Genomics in the Evaluation and Management of Sepsis
This chapter focuses on the tremendous achievements in describing the genomes of various bacterial, viral, and fungal pathogens. The human genome and its response to the infectious perturbations that result in sepsis are discussed. Sepsis is a common, heterogeneous clinical entity that is defined by the physiological changes known collectively as the systemic inflammatory response syndrome (SIRS), occurring in response to a presumed infectious etiology. The insulting agent may be bacterial, viral, fungal, or parasitic with more than 80% of cases originating from a pulmonary, genitourinary, or abdominal source. However, sepsis is not a single disease, but a heterogeneous syndrome that is expressed through the interaction of networks of biochemical mediators and inflammatory cascades. Clinical expression is variable and its severity is influenced by the infectious etiology, the genetic background of the patient, comorbid conditions, the time to clinical intervention, and the supportive care provided by the physician. The recognition and treatment of sepsis have posed a daunting challenge for clinicians despite the improvements in technology and the principles of critical care medicine. The characterization of the human genome has provided a mechanism to study infection at the molecular level. Whereas former techniques focused on obtaining fluid or tissue from a body compartment and incubating the sample to determine the cause of the infection, the study of genomics provides other means. © 2010 Copyright © 2010 Elsevier Inc. All rights reserved.
