Last week, The Lancet published the findings of a comprehensive study of global, regional and national sepsis incidence and mortality from 1990-2017. In 2017, the authors found a staggering 11 million sepsis-related deaths were reported worldwide – representing nearly 20 % of all global deaths. More than half of these were among children and neonates. Incidence and mortality varied globally, and the regional disparity in sepsis-related deaths is particularly stark, with the highest burden in sub-Saharan Africa, Oceania, and southeast Asia.

The study is significant, as it is the largest of its kind, and it more than doubles the previous estimated global figures - although it does offer hope in that overall, sepsis related mortality has declined since 1990. In many ways, sepsis is a perfect example of the complexity surrounding the practical challenges of AMR. Sepsis can be caused by a variety of different pathogens, which may or may not be sensitive to antibiotics, and treating a patient rapidly and effectively is of critical importance to the outcome. Literally every hour is of the essence, and so understandably, there is a strong motivation to begin an antibiotic treatment without knowledge of the causative agent or before the appropriate antibiotic has been determined and selected. This dilemma may be helped with improved rapid diagnostics in the future, but it might well remain an area where theoretical principles and pragmatic application continue to collide.

For their part, the authors discuss several implications that are relevant to health policy makers, clinicians and researchers, irrespective of whether the sepsis is caused by a drug resistant pathogen or not. For example, infection-prevention efforts should be targeted to areas with the highest incidence of sepsis and among the most vulnerable populations, such as neonates. Public health work might be expanded to target sepsis due to non-communicable diseases in high-burden areas. With regards to AMR, the authors point to the need for basic acute care services such as microbiology facilities and timely antibiotic administration. Research and policy interventions targeting AMR as a driver of nosocomial infection resulting in sepsis are also of special importance.

The twin problems of AMR and sepsis are interconnected, the solutions should be similarly holistic if mortality rates are to continue to improve, especially in the groups most at risk.