Acute medicine & surgery
Sepsis Mimics in the ICU: A Qualitative Study of Physicians' Diagnostic Experiences in Japan
By Kasugai D, Higashi M, Satoh K and 5 others.
Abstract
Background
Sepsis mimics are non-infectious conditions that resemble sepsis, leading to diagnostic uncertainty, delayed disease-specific therapy, and unnecessary antibiotics.
Methods
We conducted semi-structured online interviews with seven physicians with experience in adult general intensive care unit (ICU) practice in Japan (October-December 2023) and analyzed data using Reflexive Thematic Analysis.
Results
Four themes were generated: (1) Spectrum-participants described sepsis mimics as spanning hematologic malignancy, autoimmune/inflammatory disease, endocrine/metabolic crises, drug/toxic states, and other acute non-infectious conditions. (2) Diagnostic challenges-participants described phenotypic overlap, missing or fragmented history, organizational barriers to definitive testing in unstable patients, competing pathophysiology, and diagnostic masking by early corticosteroids. (3) Therapeutic and diagnostic strategies-participants described a sepsis-oriented initial approach with broad antibiotics and organ support, followed by reactive re-evaluation for nonresponse or early parallel work-up for selected mimics. (4) Triggers for re-evaluation-participants described reconsidering sepsis when the clinical course or physiology diverged from expectations, including discrepant hemodynamics, atypical fever patterns, focal physical signs, and metabolic abnormalities not readily explained by presumed infection.