Scoping review on diagnostic criteria and investigative approach in sepsis of unknown origin in critically ill patients

Abstract

Background Up to 11% of critically ill patients with sepsis have an unknown source, where the pathogen and site of infection are unclear. The aim of this scoping review is to document currently reported diagnostic criteria of sepsis of unknown origin (SUO) and identify the types and breadth of existing evidence supporting diagnostic processes to identify the infection source in critically ill patients with suspected SUO. Methods A literature search of Embase, MEDLINE and PubMed for published studies from 1910 to August 19, 2021 addressing the topic of SUO was performed. Study type, country of origin according to World Bank classification, diagnostic criteria of sepsis of unknown origin, and investigative approaches were extracted from the studies. Results From an initial 722 studies, 89 unique publications fulfilled the inclusion and exclusion criteria and were included for full text review. The most common publication type was case report/series 45/89 (51%). Only 10/89 (11%) of studies provided a diagnostic criteria of SUO, but a universally accepted diagnostic criterion was not identified. The included studies discussed 30/89 (34%) history, 23/89 (26%) examination, 57/89 (64%) imaging, microbiology 39/89 (44%), and special tests 32/89 (36%) as part of the diagnostic processes in patients with SUO. Conclusions Universally accepted diagnostic criteria for SUO was not found. Prospective studies on investigative processes in critically ill patients managed as SUO across different healthcare settings are needed to understand the epidemiology and inform the diagnostic criteria required to diagnose SUO.

Central line associated and primary bloodstream infections

“…Primary BSI that are associated with vascular catheters or not, while commonly grouped together, represent distinct clinical entities. Primary BSI that are not catheter-associated often are of community-onset and their correct diagnosis is dependent on the degree and breadth of investigation [5]. In contrast CA-BSI is by definition a complication of the receipt of healthcare.…”

“…Some studies also categorize intravascular catheter-associated BSI (CA-BSI) as primary. The proportion of cases that will be classified as primary depend on this distinction and on the thoroughness of clinical evaluation, as a more extensive clinical and diagnostic search will increase the proportion with an evident secondary focus [5].…”