These include the following: increasing use of chemotherapy and radiotherapy; more widespread employment of corticosteroids and immunosuppressive agents in inflammatory diseases and organ transplantation; greater survival of predisposed patients (including the elderly), as well as those with cancer, diabetes, major organ failure, or granulocytopenia; and the increased use of invasive devices, such as surgical prostheses, inhalation equipment, and intravenous and urinary catheters.’ The dynamic process leading to increased numbers of cases of sepsis, therefore, consists of an antibiotic usage pattern that promotes emergence of resistant Gram-negative strains, coupled with expanded exposure to risk factors that encourage bacterial colonization.
Signs and Symptoms
The principal signs and symptoms of sepsis syndrome are reflected in the inclusion criteria we established for a major prospective intervention study (Table 2). These include fever or hypothermia, tachycardia, tachypnea, clinical evidence of an infection site, and inadequate organ perfusion or dysfunction as expressed by at least one of the following: poor or altered cerebral function, hypoxemia, elevated plasma lactate level, or oliguria.

Table 2—Criteria for Sepsis Syndrome

Clinical evidence of infection
Rectal temperature >38.3°C or <35.5°C
Tachycardia (>90 beats/min)
Tachypnea (>20 breaths/min while spontaneously breathing)
At least one of the following manifestations of inadequate organ (unction/perfusion:
Alteration in mental status
Hypoxemia (Pa02 <72 mm Hg breathing room air) (overt pulmonary disease not direct cause of hypoxemia)
Elevated plasma lactate level
Oliguria (urine output <30 ml or 0.5 ml/kg for at least 1 h)