Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23. 315 (8):775-87. [Medline].
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23. 315 (8):801-10. [Medline]. [Full Text].
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995 Oct. 23 (10):1638-52. [Medline]. [Full Text].
Merrell RC. The abdomen as source of sepsis in critically ill patients. Crit Care Clin. 1995 Apr. 11(2):255-72. [Medline].
van Nieuwkoop C, Bonten TN, van't Wout JW, Kuijper EJ, Groeneveld GH, Becker MJ, et al. Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit Care. 2010. 14(6):R206. [Medline]. [Full Text].
Heyland DK, Johnson AP, Reynolds SC, Muscedere J. Procalcitonin for reduced antibiotic exposure in the critical care setting: A systematic review and an economic evaluation. Crit Care Med. 2011 Jul. 39(7):1792-9. [Medline].
Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007 Mar. 7 (3):210-7. [Medline]. [Full Text].
Lu B, Zhang Y, Li C, Liu C, Yao Y, Su M, et al. The utility of presepsin in diagnosis and risk stratification for the emergency patients with sepsis. Am J Emerg Med. 2018 Aug. 36 (8):1341-1345. [Medline]. [Full Text].
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun. 101 (6):1644-55. [Medline].
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr. 31(4):1250-6. [Medline].
Marik PE. Fever in the ICU. Chest. 2000 Mar. 117 (3):855-69. [Medline]. [Full Text].
Dimopoulos G, Falagas ME. Approach to the febrile patient in the ICU. Infect Dis Clin North Am. 2009 Sep. 23 (3):471-84. [Medline]. [Full Text].
Bone RC. Sepsis and its complications: the clinical problem. Crit Care Med. 1994 Jul. 22(7):S8-11. [Medline].
Siegel JP, Stein KE, Zoon KC. Anti-endotoxin monoclonal antibodies. N Engl J Med. 1992. 327:890.
Warren HS, Danner RL, Munford RS. Anti-endotoxin monoclonal antibodies. N Engl J Med. 1992 Apr 23. 326(17):1153-7. [Medline].
Kobayashi M, Tsuda Y, Yoshida T, et al. Bacterial sepsis and chemokines. Curr Drug Targets. 2006 Jan. 7(1):119-34. [Medline].
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003 Apr 17. 348 (16):1546-54. [Medline]. [Full Text].
Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. 2010 May. 38(5):1276-83. [Medline].
Sarikonda KV, Micek ST, Doherty JA, et al. Methicillin-resistant Staphylococcus aureus nasal colonization is a poor predictor of intensive care unit-acquired methicillin-resistant Staphylococcus aureus infections requiring antibiotic treatment. Crit Care Med. 2010 Oct. 38(10):1991-5. [Medline].
Frydrych LM, Bian G, O'Lone DE, Ward PA, Delano MJ. Obesity and type 2 diabetes mellitus drive immune dysfunction, infection development, and sepsis mortality. J Leukoc Biol. 2018 Sep. 104 (3):525-534. [Medline].
Peres Bota D, Lopes Ferreira F, Mélot C, Vincent JL. Body temperature alterations in the critically ill. Intensive Care Med. 2004 May. 30 (5):811-6. [Medline]. [Full Text].
Thiery-Antier N, Binquet C, Vinault S, Meziani F, Boisramé-Helms J, Quenot JP, et al. Is Thrombocytopenia an Early Prognostic Marker in Septic Shock?. Crit Care Med. 2016 Apr. 44 (4):764-72. [Medline]. [Full Text].
van Vught LA, Wiewel MA, Klein Klouwenberg PM, Hoogendijk AJ, Scicluna BP, Ong DS, et al. Admission Hyperglycemia in Critically Ill Sepsis Patients: Association With Outcome and Host Response. Crit Care Med. 2016 Jul. 44 (7):1338-46. [Medline]. [Full Text].
Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al. Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients. Crit Care Med. 2015 Sep. 43 (9):1938-44. [Medline]. [Full Text].
Shorr AF, Tabak YP, Killian AD, Gupta V, Liu LZ, Kollef MH. Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database. Crit Care Med. 2006 Oct. 34 (10):2588-95. [Medline]. [Full Text].
Labelle A, Juang P, Reichley R, Micek S, Hoffmann J, Hoban A, et al. The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*. Crit Care Med. 2012 Jul. 40 (7):2016-21. [Medline]. [Full Text].
Bassetti M, Righi E, Ansaldi F, Merelli M, Trucchi C, De Pascale G, et al. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med. 2014 Jun. 40 (6):839-45. [Medline]. [Full Text].
Cunha BA. Empiric antimicrobial therapy for bacteremia: get it right from the start or get a call from infectious disease. Clin Infect Dis. 2004 Oct 15. 39(8):1170-3. [Medline].
Cunha BA. Antibiotic treatment of sepsis. Med Clin North Am. 1995 May. 79(3):551-8. [Medline].
Leibovici L, Paul M. Benefit associated with appropriate antibiotic treatment. Clin Infect Dis. 2007 Nov 15. 45(10):1400; author reply 1401-2. [Medline].
Johnson MT, Reichley R, Hoppe-Bauer J, Dunne WM, Micek S, Kollef M. Impact of previous antibiotic therapy on outcome of Gram-negative severe sepsis. Crit Care Med. 2011 Aug. 39 (8):1859-65. [Medline]. [Full Text].
