Etiology of illness in patients with severe sepsis admitted to the hospital from the emergency department.
Open accessAbstract
BACKGROUND: Patients identified with sepsis in the emergency department often are treated on the basis of the presumption of infection; however, various noninfectious conditions that require specific treatments have clinical presentations very similar to that of sepsis. Our aim was to describe the etiology of illness in patients identified and treated for severe sepsis in the emergency department. METHODS: We conducted a prospective observational study of patients treated with goal-directed resuscitation for severe sepsis in the emergency department. Inclusion criteria were suspected infection, 2 or more criteria for systemic inflammation, and evidence of hypoperfusion. Exclusion criteria were age of <18 years and the need for immediate surgery. Clinical data on eligible patients were prospectively collected for 2 years. Blinded observers used a priori definitions to determine the final cause of hospitalization. RESULTS: In total, 211 patients were enrolled; 95 (45%) had positive culture results, and 116 (55%) had negative culture results. The overall mortality rate was 19%. Patients with positive culture results were more likely to have indwelling vascular lines (P = .03), be residents of nursing homes (P = .04), and have a shorter time to administration of antibiotics in the emergency department (83 vs 97 min; P = .03). Of patients with negative culture results, 44% had clinical infections, 8% had atypical infections, 32% had noninfectious mimics, and 16% had an illness of indeterminate etiology. CONCLUSION: In this study, we found that >50% of patients identified and treated for severe sepsis in the emergency department had negative culture results. Of patients identified with a sepsis syndrome at presentation, 18% had a noninfectious diagnosis that mimicked sepsis, and the clinical characteristics of these patients were similar to those of patients with culture-positive sepsis.
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A third or more of patients initially diagnosed with sepsis turn out to have non-infectious conditions.
“Indeed, a third or more of patients initially diagnosed with sepsis turn out to have non-infectious conditions [90, 93, 94].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [93]
Accurately diagnosing sepsis is challenging because sepsis can present subtly, and some presentations that first appear to be sepsis turn out to be non-infectious conditions.
“Accurately diagnosing sepsis is challenging as sepsis can present in subtle ways, and some presentations that first appear to be sepsis turn out to be non-infectious conditions [90, 93, 107, 108].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [93]
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- Authors
- Heffner, A. C., Horton, J. M., Marchick, M. R., & Jones, A. E.
- Affiliations
- Carolinas Medical Center (US)
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-03-15
- Volume
- 50
- Issue
- 6
- Pages
- 814-820
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC2921279
- OpenAlex
- W2130300971
- Semantic Scholar
- 94fa024460005ba949558ec86a6b4cc5ce4a10a8
- Cited by
- 157
- References
- 14
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 4 · 2023: 13 · 2022: 17 · 2021: 17 · 2020: 14 · 2019: 15 · 2018: 10 · 2017: 6 · 2016: 7 · 2015: 6 · 2014: 15 · 2013: 5 · 2012: 8
- FWCI
- 5.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of General Medical Sciences (K23GM076652, GM76652)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
- Keywords
- severe sepsis, sepsis etiology, atypical infection, nursing home residents, timing of antibiotic administration, goal-directed resuscitation, sepsis mortality
- MeSH terms
- Adult, Bacteria, Bacterial Infections, Emergency Service, Hospital, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Systemic Inflammatory Response Syndrome, Sepsis
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