eMedicine Specialties > Infectious Diseases > Bacterial Infections

Sepsis, Bacterial: Follow-up

Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Oct 19, 2009

Follow-up

Further Inpatient Care

  • Antibiotics are normally continued until the septic process and surgical interventions have controlled the source of infection. Ordinarily, patients are treated for approximately 2 weeks. Admission to an ICU or surgical ICU depends on the severity of the septic process and organ dysfunction, as well as the need for surgical intervention.
  • As soon as patients are able to tolerate medications orally, the patient may be switched to an equivalent regimen of antibiotics by mouth in an intravenous-to-oral switch program.

Further Outpatient Care

  • Coordinate surgical follow-up with the surgeon.

Inpatient & Outpatient Medications

  • If additional antimicrobial therapy is needed outside the hospital setting, it should be given orally, not intravenously. Do not allow the total course of antibiotics to exceed 3 weeks, except for the treatment of liver abscesses, which may require prolonged courses of oral antibiotics for cure or complete clinical resolution.

Transfer

  • Transfer may be necessary to a facility able to perform diagnostic imaging tests or required surgical procedures if they are not available at the admitting hospital.

Complications

  • Peritonitis may result in abscesses, which may subsequently need to be drained. Inadequate correction of intra-abdominal perforation or drainage procedures may result in a continuance or relapse of the patient's septic condition.

Prognosis

  • The prognosis in most patients is good, except in those with intra-abdominal or pelvic abscesses due to organ perforation. The underlying physiologic condition of the host is the primary determinant of outcome.
  • Early and appropriate empiric antimicrobial therapy and surgical intervention are critical in decreasing mortality and morbidity.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The most important medicolegal concerns regarding sepsis treatment include (1) ensuring that the patient indeed does have sepsis, (2) rapidly identifying its source, and (3) implementing effective treatments. The most common error is failure to consider pseudosepsis as a cause of the presenting syndrome complex. Most causes of pseudosepsis are readily treatable and reversible if recognized and treated early.

Special Concerns

  • Elderly patients may present with peritonitis and may not experience rebound tenderness of the abdomen. An acute surgical abdomen in a pregnant patient may be difficult to diagnose, but, fortunately, most pregnant women are young, healthy, and physiologically strong. The most common cause of sepsis in pregnancy is urosepsis due to an obstructed urinary tract, which may be caused by the hormone effects of pregnancy on the ureters (hydroureters) and the mechanical obstructing effect of the uterus impinging on the ureters.
 


More on Sepsis, Bacterial

Overview: Sepsis, Bacterial
Differential Diagnoses & Workup: Sepsis, Bacterial
Treatment & Medication: Sepsis, Bacterial
Follow-up: Sepsis, Bacterial
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am. Mar 1996;10(1):185-209. [Medline].

  2. Abraham E. Why immunomodulatory therapies have not worked in sepsis. Intensive Care Med. Jun 1999;25(6):556-66. [Medline].

  3. Ammerlaan H, Seifert H, Harbarth S, Brun-Buisson C, Torres A, Antonelli M, et al. Adequacy of antimicrobial treatment and outcome of Staphylococcus aureus bacteremia in 9 Western European countries. Clin Infect Dis. Oct 1 2009;49(7):997-1005. [Medline].

  4. Bartlett JG. Intra-abdominal sepsis. Med Clin North Am. May 1995;79(3):599-617. [Medline].

  5. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. Mar 8 2001;344(10):699-709. [Medline].

  6. Bone RC. Sepsis and its complications: the clinical problem. Crit Care Med. Jul 1994;22(7):S8-11. [Medline].

  7. Bryan CS, Reynolds KL, Brenner ER. Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy. Rev Infect Dis. Jul-Aug 1983;5(4):629-38. [Medline].

  8. Carlet J. Rapid diagnostic methods in the detection of sepsis. Infect Dis Clin North Am. Jun 1999;13(2):483-94, xi. [Medline].

