Diagnosis edit
Early diagnosis is necessary to properly manage sepsis, as initiation of rapid therapy is key to reducing death.[1] Within the first three hours of suspected sepsis, diagnostic studies should include white blood cell counts, serum lactate, and obtaining appropriate cultures before starting antibiotics, so long as this does not delay their use by more than 45 minutes.[1]
Blood cultures edit
To identify the causative organism, at least two sets of blood cultures using bottles with media for aerobic and anaerobic organisms should be obtained, with at least one drawn through the skin and one drawn through each vascular access device (such as an intravenous catheter) in place more than 48 hours.[1] Bacteria are present in the blood in only about 30% of cases.[2]
Blood culture may help confirm if microorganisms are in the blood. Blood cultures drawn through the skin can be falsely positive.[3] Contamination can occur during drawing blood cultures from a number of sources: if aseptic technique is not maintained; if bacteria are introduced when the syringe or collection supplies are assembled; if some bacteria on the person’s skin survive surface antisepsis and are dislodged by the needle used to access the their bloodstream; if microbes contaminate the tops of standard blood collection tubes; and from bacteria commonly found in the environment where blood cultures are collected.[3] Confusion from false positives can lead to unnecessary and expensive procedures, inappropriate overuse of antibiotics, extended length of stay in hospitals, and risk of hospital-acquired conditions.[4]
Definitions
As is, etc.
References
- ^ a b c Dellinger, RP; Levy, MM; Rhodes, A; Annane, D; Gerlach, H; Opal, SM; Sevransky, JE; Sprung, CL; Douglas, IS; Jaeschke, R; Osborn, TM; Nunnally, ME; Townsend, SR; Reinhart, K; Kleinpell, RM; Angus, DC; Deutschman, CS; Machado, FR; Rubenfeld, GD; Webb, SA; Beale, RJ; Vincent, JL; Moreno, R; Surviving Sepsis Campaign Guidelines Committee including the Pediatric, Subgroup. (February 2013). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Critical care medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. PMID 23353941.
- ^ Wacker, C; Prkno, A; Brunkhorst, FM; Schlattmann, P (May 2013). "Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis". The Lancet. Infectious diseases. 13 (5): 426–35. doi:10.1016/S1473-3099(12)70323-7. PMID 23375419.
- ^ a b Garcia, RA; Spitzer, ED; Beaudry, J; Beck, C; Diblasi, R; Gilleeny-Blabac, M; Haugaard, C; Heuschneider, S; Kranz, BP; McLean, K; Morales, KL; Owens, S; Paciella, ME; Torregrosa, E (November 2015). "Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections". American journal of infection control. 43 (11): 1222–37. doi:10.1016/j.ajic.2015.06.030. PMID 26298636.
- ^ Hall, KK; Lyman, JA (October 2006). "Updated review of blood culture contamination". Clinical microbiology reviews. 19 (4): 788–802. doi:10.1128/CMR.00062-05. PMID 17041144.