Lange D, Zappavigna C, Hamidizadeh R, Goldenberg SL, Paterson RF, Chew BH. Bacterial Sepsis After Prostate Biopsy-A New Perspective. Urology. 2009 Oct 6. [Medline].
Sacks-Berg A, Calubiran OV, Epstein HY, et al. Sepsis associated with transhepatic cholangiography. J Hosp Infect. 1992 Jan. 20(1):43-50. [Medline].
Price CS, Hacek D, Noskin GA, et al. An outbreak of bloodstream infections in an outpatient hemodialysis center. Infect Control Hosp Epidemiol. 2002 Dec. 23(12):725-9. [Medline].
Cunha BA. Central intravenous line infections in the critical care unit. Cunha BA, ed. Infectious Diseases in Critical Care Medicine. 2nd ed. New York, NY: Informa Healthcare, Inc.; 2007. 283-7/13.
Jenny-Avital ER. Catheter-related bloodstream infections. N Engl J Med. 2007 Mar 22. 356(12):1267; author reply 1268. [Medline].
Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med. 2007 Aug. 23(3):633-47, viii. [Medline].
Faro S. Sepsis in obstetric and gynecologic patients. Curr Clin Top Infect Dis. 1999. 19:60-82. [Medline].
Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am. 1996 Mar. 10(1):185-209. [Medline].
Cunha BA. Sepsis and its mimics. Intern Med. 1992. 13:48-55.
Sepsis and its mimics in the critical care unit. Cunha BA, ed. Infectious Diseases in Critical Care Medicine. 2nd Ed. New York, NY: Informa Healthcare, Inc; 2007. 73-8/4.
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. 1983 Jan-Feb. 5(1):35-53. [Medline].
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].
Chant C, Smith OM, Marshall JC, Friedrich JO. Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Med. 2011 May. 39(5):1167-73. [Medline].
Carlet J. Rapid diagnostic methods in the detection of sepsis. Infect Dis Clin North Am. 1999 Jun. 13(2):483-94, xi. [Medline].
Cunha BA. Antibiotic Essentials. 5th ed. Royal Oak, Mich: Physicians Press; 2006.
Cunha BA. Bacteremia and sepsis. Rakel RE, Bope ET, eds. Conn's Current Therapy. 2003. 68-75.
Dellinger RP. Current therapy for sepsis. Infect Dis Clin North Am. 1999 Jun. 13(2):495-509. [Medline].
Mackenzie I, Lever A. Management of sepsis. BMJ. 2007 Nov 3. 335(7626):929-32. [Medline].
Morrell MR, Micek ST, Kollef MH. The management of severe sepsis and septic shock. Infect Dis Clin North Am. 2009 Sep. 23(3):485-501. [Medline].
Neu HC. General Therapeutic Principles. Infectious Diseases. Philadelphia, Pa: WB Saunders; 1992. 153.
Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med. 1999 Jan 21. 340(3):207-14. [Medline].
Wiessner WH, Casey LC, Zbilut JP. Treatment of sepsis and septic shock: a review. Heart Lung. 1995 Sep-Oct. 24(5):380-92; quiz 392-3. [Medline].
Carleton SC. The cardiovascular effects of sepsis. Cardiol Clin. 1995 May. 13(2):249-56. [Medline].
Fuller BM, Dellinger RP. Hemodynamic resuscitation in septic shock: cardiovascular support and adjunctive therapy. Curr Infect Dis Rep. 2009 Sep. 11(5):357-64. [Medline].
Damian McNamara. Severe Sepsis Strategy Significantly Reduces Mortality. American College of Emergency Physicians (ACEP) 2013 Scientific Assembly. October 2013. [Full Text].
Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1. 49 (1):1-45. [Medline]. [Full Text].
Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010 Jan 15. 50 (2):133-64. [Medline]. [Full Text].
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013 Feb. 41 (2):580-637. [Medline].
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017 Mar. 43 (3):304-377. [Medline]. [Full Text].
Lehman KD. Evidence-based updates to the 2016 Surviving Sepsis Guidelines and clinical implications. Nurse Pract. 2019 Feb. 44 (2):26-33. [Medline].
Barrier KM. Summary of the 2016 International Surviving Sepsis Campaign: A Clinician's Guide. Crit Care Nurs Clin North Am. 2018 Sep. 30 (3):311-321. [Medline]. [Full Text].
IDSA Sepsis Task Force . Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines. Clin Infect Dis. 2018 May 2. 66 (10):1631-1635. [Medline]. [Full Text].
William BM, Corazza GR. Hyposplenism: a comprehensive review. Part I: basic concepts and causes. Hematology. 2007 Feb. 12(1):1-13. [Medline].
McNamara D. Severe sepsis strategy significantly reduces mortality. Medscape Medical News. October 16, 2013. Available at http://www.medscape.com/viewarticle/812674. Accessed: October 22, 2013.
Harding A. Catheter Care Strategies Help Reduce Sepsis in Dialysis Patients. Medscape. Jan 3 2014. [Full Text].
Rosenblum A, Wang W, Ball LK, et al. Hemodialysis catheter care strategies: a cluster-randomized quality improvement initiative. Am J Kidney Dis. 2013 Nov 29. [Medline].
Gupta S, Sakhuja A, Kumar G, McGrath E, Nanchal RS, Kashani KB. Culture-Negative Severe Sepsis: Nationwide Trends and Outcomes. Chest. 2016 Dec. 150 (6):1251-1259. [Medline]. [Full Text].
O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011 May. 52 (9):e162-93. [Medline]. [Full Text].

