Bacterial Sepsis: Challenges of Diagnosis and Treatment in a Teaching Hospital Southwest of Iran

BACKGROUND Management of bacterial sepsis as a common cause of hospitalization and a life threatening clinical syndrome is a challenge. In previous studies, incorrect diagnosis of sepsis and unnecessary treatment have been frequently reported. OBJECTIVES The aim of this study was to evaluate the diagnosis and treatment of cases with a primary diagnosis of sepsis. PATIENTS AND METHODS Of 410 medical files of patients with primary diagnosis of bacterial sepsis, 187 fulfilled our criteria and were enrolled in the study. The study was conducted in Razi Hospital of Ahvaz, southwest Iran, from 2009 to 2011. Data included demographic characteristics, underlying disease, clinical symptoms, laboratory and imaging findings, administrated antibacterial drugs, and nurses and doctors-analyzed notes. For evaluation of the diagnosis, patients were divided to two groups, sepsis group and pseudosepsis group, and for evaluation of the treatment, patients were categorized in appropriate and inappropriate treatment groups and compared using SSPS software version 16 by chi-square and fisher exact tests. P-values less than 0.05 were considered significant. RESULTS Out of 187 cases, 61 were in the intensive care unit (ICU), 98 in the infectious disease ward, and 28 in the internal medicine ward. Correct diagnosis of sepsis in the ICU, internal and infectious diseases wards were made in 16 (26.2%), 4 (14.3%) and 71 (72.4%) cases, respectively. Appropriate treatments for sepsis in the ICU, internal and infectious wards were applied in 12 (19.7%), 3 (10.7%) and 61 (78.2%) cases, respectively. Ninety-one patients (48.6%) were diagnosed correctly (true sepsis) and 76 (40.6%) were treated with proper regimes. CONCLUSIONS Inappropriate and unnecessary use of antibiotics by patients with preliminary diagnosis of sepsis in our hospital, similar to other parts of the world, was high.