Journal Article

Etiology of Illness in Patients with Severe Sepsis Admitted to the Hospital from the Emergency Department

Alan E. Jones, Alan C. Heffner, James M. Horton and Michael R. Marchick

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 6, pages 814-820
Published in print March 2010 | ISSN: 1058-4838
Published online March 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/650580
Etiology of Illness in Patients with Severe Sepsis Admitted to the Hospital from the Emergency Department

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Background. Patients identified with sepsis in the emergency department often are treated on the basis of the presumption of infection; however, various noninfectious conditions that require specific treatments have clinical presentations very similar to that of sepsis. Our aim was to describe the etiology of illness in patients identified and treated for severe sepsis in the emergency department.

Methods. We conducted a prospective observational study of patients treated with goal-directed resuscitation for severe sepsis in the emergency department. Inclusion criteria were suspected infection, 2 or more criteria for systemic inflammation, and evidence of hypoperfusion. Exclusion criteria were age of µ18 years and the need for immediate surgery. Clinical data on eligible patients were prospectively collected for 2 years. Blinded observers used a priori definitions to determine the final cause of hospitalization.

Results. In total, 211 patients were enrolled; 95 (45%) had positive culture results, and 116 (55%) had negative culture results. The overall mortality rate was 19%. Patients with positive culture results were more likely to have indwelling vascular lines (P=.03), be residents of nursing homes (P=.04), and have a shorter time to administration of antibiotics in the emergency department (83 vs 97 min; P=.03). Of patients with negative culture results, 44% had clinical infections, 8% had atypical infections, 32% had noninfectious mimics, and 16% had an illness of indeterminate etiology.

Conclusion. In this study, we found that>50% of patients identified and treated for severe sepsis in the emergency department had negative culture results. Of patients identified with a sepsis syndrome at presentation, 18% had a noninfectious diagnosis that mimicked sepsis, and the clinical characteristics of these patients were similar to those of patients with culture-positive sepsis.

Journal Article.  3286 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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