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A right lower quadrant abdominal wall abscess and enteric fistula are observed and confirmed by the presence of enteral contrast in the abdominal wall.

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Table 1. Infectious and Noninfectious Causes of Fever ^[12]

System	Infectious Causes	Noninfectious Causes
Central nervous	Meningitis, encephalitis	Posterior fossa syndrome, central fever, seizures, cerebral infraction, hemorrhage, cerebrovascular accident
Cardiovascular	Central line, infected pacemaker, endocarditis, sternal osteomyelitis, viral pericarditis, myocardial/perivalvular abscess	Myocardial infarction, balloon pump syndrome, Dressler syndrome
Pulmonary	Ventilator-associated pneumonia, mediastinitis, tracheobronchitis, empyema	Pulmonary emboli, ARDS, atelectasis (without pneumonia), cryptogenic organizing pneumonia, bronchogenic carcinoma without postobstructive pneumonia, systemic lupus erythematosus, pneumonitis, vasculitis
Gastrointestinal	Intra-abdominal abscess, cholangitis, cholecystitis, viral hepatitis, peritonitis, diarrhea (Clostridium difficile)	Pancreatitis, acalculous cholecystitis, ischemia of the bowel/colon, bleeding, cirrhosis, irritable bowel syndrome
Urinary tract	Catheter-associated bacteremia, urosepsis, pyelonephritis, cystitis	Allergic interstitial nephritis
Skin/soft tissue	Decubitus ulcers, cellulitis, wound infection	Vascular ulcers
Bone/joint	Chronic osteomyelitis, septic arthritis	Acute gout
Other	Transient bacteremia, sinusitis	Adrenal insufficiency, phlebitis/thrombophlebitis, neoplastic fever, alcohol/drug withdrawal, delirium tremens, drug fever, fat emboli, deep venous thrombosis, postoperative fever (48 h), fever after transfusion

