The International Sepsis Forum's controversies in sepsis: how will sepsis be treated in 2051?

Sepsis, the life-threatening illness that arises from innate immunity to overwhelming infection, is treated symptomatically at the start of the 21st century. Looking ahead 50 years, one can perhaps foresee profound changes in the way we manage this disorder. A shift from a focus on eradicating micro-organisms as universally inimical to one on supporting optimal host–microbial homeostasis will have a profound impact on how we treat infection, and will relegate antibiotics to a small, adjuvant role. Probiotic therapy may well be as important as antibiotic therapy. Resuscitation strategies will support microvascular flow rather than systemic pressure. Rapid genetic profiling will permit pre-emptive gene therapy for some, and titration of specific therapies directed against fundamental intracellular processes in others. We will treat diseases, not syndromes, and guide therapy by molecular staging. A fanciful victim of sepsis in 2051 illustrates how future treatments might transform sepsis from a prolonged and morbid illness to a rapidly reversed acute disease.