Table 1.
Examples of diagnostic–therapeutic paths for the control and eradication of septic sources
| Signs and symptoms | Laboratory tests | Diagnostic Imaging | Therapeutic strategies |
|---|---|---|---|
| Complicated urinary tract infections | |||
| Fever, dysuria, pollakiuria, stranguria, lower back pain | Blood culture, physicochemical urine examination, urine culture | Ultrasound, contrast-enhancement US (CEUS), or CT abdomen pelvis | Antibiotic therapy; nephrostomy (if hydronephrosis); evaluation of urinary device removal |
| Severe pneumonia | |||
| Fever, cough, dyspnoea | Blood cultures, respiratory secretion sampling (bronchoaspirate or bronchial lavage); urinary antigens for pneumococcus or legionella; swab for influenza virus identification (epidemic period) | Chest X-ray, thoracic ultrasound, or CT scan | Antibiotics, with or without antiviral therapy; possible drainage of pleural empyema |
| Complicated skin and soft tissue infections (± osteomyelitis) | |||
| Fever, erythema, pain, oedema, suppuration, or necrosis | Blood cultures and microbiological examination of biopsy samples |
Soft tissue ultrasound + bone X-ray; soft tissue + bone CT scan; soft tissue + bone MRI (magnetic Resonance imaging) (osteomyelitis*) *MRI is often the most appropriate second study, as it is highly sensitive and can detect bone marrow changes within days of infection |
Antibiotic therapy; surgical therapy evaluation; hyperbaric therapy evaluation |
| Complicated intra-abdominal infections | |||
| Fever, abdominal pain, signs of sepsis | Blood cultures and cultures from in situ drainage < 24 h | Abdominal ultrasound or CT scan | Antibiotic + antifungal therapy; surgical evaluation; interventional radiology evaluation |
| Central nervous system infections | |||
| Fever, altered state of consciousness, signs of meningeal irritation | Blood cultures and the chemical and microbiological examination of the liquor | Head CT | Antibiotic therapy, subdural empyema drainage, or liquor derivation (hydrocephalus) |
| Central nervous system infections | |||
| Fever, signs of sepsis/septic shock, local inflammation | Blood cultures and microbiological examinations of any secretions | CT scan or echocardiogram (depending on the type of infection, location, and severity) | Antibiotic + antifungal therapy; Evaluation of device removal |