NORTH & SOUTH| JUNE 2019| 37tients’survivalchances.“Sepsisisnot
a mildillness.Youdon’twalkaround
havinga bitofit,”saysHuggan.Red-flag
symptomsincludelackofresponsive-
ness,confusion,lowbloodpressure,high
heartandrespiratoryrate,lowoxygen
saturation,rashesandpoorurineoutput.
SincetheWaikato“SepsisReady”pro-
grammewaslaunchedinSeptember
lastyear,everyadultpatientidentified
intheemergencydepartmentwithsep-
sishasseena doctorwithinanhour,
andmostwithinhalfanhour– before,
somepatientswaitedsixhourstobe
seen.Whilethere’snoproofyet,Hug-
ganbelievesthechangeswillsavelives
andshortenhospitalstays.
AlthoughHugganacknowledgesthe
increasingthreatfromantibioticresist-
ance,hesaysmostbacteriaremainsen-
sitivetotreatmentandearlierdiagnosis
stillhasthepotentialtomakethebig-
gestimpact,atleastshort-term.Sohowrealisticarethewarningsof
a comingantibioticapocalypse,a fu-
tureinwhichtreatment-resistantsuper
bugsrenderevenroutinesurgeryprob-
lematicandputentirepopulationsat
riskofa diseasepandemic?Remember
WHOdirector-generalDrMargaret
Chan’swarningfrom 2015 thatwewere
headingtowardsa post-antibioticerain
whichcommoninfectionswouldonce
againkill?“Ifdrugresistancecauses
doctors to lose more mainstay antibi-deathwouldberecordedastheresultof
meningitis.Infectiousdiseasesexperts
saythatmeanssepsisisn’tgiventhe
recognitionit deservesasa significant
publichealthissue– andthatinaction,
togetherwiththeinexorableriseofan-
tibioticresistance– iscostinglives.
Inmanycases,delayedrecognition
ofsepsisisfatal.Milnewasonlyhours
awayfrombeing“pastthepointofno
return”,saysTaurangainfectiousdis-
easesspecialistDianeHanfelt-Goade,
whotreatedher.WhenMilnearrived
atthehospital’semergencydepart-
menton 11 April2014,hersymptoms
suggestedmeningitis,andshewasfirst
prescribedtwointravenousantibiot-
icsrecommendedforthiscondition,
ceftriaxoneandvancomycin.Onlythe
latterwasactiveagainsttheenterococ-
cusbacteriainMilne’sblood;luckily,
evenbyguessingwronglyatthecause
ofhersymptoms,doctorshadgivenan
effectivetreatment.Nevertheless,her
situationwasdire.
Hanfelt-Goade,alreadyalerttothe
likelihoodMilne’sinfectionwasrelated
tohergynaecologicalprocedure– an
endometrialablationtostopheavype-
riods– andknowingsepsiscantrigger
muscleachesandheadaches,changed
herantibioticswhenshefirstsawher
on 12 April.“Shewasrightattheedge,”
shesaysofMilne’sprecariouscondi-
tion.“Wehadtomovequickly.”
Butalltoooften,action,whenit’s
taken,istoolate.“Whenyouarejust
lookingatsomeoneundera blanket
who’sfeelinga bitbreathlessandtired,
unlessyouhavealltheinformationin
frontofyou,sepsisisn’tnecessarilyyour
firstthought,”saysWaikatoDHBin-
fectiousdiseasesspecialistandSepsis
TrustfoundingtrusteePaulHuggan.
Thetrustwasformedlastyeartohelp
putsepsis“frontofmind”whendoctors
andnursesareassessingpatients.
“Wedidn’tfeelthatsepsishaditsown
identity,itsownpersonalitywithinthe
hospital.There’sCodeStroke,Code
HeartAttack...urgenttherapyforall
sortsofthings,buttherewasa senseno-
bodyreallyownedsepsis,becausecases
wereadmittedundermanydifferent
clinicalteams.Sepsisisa biggerissue
thanit’sbeengivencreditfor.”
WaikatoisoneofseveralDHBspro-
motingwhat’sknowninternationally
astheSepsisSix– thekeystepsdoctors
andnursesshouldtaketorecogniseand
treat potential cases, which doublespa-
WaikatoDHBinfectiousdiseasesspecialistandSepsisTrustfounding
trusteePaulHuggan.“Whenyouarejustlookingatsomeoneundera
blanketwho’sfeelingabitbreathlessandtired,unlessyouhaveallthe
information in front of you, sepsis isn’t necessarily your first thought.”AyeshaVerrall,aninfectious
diseasesspecialistatWellington
Hospitalandaseniorlectureratthe
University of Otago, Wellington.otics,thiswillmeantheendofmodern
medicineasweknowit.”
Doctorsandscientistsinterviewedfor
thisstoryallregardedclimatechangeas
a biggerglobalthreat– buttheyaren’t
underestimatingtherisksofresistance.
Ina reportpublishedin2016,theIn-
stituteofEnvironmentalScienceand
Research(ESR)saidtotalantibioticcon-
sumptioninNewZealandin 2013 was
higherthan 22 of 29 Europeancountries
thatparticipatedina surveillancepro-
gramme.Consumptionhereincreased
by49%from 2006 to2014,a riseacross
all regions, ages and ethnic groups.