Infectious Diseases in Critical Care Medicine

pseudosepsis have temperatures 1028 F. The temperature relationships are critical when
considered together with organ involvement, such as GI, GU, etc. are key factors in determining
if the patient is septic or has a noninfectious disorder resembling sepsis. Hyperthermia 1068 F
is only caused by noninfectious disorders. Hypothermia is an important clinical clue to
bacteremia, particularly in renal insufficiency. In normal hosts with fever, sepsis should not be a
diagnostic consideration if temperatures are< 1028 For> 1068 F (22–25) (Table 2).

Table 1 Clinical Conditions Associated with Sepsis

Associated with sepsis (fevers 1028 F) Not associated with sepsis (fevers 1028 F)

.GI source .GI source
Liver Esophagitis
Abscess Gastritis
Gallbladder Pancreatitis
Gallbladder ‘‘wall abscess’’ GI bleed
Cholangitis .Genitourinary source
Colon Urethritis
Colitis
IschemicC. difficile

Cystitis (normal hosts)

Cervicitis

Diverticulitis Vaginitis

Toxic megacolon PID

Perforation Catheter-associated bacteriuria (CAB) in normal hosts

Obstruction

Abscess

.Upper respiratory source

.Genitourinary source

Pharyngitis

Renal

Sinusitis

Pyelonephritis

Mastoiditis

Intra/perinephric abscess

Bronchitis

Calculi

Otitis

Urinary tract obstruction

.Lower respiratory source

Partial

CAP (normal host)

Total

.Skin/soft tissue source

Prostate

Osteomyelitis

Abscess

Uncomplicated wound infections

.Pelvic source

.Cardiovascular source

Pelvic peritonitis

Subacute bacterial endocarditis (SBE)

Tubo-ovarian abscess

.Central nervous system source

Pelvic septic thrombophlebitis

Bacterial meningitis (excluding meningococcal meningitis

with meningococcemia)

.Lower respiratory source

.Intravascular source

CAP

A-lines

Asplenia/hyposplenism

Peripheral IV lines

Empyema

Phebitis

Lung abscess

Nosocomial pneumonia

.Intravascular source
IV line infection
Central venous catheters (CVC)
PICC lines
Hickman/Broviac catheters
Infected prosthetic devices
AV grafts
Jugular vein septic thrombophlebitis
.Cardiovascular source
Acute bacterial endocarditis (ABE)
Myocardial abscess
Paravalvular abscess
.Other
Toxic shock syndrome

Abbreviations: GI, gastrointestinal; IV, intravenous; PID, pelvic inflammatory disease; CAP, community acquired
pneumonia; BPH, benign prostatic hyperpertrophy; PICC, peripherally inserted central catheter; AV, arteriovenous.
Source: From Refs. 9 and 22.

Clinical Approach to Sepsis and Its Mimics in Critical Care 129