To have sepsis or to be septic—is the difference between these clinical conditions important?

The past three decades has seen various controversies over definitions and approaches to managing the patient with sepsis. The recent proposal for a new definition of ‘sepsis’ arising from the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) has created further confusion, and a lively debate has followed its publication, with calls for a re-assessment of the definitions. The key point of confusion seems to be that the clinical condition referred to as ‘sepsis’ is being confused with the patient ‘being septic’. Accurate definition of a disease entity should help facilitate immediate clinical action through instituting relevant diagnostic procedures and appropriate management. The recent proposal of sepsis does not do that, because a septic patient may be ill due to a range of other infections such as severe malaria, influenza, or Ebola virus disease, and will still be labelled as having sepsis. The new definition, or should we call it the ‘so-called definition’, is based on a set of organ-specific predictors of outcome and is not a definition of a clinical entity that could usefully help the clinician to manage septic patients rationally. ‘Sepsis’, to the infectious disease physician, is an illness caused by the presence of bacteria in the body tissues or bloodstream, i.e., an ill patient for whom blood culture is positive or is expected to be positive. Thus the word ‘sepsis’ immediately informs the physician that here is someone with a potentially life-threatening bacterial infection that requires treatment with appropriate antibiotic cover, and that the identification of the focus or source of the bacterial infection via appropriate investigations, including microbiological and imaging diagnostic procedures, may be required. ‘Septic’ is a very different term from ‘sepsis’ to the infectious disease physician; the patient being septic means that the patient has the same symptomatology as a patient with sepsis, but the bacterial diagnosis may not be obvious and a range of other pathogens need to be considered much more broadly, so that appropriate, pathogen-specific therapy can be instituted. For instance, a patient with severe influenza, malaria, or viral Sepsis Septic Critical care Definition Bacteria Viruses