Infectious Diseases in Critical Care Medicine

Table 3 Sepsis Vs. Mimics of Sepsis

Parameters Disorders mimicking sepsis Sepsis (bacteremia from GI/pelvic GU, IV source)

.Microbiologic Negative blood cultures (excluding
skin contaminants)

Positive buffy-coat smear
Bacteremia (excluding skin contaminants)
.Hemodynamic ;PVR ;PVR
:CO :CO
.Laboratory :WBC (with left shift) :WBC (with left shift)
Normal platelet count ;Platelet count
;Albumin ;Albumin
:FSP :FSP
:Lactate :Lactate
:D-dimers :D-dimers
:PT/PTT :PT/PTT
;Fibrinogen
;a 2 globulins
.Clinical  1028 F  1028 F
Hypotension Hypotension
Tachycardia Tachycardia
Respiratory alkalosis Respiratory alkalosis

Abbreviations: PVR, peripheral vascular resistance; CO, cardiac output; FSP, fibrin split products; WBC, white
blood cell; PT/PTT, prothrombin time/partial thromboplastin time; GI, gastrointestinal; GU, genitourinary;
IV, intravenous.
Source: From Refs. 9 and 22.

Table 4 Empiric Therapy of Sepsis Based on Organ System Involved

Empiric therapy usual organisms

Source/usual organisms Monotherapy Combination therapy

.Lower GI tract/pelvis (common coliforms
plusBacteroides fragilis)

Meropenem

Tigacycline

Aztreonam or aminoglycoside plus
either clindamycin or
Ertapenem metronidazole
Piperacillin/tazobactam
moxifloxacin
.GU tract/kidneys/prostate (aerobic
gram-negative bacilli)

Levofloxacin
Third-generation
cephalosporin
Aztreonam
Amikacin
.E. faecalis(VSE) Ampicillin
Meropenem
.E. faecium(VRE) Linezolid
Daptomycin
Quinupristin/dalfopristin
.Bloodstream (CVC)
(aerobic gram-negative bacilli,
Staphylococcus aureus, Enterococci)

Meropenemb Cefepime plus vancomycin

.Lung nosocomial pneumonia/vent-
associated pneumonia
(aerobic gram-negative bacilli)

Meropenem Meropenem or cefepime plus either

levofloxacin or aztreonam or

amikacin

Cefepime
Cefoperazone
Levofloxacin
.Organism unknown Meropenem
Piperacillin/tazobactam
Tigacyclinea

aif Proteus and P. aeruginosa unlikely.
bplus vancomycin, daptomycin, or linezolid if most CVC infections in hospital due to methicillin-resistant

Staphylococcus aureus(MRSA).
Abbreviations: IV, intravenous; GI, gastrointestinal; GU, genitourinary; VSE, vancomycin susceptible enterococci;
VRE, vancomycin-resistant enterococci.
Source: From Ref. 32.

Clinical Approach to Sepsis and Its Mimics in Critical Care 131