Laboratory Diagnosis of Sepsis? No SIRS, Not Just Yet

In order to maximize the benefit of prompt antimicrobial therapy and avoid the risk associated with inappropriate use of antimicrobial agents, patients with suspected sepsis must be rapidly differentiated from patients with systemic inflammatory response syndrome (SIRS). In combination with standard microbiological testing, a number of biomarkers have been recently evaluated for this purpose, and the performance characteristics of the most promising of these are reviewed.

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SYSTEMIC INFLAMMATORY RESPONSE SYNDROME: THE CURRENT STATUS

Journal of Universal College of Medical Sciences ◽

10.3126/jucms.v6i1.21732 ◽

2018 ◽

Vol 6 (1) ◽

pp. 56-61

Author(s):

Manisha Shrestha ◽

Anand Kumar

Keyword(s):

Critical Care ◽

Intensive Care ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Diagnostic Criteria ◽

Current Knowledge ◽

Laboratory Diagnosis ◽

Systemic Inflammatory Response ◽

Current Status ◽

American Society

Systemic inflammatory response syndrome (SIRS) is a frequent and serious problem faced by clinicians in day to day practice and is a major factor of intensive care morbidity and mortality. The American College of Chest Physicians and the American Society of Critical Care Medicine in 1991 published definitions and criteria for systemic inflammatory response syndrome. Since then many researches have been undertaken to better understand the pathophysiology of systemic inflammatory response syndrome and to determine the accuracy of its diagnostic criteria. The criteria set by the 1991 consensus is still popularly used today. However, with the current knowledge on this matter many researchers have put forward the need of refinement in the criteria of systemic inflammatory response syndrome defined by 1991 consensus. This article aims to review the epidemiology, etiology, pathophysiology, laboratory diagnosis, treatment and the current views regarding SIRS.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 56-61

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226. Evaluating the Unnecessary Use of Intravenous Broad-Spectrum Antibiotics in Patients Based on Systemic Inflammatory Response Syndrome Criteria in the Emergency Department (ED)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.270 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S114-S114

Author(s):

Esther Y Bae ◽

Marguerite Monogue ◽

Tiffeny T Smith

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Bacterial Infection ◽

Broad Spectrum ◽

Bacterial Infections ◽

Antibiotic Use ◽

Systemic Inflammatory Response ◽

Broad Spectrum Antibiotic ◽

Suspected Sepsis ◽

Broad Spectrum Antibiotics

Abstract Background Recognition of sepsis frequently occurs in the ED. To demonstrate the need to optimize antibiotic use for suspected sepsis and evaluate the reliability of systemic inflammatory response syndrome (SIRS) criteria in predicting bacterial infection, we quantified the rate of unnecessary intravenous (IV) broad-spectrum antibiotic use for suspected sepsis in the ED at an academic medical center. Methods Adult patients who were admitted to the ED between January 2018 and June 2018 with suspected sepsis (≥ 2 SIRS) and received ≥ 1 dose of IV broad-spectrum antibiotic were included in this retrospective study. The presence of bacterial infection was determined using Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) definitions, microbiologic, radiographic, and laboratory findings. Suspected infections lacked microbiologic data. The primary outcome was the percentage of confirmed and suspected infections. Secondary outcomes included 90-day Clostridioides difficile infection (CDI) and 90-day drug-resistant organism (DRO) infections. Results A total of 218 patients were included. The percentages of confirmed/suspected and absence of bacterial infections were 63.8% and 36.2%, respectively. Elevated SIRS (≥ 2) and Quick Sequential Organ Failure Assessment (qSOFA; ≥ 2) scores were not associated with the presence of bacterial infections. 82% of patients were discharged from the ED. Antibiotic exposure in days of therapy in the ED and/or hospital admission did not significantly vary between patients with confirmed/suspected bacterial infection and those with absence of bacterial infections. Among patients who lacked evidence of bacterial infections, 44% were prescribed outpatient antibiotics after being discharged from the ED. 90-day CDI and DRO infections were identified in 7 and 6 patients, respectively, regardless of the presence of bacterial infections. Table 1. Baseline demographics of patients admitted to the ED with suspected sepsis Conclusion A third of the patients with suspected sepsis received IV broad-spectrum antibiotics in the ED but ultimately lacked bacterial infection. Our findings suggest that identification of bacterial infection and patients with sepsis using SIRS or qSOFA lack specificity and can lead to the overuse of unnecessary antibiotics in the ED. Disclosures All Authors: No reported disclosures

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Systemic inflammatory response syndrome, sepsis, and antimicrobial therapy

Clinical Techniques in Equine Practice ◽

10.1016/s1534-7516(03)00026x ◽

2003 ◽

Vol 2 (1) ◽

pp. 3-8 ◽

Cited By ~ 16

Author(s):

Martin Furr

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Antimicrobial Therapy ◽

Systemic Inflammatory Response

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Systemic inflammatory response syndrome is more associated with bacteremia in elderly patients with suspected sepsis in emergency departments

Medicine ◽

10.1097/md.0000000000005634 ◽

2016 ◽

Vol 95 (49) ◽

pp. e5634 ◽

Cited By ~ 10

Author(s):

Hsien-Ling Chou ◽

Shih-Tsung Han ◽

Chun-Fu Yeh ◽

I-Shaing Tzeng ◽

Tsung-Han Hsieh ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Elderly Patients ◽

Emergency Departments ◽

Systemic Inflammatory Response ◽

Suspected Sepsis

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Acute Pancreatitis - Clinical and Laboratory Diagnosis

Swiss Surgery ◽

10.1024/1023-9332.6.5.235 ◽

2000 ◽

Vol 6 (5) ◽

pp. 235-240 ◽

Cited By ~ 3

Author(s):

Müller ◽

Uhl ◽

Gloor ◽

Worni ◽

Roggo ◽

...

