

The Diagnostic and Prognostic Value of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Urosepsis

by Petru Octavian Drăgoescu, Bianca Liana Grigorescu, Andreea Doriana Stănculescu, Andrei Pănuș, Nicolae Dan Florescu, Monica Cara, Maria Andrei, Mihai Radu, George Mitroi and Alice Nicoleta Drăgoescu

Medicina 2025, 61(9), 1713; https://doi.org/10.3390/medicina61091713 - 19 Sep 2025

Cited by 2 | Viewed by 2220

Abstract

Background and Objectives: The severe systemic response to urinary tract infections known as urosepsis is associated with significant morbidity and mortality rates. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are simple blood tests that could be useful in predicting the outcome of sepsis. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital, where our team studied 223 patients with urosepsis. The patients underwent Sepsis-3 criteria-based urosepsis and septic shock stratification followed by survivor and non-survivor classification. Clinical scores (Sequential Organ Failure Assessment-SOFA, National Early Warning Score-NEWS), laboratory markers (NLR, PLR, PCT-procalcitonin), and patient outcomes were then analysed. Results: An admission NLR ≥ 13 was a strong predictor of septic shock (adjusted Odds Ratio (OR) 2.10, 95% Confidence Interval (CI) 1.25–3.54) and in-hospital mortality (adjusted OR 2.45, 95% CI 1.40–4.28). While the prognostic value of the PLR remained moderate, the NLR demonstrated superior predictive power. As easily measurable biomarkers, the NLR and PLR provide valuable information to help clinicians identify at-risk patients during the early stages of urosepsis. Conclusions: The NLR is an independent predictor with high predictive value for both septic shock and mortality, performing as well as established clinical scores. The combination of these parameters with clinical assessments could lead to better early decisions and improved outcomes for patients with urosepsis. Full article

(This article belongs to the Special Issue Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies)

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19 pages, 2404 KB

Open AccessArticle

Sepsis Burden in a Major Romanian Emergency Center—An 18-Year Retrospective Analysis of Mortality and Risk Factors

by Florentina Mușat, Dan Nicolae Păduraru, Alexandra Bolocan, Cosmin-Alexandru Palcău, Andrei-Alexandru Bunea, Daniel Ion and Octavian Andronic

Medicina 2025, 61(5), 864; https://doi.org/10.3390/medicina61050864 - 8 May 2025

Cited by 3 | Viewed by 1454

Abstract

Background and Objectives: Sepsis is a leading cause of morbidity and mortality worldwide, yet data from Central and Eastern Europe remain scarce. Our study aims to address the scarcity of information regarding the characteristics and mortality rates of patients with sepsis by reporting recent data from one of the largest emergency centers in Romania over an 18-year period (2007–2024). Materials and Methods: A retrospective analysis was conducted on 12,089 adult patients diagnosed with sepsis at the University Emergency Hospital of Bucharest. Patients were identified using International Classification of Diseases (ICD-10) codes and free-text diagnosis. Demographic and clinical data were extracted, including comorbidities, interventions, and mortality outcomes. Associations between comorbidities and in-hospital mortality were assessed using odds ratios (ORs) and 95% confidence intervals (CIs). Results: The study population had a mean age of 68.7 years, with a slight predominance of males (50.9%). In-hospital mortality was 53.9%, and 30-day mortality reached 85.1%. The most common comorbidities were diabetes (27.2%), chronic kidney disease (14.0%), and cancer (12.9%). Pneumonia (OR = 2.08, 95% CI: 1.89–2.28), cirrhosis (OR = 1.69, 95% CI: 1.40–2.03), and chronic obstructive pulmonary disease (OR = 1.50, 95% CI: 1.27–1.77) were strong predictors of mortality, while diabetes was associated with a slightly lower risk (OR = 0.90, 95% CI: 0.83–0.97). Conclusions: Sepsis-related mortality in Romania is higher than reported in Western Europe and North America, resembling trends in resource-limited settings. Targeted early recognition, antimicrobial stewardship, and improved intensive care units (ICU) resource allocation are crucial for reducing mortality. Multicenter studies and microbiological analyses are needed to further understand sepsis outcomes in this region. Full article

(This article belongs to the Special Issue Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies)

