Última revisión: 18 Mayo 2021
Última actualización: 03 Dic 2020

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • presencia de factores de riesgo
  • temperatura alta (>38°C) o baja (<36°C)
  • taquicardia
  • taquipnea
  • alteración aguda del estado mental
  • llenado capilar deficiente, piel moteada o apariencia grisácea
  • signos asociados con una fuente de infección específica
  • baja saturación de oxígeno
  • hipotensión arterial
  • disminución de la diuresis
  • cianosis

Factores de riesgo

  • neoplasia maligna subyacente
  • edad >65 años
  • compromiso inmunológico
  • hemodiálisis
  • alcoholismo
  • diabetes mellitus
  • cirugía reciente u otros procedimientos invasivos
  • afectación de la integridad de la piel
  • sondas intravenosas o urinarias permanentes
  • consumo de drogas ilícitas por vía intravenosa
  • embarazo
  • residencia en centros urbanos
  • enfermedad pulmonar
  • sexo masculino
  • ascendencia no blanca
  • estación invernal

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • hemograma completo (HC) con diferencial
  • urea en sangre y electrolitos séricos
  • creatinina sérica
  • pruebas de función hepática
  • estudios de coagulación (índice internacional normalizado [INR], tiempo de tromboplastina parcial activada [TTPa])
  • glucosa sérica
  • niveles de lactato
  • proteína C-reactiva
  • hemocultivo
  • otros cultivos (p. ej., de esputo, heces, orina, heridas, catéteres, implantes protésicos, áreas epidurales y líquido peritoneal o pleural)
  • gasometría arterial (GSA) o gasometría venosa (GSV)
  • radiografía de tórax
  • electrocardiograma (ECG)

Pruebas diagnósticas que deben considerarse

  • punción lumbar
  • ecocardiograma (transtorácico o transesofágico)
  • ultrasonido
  • TC de tórax o abdomen
  • procalcitonina sérica

Algoritmo de tratamiento

Colaboradores

Professor

Department of Internal Medicine

Division of Infectious Diseases

University of Nebraska Medical Center

Omaha

NE

Divulgaciones

ACK declares that he has no competing interests. ACK is an author of references cited in this topic.

Assistant Professor

Department of Internal Medicine

Division of Pulmonary, Critical Care, Sleep & Allergy

University of Nebraska Medical Center

Omaha

NE

Divulgaciones

KC declares that she has no competing interests.

Professor Andre Kalil and Dr Kelly Cawcutt would like to gratefully acknowledge Dr Ron Daniels, Dr Matt Inada-Kim, Dr Aamir Saifuddin, Dr Tim Nutbeam, Dr Edward Berry, Dr Lewys Richmond, and Dr Paul Kempen, previous contributors to this topic.

Divulgaciones

RD has received payment for consultancy on sepsis from Kimal Plc, manufacturers of vascular access devices; from the Northumbria Partnership, a patient safety collaborative; and, where annual leave or other income was compromised in fulfilling his charity duties, from the UK Sepsis Trust. RD has received sponsorship to attend and speak at one meeting from Abbott Diagnostics. He is CEO of the UK Sepsis Trust and Global Sepsis Alliance, and advises HM Government, the World Health Organization, and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis. MIK is a national clinical advisor on sepsis to NHS England and a national clinical advisor on deterioration to NHS Improvement. He was reimbursed for a slide set by Relias Learning. AS is the clinical fellow to the National Medical Director at NHS Improvement. AS has been sponsored on two occasions by Dr Falk Pharma UK to attend specialist gastroenterology conferences abroad; there was no contractual obligation to disseminate product information. TN is a clinical adviser to the UK Sepsis Trust. EB, LR, and PK declare that they have no competing interests.

Revisores por paresVER TODOS

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University

Providence

RI

Divulgaciones

SMO declares that he has no competing interests.

Associate Professor

NYU School of Medicine

Medical Director of Critical Care

Bellevue Hospital Center

New York

NY

Divulgaciones

LE serves as the guidelines co-chair and on the steering committee of the Surviving Sepsis Campaign.

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