  9. Carleton SC. The cardiovascular effects of sepsis. Cardiol Clin. May 1995;13(2):249-56. [Medline].

  10. Corriveau CC, Danner RL. Antiendotoxin therapies for septic shock. Infect Agents Dis. Feb 1993;2(1):44-52. [Medline].

  11. Cunha BA. Antibiotic Essentials. 5th ed. Royal Oak, Mich: Physicians Press; 2006.

  12. Cunha BA. Antibiotic treatment of sepsis. Med Clin North Am. May 1995;79(3):551-8. [Medline].

  13. Cunha BA. Bacteremia and sepsis. In: Rakel RE, Bope ET, eds. Conn's Current Therapy. 2003:68-75.

  14. Cunha BA. Empiric antimicrobial therapy for bacteremia: get it right from the start or get a call from infectious disease. Clin Infect Dis. Oct 15 2004;39(8):1170-3. [Medline].

  15. Cunha BA. Sepsis and its mimics. Intern Med. 1992;13:48-55.

  16. Cunha BA. Central intravenous line infections in the critical care unit. In: Cunha BA, ed. Infectious Diseases in Critical Care Medicine. 2nd ed. New York, NY: Informa Healthcare, Inc.; 2007:283-7/13.

  17. Dellinger RP. Current therapy for sepsis. Infect Dis Clin North Am. Jun 1999;13(2):495-509. [Medline].

  18. Faro S. Sepsis in obstetric and gynecologic patients. Curr Clin Top Infect Dis. 1999;19:60-82. [Medline].

  19. Fuller BM, Dellinger RP. Hemodynamic resuscitation in septic shock: cardiovascular support and adjunctive therapy. Curr Infect Dis Rep. Sep 2009;11(5):357-64. [Medline].

  20. Gibaldi M. Anatomy of an antibody, and related misadventures in developing an effective treatment for septic shock. Pharmacotherapy. Jul-Aug 1993;13(4):302-8. [Medline].

  21. Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med. Aug 2007;23(3):633-47, viii. [Medline].

  22. Sepsis and its mimics in the critical care unit. In: Cunha BA, ed. Infectious Diseases in Critical Care Medicine. 2nd Ed. New York, NY: Informa Healthcare, Inc; 2007:73-8/4.

  23. Jenny-Avital ER. Catheter-related bloodstream infections. N Engl J Med. Mar 22 2007;356(12):1267; author reply 1268. [Medline].

  24. Klein NC, Cunha BA. Third-generation cephalosporins. Med Clin North Am. Jul 1995;79(4):705-19. [Medline].

  25. Kobayashi M, Tsuda Y, Yoshida T, et al. Bacterial sepsis and chemokines. Curr Drug Targets. Jan 2006;7(1):119-34. [Medline].

  26. Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. Mar 1980;68(3):344-55. [Medline].

  27. Kroesen S, Widmer AF, Tyndall A, et al. Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy. Rheumatology (Oxford). May 2003;42(5):617-21. [Medline].

  28. Lange D, Zappavigna C, Hamidizadeh R, Goldenberg SL, Paterson RF, Chew BH. Bacterial Sepsis After Prostate Biopsy-A New Perspective. Urology. Oct 6 2009;[Medline].

  29. Leibovici L, Paul M. Benefit associated with appropriate antibiotic treatment. Clin Infect Dis. Nov 15 2007;45(10):1400; author reply 1401-2. [Medline].

  30. Mackenzie I, Lever A. Management of sepsis. BMJ. Nov 3 2007;335(7626):929-32. [Medline].

  31. Martin MA. Epidemiology and clinical impact of gram-negative sepsis. Infect Dis Clin North Am. Dec 1991;5(4):739-52. [Medline].

  32. Merrell RC. The abdomen as source of sepsis in critically ill patients. Crit Care Clin. Apr 1995;11(2):255-72. [Medline].

  33. Mieszczanska H, Lazar J, Cunha BA. Cardiovascular manifestations of sepsis. Infectious Disease Practice. 2003;27:183-6.

  34. Morrell MR, Micek ST, Kollef MH. The management of severe sepsis and septic shock. Infect Dis Clin North Am. Sep 2009;23(3):485-501. [Medline].