Table 2. Clinical Conditions Associated With Sepsis

System

Associated With Sepsis

Not Typically Associated With Sepsis

GI tract

Liver

Gallbladder

Colon

Abscess

Intestinal obstruction

Instrumentation

Esophagitis

Gastritis

Pancreatitis (may have multiorgan dysfunction but not infectious in origin)

Small bowel disorders

GI bleeding

GU tract

Pyelonephritis

Intra- or perinephric abscess

Renal calculi

Urinary tract obstruction

Acute prostatitis/abscess

Renal insufficiency

Instrumentation in patients with bacteriuria

Urethritis

Cystitis

Cervicitis

Vaginitis

Catheter-associated bacteriuria (in otherwise healthy hosts without genitourinary tract disease)

Pelvis

Peritonitis

Abscess

Upper respiratory tract

Deep neck space infection

Abscess

Pharyngitis

Sinusitis

Bronchitis

Otitis

Lower respiratory tract

Community-acquired pneumonia (with asplenia)

Empyema

Lung abscess

Community-acquired pneumonia (in otherwise healthy host)

Intravascular

IV line sepsis

Infected prosthetic device

Acute bacterial endocarditis

Cardiovascular

Acute bacterial endocarditis

Myocardial/perivalvular ring abscess

Subacute bacterial endocarditis

CNS

Bacterial meningitis

Aseptic meningitis

Skin/soft-tissue

Necrotizing fasciitis

Osteomyelitis

Uncomplicated wound infections

CNS = central nervous system; GI = gastrointestinal; GU = genitourinary; IV = intravenous. Adapted from: Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am. Mar 1996;10(1):185-209.^[39]

Table 3. Noninfectious Conditions Mimicking Clinical and Hemodynamic Parameters of Sepsis

Clinical Presentations Mimicking Sepsis	Hemodynamic Parameters Mimicking Sepsis
Myocardial infarction	Spinal cord injury
Pancreatitis	Adrenal insufficiency
Diabetic ketoacidosis	Acute pancreatitis
Systemic lupus erythematosus flare with abdominal crisis	Hemorrhage
Ventricular pseudoaneurysm	Pulmonary embolism
Massive aspiration/atelectasis	Anaphylaxis
Systemic vasculitis
Hypovolemia (eg, due to diuretics, dehydration)

Table 4. Characteristics of Pseudosepsis and Sepsis

Parameters	Pseudosepsis	Sepsis
Microbiologic	No definite source PLUS ≥1 abnormalities Negative blood cultures excluding contaminants	Proper identification/process/source PLUS ≥1 microbiologic abnormalities Positive buffy coat smear result OR several positive blood culture results with a pathogenic organism
Hemodynamic	⇓ PVR ⇑ CO	⇓ PVR ⇑ CO Left ventricular dilatation
Laboratory	⇑ WBC count (with left shift) Normal platelet count ⇑ FSP ⇑ Lactate ⇑ D-dimers ⇑ PT/PTT ⇓ Albumin ⇓ Fibrinogen ⇓ Globulins	⇑ WBC count (with left shift) ⇓ Platelets ⇑ FSP ⇑ Lactate ⇑ D-dimers ⇑ PT/PTT ⇓ Albumin
Clinical	≤102°F ± Tachycardia ± Respiratory alkalosis ± Hypotension	≥102°F OR Hypothermia ± Mental status changes ± Hypotension
CO = cardiac output; FSP = fibrin split products; GI = gastrointestinal; GU = genitourinary; PT/PTT = prothrombin time/partial thromboplastin time; PVR = peripheral vascular resistance; WBC = white blood cell.

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Author

Amber Mahmood Bokhari, MBBS Assistant Professor, Department of Infectious Disease, University of South Alabama College of Medicine

Amber Mahmood Bokhari, MBBS is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Nirav Patel, MD Assistant Professor of Internal Medicine, Division of Infectious Diseases, Allergy and Immunology, and Division of Pulmonary, Critical Care, and Sleep Medicine, St Louis University School of Medicine; Chief Medical Officer, Director of Antibiotic Stewardship, Infection Control Officer, St Louis University Hospital

Nirav Patel, MD is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, Infectious Diseases Society of St Louis, Missouri State Medical Association, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Received research grant from: Regeneron.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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