Infectious Diseases in Critical Care Medicine

SUMMARY
The immediate task of the clinician is to determine whether the patient has sepsis or a mimic of
sepsis. Diagnostic approach may be approached from the negative perspective, i.e., if the
patient does not have a GI, GU, IV process usually associated with sepsis, then the patient in all
probability does not have sepsis, and the workup should be directed to diagnosed disorders
that mimic sepsis.
The temperature of the patient is of key importance in determining if the patient has
sepsis or a noninfectious mimic. In temperatures 1068 F and 1028 F, a noninfectious disease
process is likely and argues against a diagnosis of sepsis. Antibiotic therapy should be
instituted as soon as there is a basis for the diagnosis of sepsis, i.e., characteristic (perforation,
obstruction, or abscess) organ system of infection, GI, GU, or IV site. Coverage should be based
on the usual pathogens associated with the involved organ system. Antibiotics with
appropriate spectrum, good safety profile, low resistance potential, and anti-endotoxin
qualities are preferred. In sepsis related to perforation, obstruction, or abscess, surgical
intervention is paramount and should be done as soon as the diagnosis is confirmed.

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