Sepsis on the Basis of Suspicion of Infection


  • 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:
      • No Infection
      • Possible
      • Probable
      • Definite
    • 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.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (, or video chat.