Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to
infection. This definition, updated in 2016, shifted the conceptual focus from exclusive attention to the systemic inflammatory response toward the multifactorial tissue damage that occurs during the progression of
infection to
sepsis and
shock. Whereas targeting the inflammatory host response to
infection did not translate into improved clinical management of
sepsis, recent findings might shed new light on the maladaptive host-pathogen interaction in
sepsis and pave the way for "
theranostic" interventions. In addition to the well-known resistance responses of the immune system that result in pathogen clearance, "disease tolerance" has recently been acknowledged as a coping mechanism of presumably equal importance. We propose that both defense mechanisms, "resistance" and "disease tolerance", can get out of control in
sepsis. Whereas excessive activation of resistance pathways propagates tissue damage via immunopathology, an inappropriate "tolerance" might entail immunoparalysis accompanied by fulminant, recurrent or persisting
infection. The review introduces key signaling processes involved in
infection-induced "resistance" and "tolerance". We propose that elaboration of these signaling pathways allows novel insights into
sepsis-associated tissue damage and repair processes. Moreover
theranostic opportunities for the specific treatment of
sepsis-related hyperinflammation or immunoparalysis will be introduced. Agents specifically affecting either hyperinflammation or immunoparalysis in the course of
sepsis might add to the therapeutic toolbox of personalized care in the field of organ dysfunction caused by
infection. (This article is freely available.).