Palliative Care, Sepsis & Antimicrobial Resistance: 
Shared problems, shared solutions

By Natalie Greaves, IAHPC Board Member
& Michael H. Campbell

Natalie Greaves, MBBS, PhD, and Michael Campbell, PhD. Photos used with permission.

Advocating for improvement in palliative and end-of-life care services for all and, especially, the marginalized and forgotten around the word is central to the purpose and mission of the IAHPC. Fidelity to this mission often requires considering other factors and contexts influencing global palliative care health outcomes.

Currently, millions of people globally are experiencing psychological stress because of the compounded effects of social, political, economic, and environmental instability.(1, 2) More than 110 armed conflicts are actively raging across five world regions, reducing the quality of everyday life, including services and supports provided to people with end-of-life and palliative care needs.(3)

In 2023, we drew attention to the link between palliative care and the climate crisis, highlighting the fact that patients and caregivers struggle with climate-related disasters, food and water insecurity, and emerging and remerging vector-borne diseases alongside their existing (and sometimes unmet and worsening) palliative care needs.(4) 

Now, we draw attention to another important but neglected relationship among sepsis, anti-microbial resistance (AMR), and palliative care. The intersection of these issues may not be intuitive, but nonetheless has significant implications for public health and palliative care.

Understanding sepsis & AMR

Sepsis refers to “the body’s response to an infection resulting in injury to its own tissues and organs.” (5-7) The end results of untreated or poorly treated sepsis includes “shock, multiorgan failure and death.”(5-7)

The prevention and effective management of sepsis revolves around using: good water, hygiene, and sanitation practices; early detection; and prompt appropriate treatment.(7) 

Sepsis accounts for nearly 1 in 5 deaths

In 2017, an estimated 48 million people were newly affected by sepsis, and nearly one in five deaths globally were associated with the condition.*(8) The global health impact of sepsis is expected to increase, partly due to the inappropriate and indiscriminate use of antimicrobials.(9) Such use results in disease-causing agents, such as bacteria, viruses, and fungi, becoming resistant to the very medicines designed to kill them and prevent disease in humans. This antimicrobial resistance (AMR) reduces the number of effective treatment options available to health care providers, including palliative care teams.(6, 7, 10) 

AMR is a priority health issue,
particularly for palliative care

At the United Nations General Assembly Second High-Level Meeting on Antimicrobial Resistance held September 26, 2024, AMR was highlighted as a priority global health issue, with the political declaration noting that “antimicrobial resistance is one of the most urgent global health threats […] and demands immediate action to safeguard our ability to treat human [...] diseases."(11) 

The unfortunate reality is that the population most susceptible to sepsis and AMR directly overlaps with those likely to have palliative care needs, including children and older persons who face challenges associated with life-threatening illness and immunocompromised states. 

These are our children with chronic respiratory conditions such as cystic fibrosis, our patients and loved ones with progressive neurological diseases, and our citizens with cancer and end-stage renal, pulmonary, and heart diseases (especially in low-resourced settings).

Adding our voices

So, as we advocate for palliative care, we should amplify the call for measures that will decrease the likelihood of premature death in our clients, family members, and loved ones due to sepsis and AMR. 

Let us add our voices as advocates for, and practitioners of, safe and rational prescribing of antimicrobial medicines to protect our palliative care patients from sepsis involving AMR. By doing this, we help to safeguard their quality of life by increasing the effectiveness of treatments to mitigate the risk and severity of sepsis along their journey. 

The time to act collectively is now, as shared problems require shared solutions.  

* The Global Burden of Disease Study(8) referenced here also highlighted the disproportionate impact of sepsis in developing countries especially in sub-Saharan Africa.

References

  1. Connecting Climate Minds. Global research and action agenda for climate and mental health. July 22, 2024. Accessed Oct. 1, 2024.
  2. Connecting Climate Minds. Lived experiences. Accessed Oct. 1, 2024
  3. Geneva Academy of International Humanitarian Law and Human Rights. Today’s armed conflicts. Accessed Oct 1, 2024 
  4. Greaves N, Campbell M. Climate and Health at the 76th World World Health Assembly: Implications for the global palliative care movement. IAHPC Newsletter, Vol. 24 No. 7 (July 2023).
  5. World Health Organization. Sepsis: key facts. 3 May 2024. Accessed Oct. 1, 2024.
  6. Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-resistant sepsis: a critical healthcare challenge. Antibiotics 2024; 13(1):46.
  7. Caribbean Sepsis and AMR Alliance. The Mount Hope Declaration on Sepsis and Antimicrobial Resistance. Accessed Oct. 1, 2024.
  8. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395(10219): 200-211. 
  9. National Institutes of Health National Cancer Institute. Definition of antimicrobial. [A substance that kills microorganisms such as bacteria or mold or stops them from growing and causing disease.] Accessed Oct. 1, 2024
  10. UN General Assembly High-Level meeting on antimicrobial resistance. Accessed Oct. 1, 2024.
  11. Political Declaration of the High-Level Meeting on Antimicrobial Resistance. Accessed Oct. 1, 2024.

Natalie Greaves, MBBS, PhD, is a lecturer in public health and coordinator of the MPhil/ PhD Programme in Public Health and Epidemiology at The University of the West Indies, Cave Hill Campus, Barbados. Natalie merges her clinical passion for community based palliative care with academic applied public health, providing expertise in using qualitative methods to explore complex issue. She is a member of the Caribbean Sepsis and AMR Alliance and a contributor to the Mount Hope Declaration on Sepsis and Antimicrobial Resistance- May 2024. 

Michael H. Campbell, PhD, is senior lecturer in behavioral science/psychology and deputy dean (research & graduate studies) in the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados. He publishes in the areas of global health psychology and bioethics, and is a fellow of the American Psychological Association, associate fellow of the British Psychological Society, and past president of the Barbados Society of Psychology. 

Read more of this week's issue of Pallinews

Divinity Within & In The Moment

A report on IAHPC/PallCHASE World Peace Day webinar—"Spiritual Care in Serious Illness: Cultivating a culture of peace"—by Katherine Pettus, Senior Director of Partnerships & Advocacy.

Report from a Palliative Care Nurse in Lebanon

Balsam nurse Batoul Haidar was doing home visits until a barrage of rockets put an end to them, and she was forced to find safer housing.

Plus

What's New in the IAHPC Calendar

Giant ECHO Session October 18: At the upcoming McGill Palliative Care Congress in Montreal, Pallium Canada is hosting an event it describes as "the world's largest palliative care ECHO session" that anyone can sign up for right up until the start.

Reminder Gear up for talking to people about your work, and the goal of alleviating serious health-related suffering, on October 12, World Hospice & Palliative Care Day.