Keyword(s):

Acute Pancreatitis ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Gold Standard ◽

Laboratory Diagnosis ◽

Systemic Inflammatory Response ◽

Akute Pankreatitis ◽

Carboxypeptidase B ◽

Eine Hohe ◽

Wenn Sich

Die Inzidenz der akuten Pankreatitis differiert zwischen 5 (Bristol) und 80 (USA) pro 100000 Einwohner. Auch wenn sich die Diagnosestellung der akuten Pankreatitis heutzutage mittels der Bestimmung von spezifischen Pankreasenzymen im Serum wesentlich verbessert hat, werden 30-40% der letalen Fälle erst bei der Autopsie entdeckt. Um so wichtiger ist die initiale Schweregrad-Einschätzung der Patienten mit akuter Pankreatitis. Damit können die Patienten mit schwerer nekrotisierender Verlaufsform identifiziert und die Intensivtherapie früh begonnen und nach neuesten Konzepten durchgeführt werden (wie z.B. Antibiotika-Therapie bei schweren Verlaufsformen). Für die Evaluation neuer spezifischer Medikamente ist das möglichst frühzeitige Staging ebenfalls von grosser Bedeutung. Bei Spitaleintritt kann der Schweregrad der akuten Pankreatitis klinisch nicht zuverlässig bestimmt werden, sodass sich die bildgebenden Verfahren (kontrastmittelverstärkte CT und das MRI) als "Gold Standard" zur Schweregrad-Einschätzung etabliert haben. Diese Untersuchungen sollten jedoch nur bei den Patienten mit nekrotisierender Verlaufsform durchgeführt werden. Ein idealer Prädiktor im Blut oder Urin sollte objektiv, reproduzierbar, günstig, jederzeit verfügbar, einfach in der Bestimmung sein und eine hohe Spezifität und Sensitivität haben. Als Faktoren im Blut eignen sich Mediatoren des "systemic inflammatory response syndrome" (z.B. C-reaktives Protein, Antiproteasen, Pankreasenzymaktivationspeptide, wie das Trypsinogen Aktivierungspeptid (TAP) und das Carboxypeptidase B Aktivierungspeptid (CAPAP), PMN-Elastase, Komplementfaktoren, Interleukine und Chemokine, etc.). Das CRP ist unter den erwähnten Parametern der am besten Untersuchte und gilt als zurzeit wichtigster Einzelprädiktor für die Einschätzung des Schweregrades der akuten Pankreatitis. Das CRP ist jedoch nicht spezifisch für die akute Pankreatitis und eine gute Differenzierung zwischen schwerer und leichter Verlaufsform wird erst > 48 Stunden nach Erkrankungsbeginn erreicht. Diese Zeitverzögerung stellt klinisch in der Regel keinen wesentlichen Nachteil dar, da die Latenzzeit zwischen Schmerzbeginn und Hospitalisation der Patienten meistens zwischen 24 bis 48 Stunden beträgt.

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Neutrophil and Monocyte CD64 and CD163 Expression in Critically Ill Neonates and Children with Sepsis: Comparison of Fluorescence Intensities and Calculated Indexes

Mediators of Inflammation ◽

10.1155/2008/202646 ◽

2008 ◽

Vol 2008 ◽

pp. 1-10 ◽

Cited By ~ 55

Author(s):

Mojca Groselj-Grenc ◽

Alojz Ihan ◽

Metka Derganc

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Diagnostic Accuracy ◽

Critically Ill ◽

Systemic Inflammatory Response ◽

Fluorescence Signal ◽

Suspected Sepsis ◽

Cd163 Expression ◽

Critically Ill Neonates

Objective. To evaluate the expression of CD64 and CD163 on neutrophils and monocytes in SIRS with/without sepsis and to compare the diagnostic accuracy of CD64 and CD163 molecules expression determined as (1) mean fluorescence intensities (MFI) of CD64 and CD163; and (2) the ratio (index) of linearized MFI to the fluorescence signal of standardized beads.Patients and methods. Fifty-six critically ill neonates and children with systemic inflammatory response syndrome (SIRS) and suspected sepsis, classified into two groups: SIRS with sepsis (n=29) and SIRS without sepsis (n=27).Results. CD64 and CD163 MFI measured on neutrophils and monocytes were elevated in patients with SIRS with sepsis. Diagnostic accuracy of indexes was equal to diagnostic accuracy of MFI for CD64 on neutrophils (0.833 versus 0.854 for day 0 and 0.975 versus 0.983 for day 1) and monocytes (0.811 versus 0.865 for day 0 and 0.825 versus 0.858 for day 1), and CD163 on neutrophils (0.595 versus 0.655 for day 0 and 0.677 versus 0.750 for day 1), but not for CD163 on monocytes.Conclusion. CD64 MFI, CD163 MFI, CD64 indexes for neutrophils and monocytes, and CD163 index for neutrophils can all be used for discrimination of SIRS and sepsis in critically ill neonates and children. CD64 index for neutrophils, however, is superior to all other markers.

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