We should be measuring genomic bacterial load and virulence factors

Objective: To describe relevant pathogen-related characteristics and their impact on sepsis pathogenesis and prognosis. Data Source: Current literature regarding genomic bacterial load and virulence factors, with an emphasis on the impact of these factors on pathophysiology and prognosis of sepsis. Data Extraction and Synthesis: The current paradigm on sepsis pathophysiology and management overlooks aspects concerning the nature and characteristics of the infecting pathogen. Our findings suggest that evaluation of genomic bacterial load might be useful to assess severity and predict prognosis in septic patients; its use during treatment for monitoring clinical response is another interesting potential application. Virulence factors identification might help to develop pathogen-specific therapeutic strategies for higher-risk septic patients. Conclusions: The recognition of the importance of quantifying the pathogen has major clinical implications and will open up a new field of exploration of therapies targeted at anticipating development and appropriate treatment in severe sepsis. The improved detection and understanding of bacterial virulence factors may lead to specific therapies. (Crit Care Med 2010; 38[Suppl.]:S656-S662)