  35. Neu HC. General Therapeutic Principles. In: Infectious Diseases. Philadelphia, Pa: WB Saunders; 1992:153.

  36. Opal SM, Cohen J. Clinical gram-positive sepsis: does it fundamentally differ from gram-negative bacterial sepsis?. Crit Care Med. Aug 1999;27(8):1608-16. [Medline].

  37. Price CS, Hacek D, Noskin GA, et al. An outbreak of bloodstream infections in an outpatient hemodialysis center. Infect Control Hosp Epidemiol. Dec 2002;23(12):725-9. [Medline].

  38. Rackow EC, Astiz ME. Pathophysiology and treatment of septic shock. JAMA. Jul 24-31 1991;266(4):548-54. [Medline].

  39. Ristuccia PA, Hoeffner RA, Digamon-Beltran M, et al. Detection of bacteremia by buffy coat smears. Scand J Infect Dis. 1987;19(2):215-7. [Medline].

  40. Sacks-Berg A, Calubiran OV, Epstein HY, et al. Sepsis associated with transhepatic cholangiography. J Hosp Infect. Jan 1992;20(1):43-50. [Medline].

  41. Sheagren JN. Corticosteroids for the treatment of septic shock. Infect Dis Clin North Am. Dec 1991;5(4):875-82. [Medline].

  42. Siegel JP, Stein KE, Zoon KC. 41 anti-endotoxin monoclonal antibodies. N Engl J Med. 1992;327:890.

  43. Sriskandan S, Cohen J. Gram-positive sepsis. Mechanisms and differences from gram-negative sepsis. Infect Dis Clin North Am. Jun 1999;13(2):397-412. [Medline].

  44. Van Amersfoort ES, Van Berkel TJ, Kuiper J. Receptors, mediators, and mechanisms involved in bacterial sepsis and septic shock. Clin Microbiol Rev. Jul 2003;16(3):379-414. [Medline].

  45. Waage A, Brandtzaeg P, Espevik T, et al. Current understanding of the pathogenesis of gram-negative shock. Infect Dis Clin North Am. Dec 1991;5(4):781-91. [Medline].

  46. Wagner S. Transfusion-related bacterial sepsis. Curr Opin Hematol. Nov 1997;4(6):464-9. [Medline].

  47. Warren HS, Danner RL, Munford RS. Anti-endotoxin monoclonal antibodies. N Engl J Med. Apr 23 1992;326(17):1153-7. [Medline].

  48. Weinstein MP, Reller LB, Murphy JR, et al. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis. Jan-Feb 1983;5(1):35-53. [Medline].

  49. Wenzel RP, Pinsky MR, Ulevitch RJ, et al. Current understanding of sepsis. Clin Infect Dis. Mar 1996;22(3):407-12. [Medline].

  50. Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med. Jan 21 1999;340(3):207-14. [Medline].

  51. Wiessner WH, Casey LC, Zbilut JP. Treatment of sepsis and septic shock: a review. Heart Lung. Sep-Oct 1995;24(5):380-92; quiz 392-3. [Medline].

  52. William BM, Corazza GR. Hyposplenism: a comprehensive review. Part I: basic concepts and causes. Hematology. Feb 2007;12(1):1-13. [Medline].

  53. Yoshikawa TT. Antimicrobial Therapy in the Elderly Patient. In: Empiric antimicrobial therapy. New York: Marcel Dekker; 1994:469.

  54. Young LS. Gram-negative sepsis. In: Principles and Practice of Infectious Diseases. 3rd ed. New York: Churchill; 1990:611.

[ CLOSE WINDOW ]

Further Reading

Additional resources on sepsis are available at Medscape's Sepsis Resource Center.

[ CLOSE WINDOW ]

Keywords

sepsis, bacterial sepsis, urosepsis, septic shock, bacteremia, symptomatic bacteremia, septicemia, leukocytosis, pseudosepsis, bacteruria

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Pranatharthi Haran Chandrasekar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Thomas M Kerkering, MD, Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia
Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.