Diagnosis of infection in sepsis: an evidence-based review.
OBJECTIVE
In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the diagnosis of infection in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis.


METHODS
The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee.


METHODS
The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591.


CONCLUSIONS
Obtaining a precise bacteriological diagnosis before starting antibiotic therapy is, when possible, of paramount importance for the success of therapeutic strategy during sepsis. Two to three blood cultures should be performed, preferably from a peripheral vein, without interval between samples to avoid delaying therapy. A quantitative approach is preferred in most cases when possible, in particular for catheter-related infections and ventilator-associated pneumonia. Diagnosing community-acquired pneumonia is complex, and a diagnostic algorithm is proposed. Appropriate samples are indicated during soft tissue and intraabdominal infections, but cultures obtained through the drains are discouraged.
Cohen
Jonathan
J
Department of Medicine, Brighton & Sussex Medical School, Brighton, UK.
Brun-Buisson
Christian
C
Torres
Antoni
A
Jorgensen
James
J
D000005:Abdomen; D000465:Algorithms; D001431:Bacteriological Techniques; D002405:Catheterization, Central Venous / Q000009:adverse effects; D017714:Community-Acquired Infections / Q000175:diagnosis; D003245:Consensus Statements as Topic; D019317:Evidence-Based Medicine; D006801:Humans; D007239:Infections / Q000175:diagnosis*; D008826:Microbial Sensitivity Tests; D011014:Pneumonia / Q000175:diagnosis; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D018461:Soft Tissue Infections / Q000175:diagnosis; D012122:Ventilators, Mechanical / Q000382:microbiology