Infection screening in Septic patient
🦠 Infection screening in sepsis:
If no obvious source, work top ➡ bottom, looking for subtle clues.
⚠️ Remember: clinical signs may be muted in the elderly, immunosuppressed, and those on steroids/chemo.
📖 About
- Systematic review helps identify hidden infective sources.
- Always consider non-infective pyrexia (e.g. malignancy, inflammatory disorders).
🧑⚕️ Clinical Systems Review
- 🌬️ Respiratory: SOB, cough, purulent sputum, hypoxia.
- 👂 ENT: Sinus tenderness, sore throat, coryza.
- ❤️ Cardiac: New murmur, splinter haemorrhages, clubbing, microscopic haematuria → think endocarditis.
- 🍽️ GI: Abdominal pain, diarrhoea, vomiting, jaundice.
- 🩹 Skin & soft tissue: Cellulitis, surgical wounds, ulcers, shingles/HSV reactivation in immunosuppressed.
- 💉 Lines & access: Central lines, cannula sites, dialysis lines - rigors with flushing may suggest line sepsis. Ask about transfusions in last 24h.
- 🚻 GU: Dysuria, frequency, loin pain, haematuria, discharge, genital rashes.
- 🧠 Neuro: Confusion, agitation, odd behaviour, focal neurology, meningism, visual disturbance.
🔬 Investigations
- 💉 Blood cultures: ≥2 sets, from separate sites.
+ from central line if in situ (don’t remove without haematology/ID advice).
- 🩻 CXR: consolidation or effusion.
- 📊 Bloods:
- FBC (look for neutropenia, leucocytosis).
- CRP/Procalcitonin (trend, not severity alone).
- U&Es (renal dosing).
- LFTs (biliary sepsis?).
- Coagulation (risk of DIC).
- 🫀 Echo: if endocarditis suspected.
- 🧪 Other cultures:
- Urine dip/MSU.
- Stool (MCS & C. difficile toxin if diarrhoea).
- Sputum culture.
- Throat swab.
- Viral serology if risk factors.
- Swabs from skin lesions or wounds.
💡 Teaching pearl: Think “Lines, Lungs, Urine, Abdomen, Wounds” as the 5 most common septic sources in hospitalised patients.
