What are the appropriate laboratory tests for an 81-year-old female with Congestive Heart Failure (CHF) presenting with a red, swollen finger and toe, suspected of having sepsis?

From the Guidelines

For an 81-year-old female with CHF presenting with red swollen finger and toe, who may have sepsis, I recommend obtaining a complete blood count with differential, comprehensive metabolic panel, blood cultures (two sets from different sites), lactic acid level, C-reactive protein, procalcitonin, urinalysis with culture, and a chest X-ray, as suggested by the Surviving Sepsis Campaign guidelines 1.

Key Laboratory Tests

• Complete blood count with differential to assess for signs of infection or inflammation
• Comprehensive metabolic panel to evaluate electrolyte balance and renal function
• Blood cultures (two sets from different sites) to identify potential pathogens, as recommended by the Surviving Sepsis Campaign guidelines 1
• Lactic acid level to assess for tissue hypoperfusion
• C-reactive protein and procalcitonin to evaluate the severity of infection
• Urinalysis with culture to assess for urinary tract infection
• Chest X-ray to evaluate for pulmonary infection or edema

Additional Recommendations

• Wound cultures from the affected finger and toe should be collected before starting antibiotics, as suggested by the Surviving Sepsis Campaign guidelines 1
• Empiric antibiotic therapy should be initiated promptly after cultures are obtained, typically with broad-spectrum coverage such as vancomycin plus piperacillin-tazobactam or cefepime
• Fluid management requires careful monitoring due to her CHF, as recommended by the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure 1
• Serial lactate measurements should be obtained to track treatment response, and antibiotics can be narrowed once culture results return, typically in 48-72 hours

Considerations

• The red, swollen extremities suggest possible cellulitis or gout, but in an elderly patient with comorbidities, these can rapidly progress to systemic infection
• The patient's age and CHF increase her risk for complications from sepsis, and prompt treatment is essential to improve outcomes, as suggested by the Surviving Sepsis Campaign guidelines 1 and the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 1

From the Research

Sepsis Labs for 81-Year-Old Female with CHF and Red Swollen Finger and Toe

• The patient's condition involves congestive heart failure (CHF) and symptoms of sepsis, including a red swollen finger and toe, which requires immediate attention 2.
• Sepsis is a life-threatening condition that can be triggered by various factors, including infection, and is associated with high mortality rates, especially in patients with underlying cardiac dysfunction 2.
• The management of sepsis in patients with CHF is challenging, as interventions for CHF may be contraindicated in sepsis and vice versa 2.

Laboratory Tests and Antibiotic Treatment

• Ceftriaxone is a commonly used antibiotic for treating sepsis, and its dosing strategy is crucial to ensure optimal exposure and effectiveness 3, 4.
• A study found that a 1-g once-daily dose of ceftriaxone may not be sufficient to achieve therapeutic exposure in patients with sepsis, especially those with normal renal function 4.
• Another study suggested that cefepime may be a better option than piperacillin-tazobactam for empirical treatment of sepsis, as it is associated with lower mortality and fewer organ failure-free days 5.

Treatment Considerations

• The choice of antibiotic therapy should be guided by the patient's clinical condition, renal function, and potential bacterial pathogens 3, 4, 5.
• Ceftriaxone may be a suitable option for definitive treatment of low-risk AmpC-harboring Enterobacterales bloodstream infections, with similar outcomes to AmpC-stable therapies 6.
• However, the patient's specific condition, including CHF and red swollen finger and toe, requires careful consideration of the potential benefits and risks of different antibiotic regimens 2, 3, 4, 5, 6.