Dear Sepsis-3, we are sorry to say that we don't like you - Critical Care Science (CCS)

The controversy

The medical community became divided over the clinical value of the new criteria (i.e., regarding their actual impact and safety when applied at the bedside). The criticism mainly focused on the following three aspects: (1) underlying theoretical concepts; (2) the methods used to define the criteria; and (3) their potential impacts on clinical practice.

Regarding the theoretical aspects, the criticism emphasized the oddity of applying different criteria to the suspicion and identification of the same pathological phenomenon, which frequently exhibited the same clinical presentation, according to whether or not the patient was admitted to the ICU. The criticism stressed that the new criteria stemmed from a purely retrospective analysis of hospital databases created for completely different purposes, were quite limited in their geographic distribution, and defined for this particular objective, infection (i.e., a clinical concept) as a “collection of biological samples + prescription of antibiotics within a given time interval” (i.e., non-clinical concepts) and using physiological data collected in a manner that was not completely explained (i.e., the reliability of the Glasgow Coma Scale assessment or the respiratory rate, especially outside the ICU). Clearly, this criticism only applies to the development of the criteria for sepsis and not to the criteria for septic shock, which as mentioned above are based on another set of data.

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