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ORIGINAL RESEARCH article

Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1503868

Sepsis in Internal Medicine: blood culture-based subtypes, hospital outcomes, and predictive biomarkers

Provisionally accepted
Gaetano Zizzo Gaetano Zizzo 1*Gabriele Guazzardi Gabriele Guazzardi 2Daniela Bompane Daniela Bompane 1Francesco Di Terlizzi Francesco Di Terlizzi 1Giorgio Rotola Giorgio Rotola 1Ilario Stefani Ilario Stefani 1Michela Medugno Michela Medugno 1Mario Bucalo Mario Bucalo 2Antonino Mazzone Antonino Mazzone 1
  • 1 ASST Ovest Milanese, Legnano, Italy
  • 2 Biomeris s.r.l., Pavia, Lombardy, Italy

The final, formatted version of the article will be published soon.

    Background. Sepsis is a challenging condition increasingly managed in medical wards, however literature and clinical evidence in this hospital setting are lacking. Methods. Using the computational i2b2 framework, we retrospectively analyzed data from patients admitted to internal medicine units of 4 hospitals in Lombardy (Italy) between January 2012 and December 2023, with a discharge diagnosis of sepsis, septic shock, or septicemia. Results. A total of 4,375 patients were recruited. Median length of stay (LOS) was 14 days, and mean ward-to-intensive care unit (ICU) transfer and in-hospital mortality rates were 11% and 26%, respectively; significant differences were observed over the years, with LOS peaks preceding mortality peaks by one year. Blood culture-negative sepses showed shorter stays and higher mortality (acute kidney injury and fast deterioration) compared to culture-positive ones; polymicrobial sepses showed higher ICU transfer rates (acute respiratory distress); while multidrug-resistant (MDR+) and/or polymicrobial sepses showed longer stays and higher mortality (complicated course) compared to drug-sensitive and monomicrobial ones. C-reactive protein elevation predicted rapidly evolving culture-negative sepsis, whereas lower leukocyte counts predicted prolonged hospitalization; higher fractions of inspired oxygen predicted polymicrobial sepsis, while lactate elevation predicted ICU transfer; ferritin elevation and increased leukocyte counts predicted MDR+ sepsis, while further ferritin elevation and decreased platelet counts predicted death. From 2016 to 2023, MDR+ sepsis frequency declined, owing to decreased resistance to several antibiotic classes, such as cephalosporins, fluoroquinolones, and aminoglycosides; however, carbapenemase- and extended-spectrum beta-lactamase-producing Gram-negative bacteria, as well as vancomycin-resistant enterococci, increased, as did the frequency of polymicrobial sepsis following the COVID-19 outbreak. Conclusion. This work provides novel insights into sepsis management in internal medicine units, highlighting the need for validated biomarkers and implemented therapies in this context.

    Keywords: Sepsis, COVID-19, Internal Medicine, Culture-negative, Polymicrobial, Multi-drug resistant (MDR), outcomes, biomarkers

    Received: 29 Sep 2024; Accepted: 09 Jan 2025.

    Copyright: © 2025 Zizzo, Guazzardi, Bompane, Terlizzi, Rotola, Stefani, Medugno, Bucalo and Mazzone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Gaetano Zizzo, ASST Ovest Milanese, Legnano, Italy

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