How is bacterial sepsis diagnosed?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Sepsis is often associated with or preceded by other conditions (see Table 2 below). [39, 40, 41] Noninfectious conditions that present in a manner similar to that of sepsis must also be considered, as should the host's immunocompetence. Early diagnosis with rapid initiation of appropriate therapy is the cornerstone of reducing mortality and morbidity associated with sepsis. Diagnostic studies should be sent within the first 3 hours of suspected sepsis, and antibiotics should be initiated within the first 45 minutes after appropriate cultures are collected. If the blood pressure remains less than 65 mm Hg despite initial fluid resuscitation of 30 mL/kg or if the initial lactate level is 4 mmol/L (36 mg/dl) or higher within 6 hours, further hemodynamic assessments should be performed to ensure adequate organ perfusion. It is essential to reach a preliminary diagnosis within the first 12 hours of presentation to decrease the likelihood of adverse clinical outcomes.

Table 2. Clinical Conditions Associated With Sepsis (Open Table in a new window)

System 

Associated With Sepsis

Not Typically Associated With Sepsis 

GI tract

Liver

Gallbladder

Colon

Abscess

Intestinal obstruction

Instrumentation

Esophagitis

Gastritis

Pancreatitis (may have multiorgan dysfunction but not infectious in origin)

Small bowel disorders

GI bleeding

GU tract 

Pyelonephritis

Intra- or perinephric abscess

Renal calculi

Urinary tract obstruction

Acute prostatitis/abscess

Renal insufficiency

Instrumentation in patients with bacteriuria

Urethritis

Cystitis

Cervicitis

Vaginitis

Catheter-associated bacteriuria (in otherwise healthy hosts without genitourinary tract disease)

Pelvis

Peritonitis

Abscess

 

 

Upper respiratory tract

Deep neck space infection

Abscess

Pharyngitis

Sinusitis

Bronchitis

Otitis

Lower respiratory tract

Community-acquired pneumonia (with asplenia)

Empyema

Lung abscess

Community-acquired pneumonia (in otherwise healthy host)

 

 

 

Intravascular

IV line sepsis

Infected prosthetic device

Acute bacterial endocarditis

 

Cardiovascular

Acute bacterial endocarditis

Myocardial/perivalvular ring abscess

Subacute bacterial endocarditis

 

CNS

Bacterial meningitis

Aseptic meningitis

Skin/soft-tissue

 

Necrotizing fasciitis

 

Osteomyelitis

Uncomplicated wound infections

CNS = central nervous system; GI = gastrointestinal; GU = genitourinary; IV = intravenous. Adapted from: Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am. Mar 1996;10(1):185-209. [39]


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