Sepsis in Internal Medicine wards: current knowledge, uncertainties and new approaches for management optimization

Abstract

Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists' increased adherence to guidelines and "bundles". The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment. Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.

Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis

“…For the first time-to our best knowledge-in a similar comparison, we found that the AUC of MDW was nearly overlapping with that of PCT, suggesting that MDW may be indeed evaluated further for sepsis prediction in clinical practice [9]. Although sepsis is one of the major cause of mortality for critically ill patients, it is not exclusively restricted to these individuals [31,32]. Outside of the intensive care units, as in the ED or in lower intensity wards, early diagnosis and rapid treatment initiation are even more crucial for halting progression of disease and poor patient prognosis [1,2,33].…”

Delta-Procalcitonin and Vitamin D Can Predict Mortality of Internal Medicine Patients with Microbiological Identified Sepsis

“…The Medicina 2021, 57, 331. https://doi.org/10.3390/medicina57040331 https://www.mdpi.com/journal/medicina prevention, diagnosis, and treatment of sepsis should be considered a global health priority according to the World Health Assembly. Medical tools available for the management of septic patients, and used in daily clinical practice, have been mainly developed in Intensive Care Units (ICUs) and have not been extensively validated in Internal Medicine (IM) wards [3]. Among the evaluated scores, only a few showed good reliability in predicting mortality [4].…”

Fast-track identification of CTX-M-extended-spectrum-β-lactamase- and carbapenemase-producing Enterobacterales in bloodstream infections: implications on the likelihood of deduction of antibiotic susceptibility in emergency and internal medicine departments

“…Extended-spectrum-β-lactamase (ESBL)- and carbapenemase-producing Enterobacterales (EB) bloodstream infections (BSIs) are a relevant clinical issue worldwide, especially given their association with limited therapeutic options, poor outcomes, and growing community-onset prevalence [ 1 – 5 ]. Since BSI patients are mainly managed in emergency and non-intensive wards [ 6 , 7 ], rapid detection of ESBL- and carbapenemase-producing EB directly from positive blood cultures (BCs) in these settings is essential for early optimization of antibiotic therapy and improvement of clinical outcomes [ 8 , 9 ]. Despite the complexity of the epidemiology, conjugative plasmids carrying CTX-M-type ESBL and KPC-, NDM-, VIM-, IMP-, and OXA-48-like genes were the main drivers of ESBL and carbapenemase dissemination in EB, respectively [ 1 , 10 , 11 ].…”