Idsa Did Not Endorse the Surviving Sepsis Campaign Guidelines

The SSC 2016 sepsis definition is based on some studies in which the rate of proven infection is very low or unknown. The new definition does not consider patients with <2 points at Sequential Organ Failure Assessment (SOFA) score but with bloodstream infection (BSI). Even though this population is not formally a “septic population,” patients may require intense care and appropriate therapy. To highlight this issue, we analyzed data on people with BSI seen in a large university hospital in Rome. Four hundred three patients were considered: mean age, 66.3 years, 56% were males, 36% were hospitalized within the previous 90 days before the BSI, and 29% received at least 1 antibiotic in the previous month. Forty percent had a central venous catheter at the onset. Sixty-five percent had no SIRS criteria and 35% only 1 criterion. The 30-day mortality was 11.2%; median of duration of antibiotic therapy was 17 days (interquartile range, 11–25 days). The 30-day mortality of people with Candida BSI was 24.7%. According to our results, the SSC 2016 sepsis definition, may omit diagnosis of infected patients who need appropriate therapy (such as Candida BSI) and who also have a high mortality. To manage the delicate balance between not starting useless therapy and not neglecting demanding conditions such as Candida BSI, we strongly suggest improving rate of diagnostic tests in patients with suspected infections to achieve the highest diagnostic sensitivity.