Sepsis and antimicrobial therapy in trauma patients

Sepsis is body’s systemic inflammatory response to infection. Sepsis physiopathogenesis is characterized by an inflammatory cascade. The cascade has humoral, cellular, complement and cytokine components. Sepsis in trauma patients is common. Multisystem trauma patients have a reduced capacity to fight infections as there immune system is compromised. Following a major trauma there is a catabolic phase secondary to tissue injury and surgical intervention. Sepsis in trauma essentially has the same physiopathogenesis. Trauma, inflammation, or infection leads to the activation of the inflammatory cascade. The host response is perhaps as important as the site of infection or type of microorganism in the cause of sepsis. Sepsis should be identified as early as possible. Sepsis patients should be rendered a comprehensive therapy. Multi organ support therapy is essential. The high morbidity and mortality of severe sepsis and septic shock fosters a continuous search for novel therapies that go beyond pure correction of oxygenation and hemodynamics. Before the advent of antibiotics, sepsis was considered almost inevitable after severe trauma. This adage was the basis of judicious antibiotic use and was seed for the concept of "Antibiotic Stewardship". The concept of antibiotic usage in trauma has always drawn controversy. There are diverse schools of thoughts on necessity, Duration and choice of antibiotics. Judicious antibiotic selection in required for various trauma scenarios.