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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Initial evaluation of common sources of sepsis

Initial evaluation of common sources of sepsis
Suspected site Symptoms/signs* Initial microbiologic evaluation
Upper respiratory tract Pharyngeal inflammation plus exudate ± swelling and lymphadenopathy Throat swab for aerobic culture
Lower respiratory tract Productive cough, pleuritic chest pain, consolidative auscultatory findings Sputum of good quality, rapid influenza testing, urinary antigen testing (eg, pneumococcus, legionella; not recommended in children), quantitative culture of protected brush or bronchoalveolar lavage
Urinary tract Urgency, dysuria, loin, or back pain Urine culture and microscopy showing pyuria
Vascular catheters: arterial, central venous Redness or drainage at insertion siteΔ Culture of blood (from the catheter and a peripheral site), culture catheter tip (if removed)
Indwelling pleural catheter Redness or drainage at insertion siteΔ Culture of pleural fluid (through catheter)
Wound or burn Inflammation, edema, erythema, discharge of pus Gram stain and culture of draining pus, wound culture not reliable
Skin/soft tissue Erythema, edema, lymphangitis Culture blister fluid or draining pus; role of tissue aspirates not proven
Central nervous system Signs of meningeal irritation CSF cell count, protein, glucose, Gram stain, and culture
Gastrointestinal Abdominal pain, distension, diarrhea, and vomiting Stool culture for Salmonella, Shigella, or Campylobacter; detection of Clostridium difficile toxin
Intra-abdominal Specific abdominal symptoms/signs Aerobic and anaerobic culture of percutaneously or surgically drained abdominal fluid collections
PD catheter Cloudy PD fluid, abdominal pain Cell count and culture of PD fluid
Genital tract

Female: Low abdominal pain, vaginal discharge

Male: Dysuria, frequency, urgency, urge incontinence, cloudy urine, prostatic tenderness

Female: Endocervical and high vaginal swabs onto selective media

Male: Urine Gram stain and culture
Bone Pain, warmth, swelling, decreased use Blood cultures, MRI, bone cultures at surgery or by interventional radiology
Joint Pain, warmth, swelling, decreased range of motion Arthrocentesis with cell counts, Gram stain, and culture

CSF: cerebrospinal fluid; PD: peritoneal dialysis; MRI: magnetic resonance imaging.

* Fever is frequently seen with all conditions.

¶ Suggested initial tests are not considered to be comprehensive. Additional testing and infectious disease consultation may be warranted.

Δ This is not always present.

◊ Bacterial antigen and/or molecular testing may also be appropriate in selected patients. Refer to UpToDate topics on diagnostic testing for meningitis.
Adapted from: Cohen J. Microbiologic requirements for studies of sepsis. In: Clinical Trials for the Treatment of Sepsis, Sibbald WJ, Vincent JL (eds), Springer-Verlag, Berlin 1995.
Graphic 59769 Version 14.0

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