A clinical laboratory approach to severe sepsis : The changing role of laboratory medicine in clinical decision support during management of septicaemia

Timothy J J Inglis
2013 Sri Lankan Journal of Infectious Diseases  
Sepsis has a different meaning to the surgeon, physician and intensivist than the clinical microbiologist. Understanding the difference between a front line clinician's diagnosis and determination of the microbial cause of severe sepsis is the key to unlocking the contribution of the clinical laboratory to critical decision support for septicaemic patients. Correct and effective use of blood culture, other culture and non-culture based methods of determining aetiology, followed by monitoring
more » ... ed by monitoring progress in severe sepsis are time-critical support measures for treatment decisions. Nucleic acid amplification techniques and MALDI-TOF mass spectrometer use have sped up the interval between blood culture inoculation and determination of a definitive aetiology. However, the aetiology can only rarely be determined soon enough to direct presumptive antibiotic choice in severe sepsis. More often, presumptive antibiotic and supportive care decisions have to be made with guidance from guidelines, clinical trial results and local laboratory-derived epidemiology. The contribution of the clinical microbiology laboratory is therefore more often in refinement of antibiotic treatment and the monitoring of progress. Until emerging laboratory technology has more to offer in the immediate assessment of severe sepsis, the clinical microbiologist will continue to play a mainly supportive role as a member of a multidisciplinary team. This is likely to change as a range of systems biology tools start to make an impact on the clinical laboratory. The meaning of sepsis. Septicaemia is a slippery word. It has a range of meanings depending on who, where and when it is used. It is therefore useful to distinguish between the clinical sepsis familiar to surgeons and general physicians, the sepsis syndrome seen in the critically ill and the clinical manifestations of laboratory confirmed bacteraemia, viraemia, fungaemia or parasitaemia familiar to clinical microbiologists. Of course, the patient with an established febrile illness
doi:10.4038/sljid.v3i1.5150 fatcat:rni7k546wjc5pdvnbneou7cdxi