Diagnosis of infection in sepsis: An evidence-based review

Abstract

Obtaining a precise bacteriological diagnosis before starting antibiotic therapy is, when possible, of paramount importance for the success of therapeutic strategy during sepsis. Two to three blood cultures should be performed, preferably from a peripheral vein, without interval between samples to avoid delaying therapy. A quantitative approach is preferred in most cases when possible, in particular for catheter-related infections and ventilator-associated pneumonia. Diagnosing community-acquired pneumonia is complex, and a diagnostic algorithm is proposed. Appropriate samples are indicated during soft tissue and intraabdominal infections, but cultures obtained through the drains are discouraged.

Burn Wound Infections

“…Bloodstream infection and the subsequent development of sepsis are among the most common infection complications occurring in burn patients in the intensive care unit (378). Sepsis syndrome is clinically heralded by the onset of hypothermia or hyperthermia, hypotension, decreased urinary output, hyperglycemia, neutropenia or neutrophilia, and thrombocytopenia (20,47,86,140,177). Burn wound sepsis was predominantly due to invasive wound infection prior to the advent of early burn wound excision (30,127,170,185,253,296,334,429).…”

“…Diagnostic tests should be done to identify the site and source of infection, including blood, urine, and sputum cultures. Empirical broad-spectrum antibiotic therapy directed at the most recent bacteria isolated from burn wound cultures and other sources should be instituted promptly (86,108,307). Patients in the intensive care unit with bloodstream infections may develop severe sepsis if initial empirical antimicrobial treatment provides inadequate activity against the organism causing infection (474).…”

Management of Peritonitis in the Critically Ill Patient

“…An upright chest radiograph is useful if perforated viscera is suspected. Free air in the abdomen may occur in 80% of cases of duodenal ulcer perforation, but it is observed with less frequency when there is colon, small bowel, or intra-peritoneal rectum perforation [1,[39][40][41][42].…”

Management of Sepsis: Recent Advancement

“…Repeated recording of these parameters will be used to evaluate clinical improvement or deterioration and trigger specific interventions. 1,[14][15] Consistently analyzing the vital signs for the presence of SIRS criteria in any possible patient with sepsis will aid in the early recognition of critical illness. Importantly, vital sign derangements may be absent early in elderly patients.…”