Division of Critical Care Medicine, Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Clin Infect Dis. 2010 Mar 15;50(6):814-20. doi: 10.1086/650580.
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.
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 <18 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.
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.
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.
在急诊科被诊断为脓毒症的患者通常根据感染的假设进行治疗；然而，需要特定治疗的各种非传染性疾病的临床表现与脓毒症非常相似。我们的目的是描述在急诊科被诊断为严重脓毒症并接受治疗的患者的病因。
我们对在急诊科接受目标导向复苏治疗严重脓毒症的患者进行了前瞻性观察研究。纳入标准为疑似感染、存在 2 项或更多全身炎症标准和灌注不足的证据。排除标准为年龄<18 岁和需要立即手术。对符合条件的患者进行了为期 2 年的前瞻性临床数据收集。盲法观察者使用事先定义的标准来确定住院的最终病因。
共纳入 211 例患者；95 例（45%）培养阳性，116 例（55%）培养阴性。总的死亡率为 19%。培养阳性的患者更有可能留置血管内导管（P =.03）、居住在养老院（P =.04）以及在急诊科接受抗生素治疗的时间更短（83 分钟 vs 97 分钟；P =.03）。培养阴性的患者中，44%有临床感染，8%有非典型感染，32%有无传染性的类似物，16%的病因不明。
在这项研究中，我们发现 50%以上在急诊科被诊断为严重脓毒症并接受治疗的患者培养结果为阴性。在出现脓毒症综合征的患者中，18%的患者有非传染性疾病，其临床表现类似于培养阳性的脓毒症患者。
