In the presence of really severe infections (called “sepsis”), to save lives, doctors need to kill the bugs causing the infection, whilst giving patients supportive therapy such as intravenous fluids. Treatment of sepsis needs to target the right bugs. This paper describes what the bugs are in Malawi, that is, the microbiological causes of sepsis. The drugs we are currently giving sepsis patients are either over-treating these bugs (risking antibiotic failure as a consequence) or under-treating them (risking patient death). We need to be smarter about getting the right treatment into the right patient to target the right bug at the right time – more research is needed to do this, but rapid tests (like urinary lipoarabinomannan [LAM] for TB) will play a role. To reduce long-term deaths, sepsis should continue being managed and monitored even after hospital discharge, especially among patients on antiretroviral therapy (ART).
