What is a sepsis work up?

From the Guidelines

A sepsis workup should include a comprehensive set of diagnostic tests and procedures to identify and assess a potential sepsis infection, prioritizing blood cultures, lactate levels, and imaging studies to guide treatment decisions and improve patient outcomes. The workup typically includes:

• Blood tests:
  • Complete blood count (CBC)
  • Blood cultures (at least two sets) as recommended by 1
  • Lactate level to assess tissue perfusion and severity of sepsis
  • Procalcitonin to help differentiate bacterial from viral infections
  • Comprehensive metabolic panel
  • Coagulation studies
• Imaging:
  • Chest X-ray
  • CT scan (if source of infection is unclear)
• Urine tests:
  • Urinalysis
  • Urine culture
• Other potential tests based on suspected source:
  • Lumbar puncture (if meningitis is suspected)
  • Wound cultures (if applicable) Immediate empiric antibiotic therapy is typically started after cultures are obtained, usually with broad-spectrum antibiotics like:

• Piperacillin-tazobactam 4.5g IV every 6 hours
• Meropenem 1g IV every 8 hours
• Ceftriaxone 2g IV daily plus Vancomycin 15-20 mg/kg IV every 8-12 hours Fluid resuscitation with crystalloids (e.g., normal saline or Lactated Ringer's) should be initiated, typically starting with a 30 mL/kg bolus, as recommended by 1. The goal of the workup is to identify the source of infection, assess organ function, and guide treatment decisions to improve patient outcomes in this life-threatening condition, with a focus on restoring a mean arterial pressure of 65 to 70 mmHg as a good initial goal during hemodynamic support of patients with sepsis, as suggested by 1.

From the Research

Sepsis Workup Overview

A sepsis workup is a comprehensive evaluation to identify the source of infection and manage sepsis effectively. It involves:

• History and physical examination to identify potential sources of infection 2
• Laboratory tests, such as:
  • Procalcitonin (PCT) to aid in diagnosis, although its efficacy is questionable 3
  • Serial lactate measurements to monitor treatment efficacy 3
  • Hematologic parameters, including white blood cell count and differential 3
• Imaging studies to identify sources of infection, such as urinalysis, chest radiographs, and intra-abdominal infections 2

Source Identification and Control

Identifying the source of infection and establishing source control is crucial in sepsis management. This may involve:

• Administration of antibiotics 2
• Surgical or other specialist intervention, as recommended by the Surviving Sepsis Campaign 2
• Use of clinical pathways and sepsis teams to optimize management in the emergency department 4

Challenges and Limitations

Diagnosing sepsis can be challenging due to the lack of a single accurate laboratory test 3. Additionally, the use of biomarkers and rapid microbiological tests has limitations, including high costs and lack of specificity 5. Clinical assessment remains essential in diagnosing sepsis, and a structured, protocol-based approach is necessary to ensure timely and effective management 4

Diagnostic Approaches

Different diagnostic approaches have been proposed, including:

• The ABCDE approach to patient assessment, which can help identify sepsis at an early stage 6
• The use of screening scores, automated triage systems, and clinical pathways to facilitate early recognition and treatment of sepsis 4