🦠 Infection Screening in Sepsis: Systematic assessment is essential when no obvious source is identified. ⚠️ Clinical signs may be muted in the elderly, immunocompromised, or patients on steroids/chemotherapy. 💡 Pathophysiology reminder: sepsis arises from dysregulated host response to infection → widespread inflammation, endothelial dysfunction, and organ hypoperfusion.

🩺 Sepsis Source Screening – Quick Flow (UK, NICE)

Step	Action / Consideration	Notes / NICE guidance
1️⃣ Identify Sepsis	Suspected infection + ≥1: SIRS/NEWS2 deterioration, hypotension, lactate ≥2 mmol/L	Early recognition; alert senior clinician; start sepsis bundle within 1 hour
2️⃣ ABC & Supportive Care	Airway, oxygen, IV fluids, monitor vitals & urine output	Follow NICE NG51 sepsis pathway; correct hypotension & hypoperfusion early
3️⃣ Blood Cultures & Labs	≥2 sets from separate sites, FBC, CRP, lactate, U&E, LFTs, coagulation	Before antibiotics if possible; include line cultures if central access
4️⃣ “Top-to-Bottom” Source Review	🌬️ Respiratory: CXR, sputum culture 💉 Lines & Access: inspect, culture if suspected 🚻 GU: MSU, urine dip, consider prostatitis/PID 🍽️ GI / Abdomen: USS/CT if pain, jaundice, diarrhoea 🩹 Skin & Wounds: swabs, surgical sites 🧠 Neuro: lumbar puncture if meningism, consider CNS imaging	Check elderly/immunocompromised carefully; subtle signs may occur
5️⃣ Imaging / Specialist Review	CT/MRI/USS as indicated; echo if endocarditis suspected; consider ID review	Early source control reduces mortality; NICE recommends targeted imaging based on clinical suspicion
6️⃣ Empirical Antimicrobials	Start broad-spectrum IV antibiotics within 1 hour of sepsis recognition	Tailor based on cultures and sensitivities; review daily
7️⃣ Reassess & Monitor	Track NEWS2, vitals, labs; monitor for organ dysfunction	Adjust therapy, escalate care, or consider ICU if deteriorating
8️⃣ Document & Communicate	Record suspected source, cultures sent, antibiotics started, escalation plan	NICE recommends clear documentation and multidisciplinary communication

💡 Quick mnemonic: “Lines, Lungs, Urine, Abdomen, Wounds, Neuro” – review in every hospitalised septic patient, especially elderly or immunocompromised. Prompt source control + targeted antibiotics = improved survival (NICE NG51, 2017).

📖 Overview

Systematic “top-to-bottom” review helps identify occult sources of infection.
Always consider non-infective pyrexia (malignancy, autoimmune disorders, drug fever).
Early recognition and source control reduces mortality and organ dysfunction.

🧑‍⚕️ Clinical Systems Review

🌬️ Respiratory: SOB, cough, sputum, hypoxia → pneumonia, empyema.
👂 ENT: Sinus tenderness, sore throat, otitis media, coryza.
❤️ Cardiac: New murmur, splinter haemorrhages, clubbing, microscopic haematuria → consider infective endocarditis.
🍽️ GI: Abdominal pain, diarrhoea, vomiting, jaundice → cholangitis, liver abscess, perforation.
🩹 Skin & Soft Tissue: Cellulitis, surgical wounds, ulcers, shingles/HSV reactivation.
💉 Lines & Vascular Access: Central lines, cannulae, dialysis catheters – rigors with flushing suggest line sepsis.
🚻 GU: Dysuria, frequency, loin pain, haematuria, discharge, genital rashes → UTI, prostatitis, PID.
🧠 Neurological: Confusion, agitation, focal deficits, meningism, visual changes → CNS infection.

🔬 Investigations (UK, NICE-aligned)

💉 Blood cultures: ≥2 sets from separate sites; add line cultures if central access in situ. Avoid unnecessary removal without ID advice.
🩻 Imaging: CXR for consolidation/effusion; consider USS/CT abdomen/pelvis if intra-abdominal source suspected.
📊 Bloods: FBC (neutropenia/leucocytosis), CRP/Procalcitonin (trend monitoring), U&Es, LFTs, coagulation profile (DIC risk), lactate (organ hypoperfusion).
🫀 Echocardiography: Transthoracic or TOE if endocarditis suspected.
🧪 Other cultures: Urine (MSU), stool (MCS & C. difficile toxin if diarrhoea), sputum, throat swab, viral serology (risk factors), swabs from wounds or lesions.

💡 Teaching pearl: Think “Lines, Lungs, Urine, Abdomen, Wounds” as the five most common sources of sepsis in hospitalised adults. Early identification, source control, and targeted antimicrobial therapy are key to NICE-compliant management.

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Infection screening in Septic patient ✅

🩺 Sepsis Source Screening – Quick Flow (UK, NICE)

📖 Overview

🧑‍⚕️ Clinical Systems Review

🔬 Investigations (UK, NICE-aligned)

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