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14 pages, 1642 KB

Open AccessArticle

An Epidemiological Survey of Sepsis in a Tertiary Academic Hospital from Southwestern Romania

by Andra Grigorescu, Florentina Dumitrescu, Stefania Dorobantu, Adina Dragos, Andrei Pirvu, Mihaela Roskanovic, on behalf of the FUSE study, Ioana Streata, Mihai Ioana, Mihai G. Netea and Anca-Lelia Riza

Medicina 2025, 61(4), 596; https://doi.org/10.3390/medicina61040596 - 26 Mar 2025

Cited by 1 | Viewed by 1874

Abstract

Background and Objectives: Sepsis is one of the major causes of death in modern society. This study is part of the FUSE (Functional Genomics in Severe Sepsis) project under the Human Functional Genomics Romania initiative. Our aim was to assess the epidemiology of sepsis in a tertiary academic hospital in southwestern Romania. Materials and methods: The study enrolled 184 patients with severe infections between May 2017 and November 2019, following the Sepsis-2 guidelines (SIRS criteria). Results: The present cohort of community-acquired severe infections shows respiratory and urinary tract as main sites of severe infection. The demographic and clinical characteristics of this Romanian study group are in line with those of other severe infection European cohorts. However, the predominance of confirmed Clostridium difficile cases represents a strong deviation, raising significant concerns for the communities to which the patients belong. Conclusions: Sepsis, with its complex pathophysiology and clinical presentation, remains one of the most daunting global health issues. In our cohort, the high number of Clostridium difficile cases prompts high vigilance and immediate intervention. Full article

(This article belongs to the Special Issue Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies)

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17 pages, 5269 KB

Open AccessArticle

Endogenous IL-7 Variation in Relation to Lymphocyte Subtypes in Septic Patients

by Raluca-Ștefania Fodor, Alice Drăgoescu, Oana Coman, Adina Huțanu, Anca Bacârea and Bianca-Liana Grigorescu

Medicina 2025, 61(2), 258; https://doi.org/10.3390/medicina61020258 - 2 Feb 2025

Cited by 1 | Viewed by 2344

Abstract

Background and Objectives: Sepsis triggers a complex immune response, disrupting the balance between pro- and anti-inflammatory signals and causing widespread immune cell apoptosis. Interleukin 7 (IL-7) is emerging as one of the most promising immunoadjuvants to boost host immunity during the immunosuppressive phase of the disorder. This study aimed to investigate the dynamics of endogenous plasma levels of IL-7 during sepsis and septic shock, correlating its levels with lymphopenia and various lymphocyte subtypes, including CD4+ and CD8+ T cells, B cells, and natural killer T cells (NKT), in both survivors and non-survivors. Materials and Methods: This prospective observational study included 87 critically ill patients. We categorized the patients into four subgroups based on their diagnosis (sepsis or septic shock) and survival status (survivors and non-survivors). The parameters were monitored on day 1 (when sepsis was diagnosed according to the Sepsis-3 Consensus) and again on day 5. Eighty-two healthy volunteers were included as a control group to establish the cut-off values for IL-7. Results: Statistical analysis revealed a significant difference in median values between days 1 and 5 for lymphocytes (p = 0.01) and NKT cells (p = 0.01), observed only in sepsis survivors. In the group of sepsis survivors, we observed a negative correlation between IL-7 levels and NKT cells but only on day 1. Additionally, we identified negative correlations between Th cells (CD4+) and Tc cells (CD8+) on both day 1 and day 5. In the group of sepsis non-survivors, we observed a positive correlation between IL-7 and B cells (CD19+) but only on day 1. We also identified a negative correlation between Th cells (CD4+) and Tc cells (CD8+) on day 1. In the group of septic shock survivors, we did not observe any correlation between IL-7 levels and other parameters studied on day 1 or day 5. We identified a negative correlation between Th cells (CD4+) and Tc cells (CD8+) on both day 1 and day 5, a negative correlation between Th cells (CD4+) and NKT cells on both day 1 and day 5, and a positive correlation between Th cells (CD4+) and B cells (CD19+) on day 1. In the group of septic shock non-survivors, we did not observe any correlation between IL-7 and other parameters studied. Conclusions: Determining the IL-7 plasmatic value every five days did not demonstrate the necessary sensitivity and specificity as a biomarker to accurately assess each patient’s immune balance. Endogenous IL-7 levels appear inadequate to overcome the immunosuppressive environment induced by sepsis. Full article

(This article belongs to the Special Issue Global Perspectives on Sepsis: Epidemiology, Awareness and Treatment Strategies)

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