A suspected or documented infection is required for the diagnosis of sepsis.
The lack of a “gold standard” for sepsis diagnosis coupled with the delay of culture results increases the likelihood of including patients in the sepsis management pathway who do not actually have sepsis.
With nonspecific findings, sepsis mimics multiple other diseases. Sepsis alone should not be the only consideration in these patients.
Infectious as well as non-infectious conditions as the patient’s etiology of their acute illness should be sought.
After hospitalization, a patient’s trajectory can rapidly change.
The recently published Surviving Sepsis Campaign 2021 International guidelines recommend continually assessing the patient to determine if other diagnoses other than sepsis are more or less likely.
Due to the deficiencies listed above, the occurrence of sepsis might be overestimated.
Recent Surviving Sepsis Campaign recommendations provide antimicrobial dosing guidance based on the clinical probability of the patient having sepsis.
Unfortunately, there guidance to determine the probability of sepsis has not been a focus of investigation, with no clear guidance.
Heffner et al 2010:
211 ED patients with suspected infections – Majority were culture Negative
45% (n=95) culture positive
55% (n=116) culture negative
Of the 116 Culture Negative Patients 32% were non-infectious
Klein Klouwenberg et al 2015:
2,579 Presumed Sepsis Admissions to ICU
Clinician review of each case for likelihood of infection
Criteria defined for:
43% of patients were determined to be in the none or possible infection group.
Accuracy of the infection diagnosis in patients with suspected sepsis corresponds poorly with the presence of infection either by culture results or clinical definitions.
30-40% of patients initially diagnosed with sepsis will have non-infectious conditions.