Diagnosis of sepsis in the practice of the infectious disease doctor

Abstract

The purpose of the study - the detection of clinical and epidemiological peculiarities of sepsis in patients admitting to the Infectious Diseases Unit on the base of the analysis of the hospital cohort. Patients and methods There was studied the Hospital cohort of the Krasnodar Specialized Infectious Disease Hospital for the period from 2010 to 2014, there were analyzed both the frequency of registration of sepsis and the structure of the mortality rate. The clinical course of sepsis and epidemiological records were considered in 81 patients. Results. The percentage of sepsis in the hospital cohort of the infectious clinic accountedfor 0.28%. In the structure of hospital lethal outcomes, the share of sepsis amounted for one fourth (24%). Among deceased patients in the clinic, the diagnosis of sepsis was predominant in 9% ofpatients; in the rest 15% cases sepsis complicated the course of the underlying disease. The mortality rate in patients with sepsis was 14%. Among the cases the males (73%) prevailed. The disease was detected at the age of 19 to 87 years. More than half ofpatients (60%) were 20-40years aged, with an average age of 41.3 ± 2.15 years. The most common of the directional diagnoses were: acute respiratory tract infection (37%), and unspecified fever (26%). Thereafter clinical diagnosis of severe sepsis was made in 94% of cases, subacute - in 3%, chronic - in 3% of cases. The disease was moderate in course in 62% of patients, severe course occurred in 38%. In all cases, the cryptogenic sepsis was diagnosed. In 2 patients sepsis developed on the background of HIV infection. 31% of patients were treated in the ICU unit. Complications of the severe course of sepsis were: infectious-toxic shock (19%), acute cardiovascular insufficiency (16%), acute hepatorenal failure (19%), ARDS, ARF (16%), DIC (9%), anemia (13%). The clinical diagnosis of sepsis has been confirmed by laboratory isolation of blood culture and a positive reaction with the autostrain in 40% of cases. In the etiological structure of sepsis staphylococcus dominated (85%), polyetiological nature of sepsis was confirmed in two patients (E.coli, St.aureus, S. pneumonae, fungi Candida). In rare cases, Str. Mitis, Kl. Pneumoniae were confirmed. Etiotropic therapy was performed with broad-spectrum antibiotics and antifungal drugs. Conclusion. In the practice of the infectious disease specialist predominantly there is made the diagnosis of cryptogenic staphylococcal sepsis as well as sepsis in the outcome of a particularly severe infectious disease. The disease was more frequently observed in young males at the age of d 20 to 40 years, it has an acute course and is manifested in moderate and, more rarely, in the severe form. The establishment of a diagnosis of sepsis in the clinic of infectious diseases is based on the following criteria: signs of SIRS, signs of organ-system failure (infectious-toxic shock , acute hepato-renal failure, acute cardio-vascular insfficiency, ARF, ARDS, DIC) in 2 or more systems; bacteremia (positive blood culture confirmed by the reaction with autostrain, positive PCR). The diagnosis is not in doubt in the presence of at least two of these signs