Diagnostic Approach in Sepsis

Abstract

AbstractSepsis occurs both community acquired and as a complication of hospital treatment. The symptoms are usually nonspecific and there is no diagnostic gold standard. The diagnostic differentiation from other clinical pictures is difficult. Therefore, the (early) diagnosis of sepsis is still a major challenge for the clinician. Despite multiple biomarkers described in the scientific literature sepsis is still primarily a clinical diagnosis. qSOFA can be a helpful screening tool.Finding and treating the focus of infection is a crucial part of sepsis therapy. Chest X-ray and sonography have limited sensitivity for this purpose. A CT-scan with contrast should be done at least in all patients where the focus of infection is still unclear. An MRI is necessary if spondylodiscitis is suspected, a transesophageal echocardiography if endocarditis is a possible focus. Biomarkers are helpful in guiding therapy but are not part of the initial diagnosis criteria. Blood cultures and microbiological samples from the suspected foci of infection should be taken in all sepsis patients. An initial lactate measurement is also part of the diagnostic workup and necessary for the diagnosis of septic shock.