(A) Major sites of infection:
(1) Intravenous lines (particularly central) : Always suspect if the patient develops evidence of sepsis and lines have not been changed for >4 days they must be replaced .
(2) Lungs : high risk of nosocomial pneumonia in intubated patients ,after being in ICU for more than 3-4 days particularly if treated with antibiotics ,the nasopharynx become colonised with gram negative bacteria which migrate to the lower respiratory tract ,prophylaxis with antibiotics to reduce the incidence of nosocomial pneumonia .
(3)Abdomen : Consider intra abdominal abscess or necrotic gut in patients who have had abdominal surgery ,pancreatitis ,acute choleycystitis , or perforated peptic ulcer may develop as a complication of critical illness ,ultrasound ,CT ,aspiration of collections of fluid/pus and laparotomy may be required
(4) Urinary tract : always culture a catheter specimen of urine in unexplained sepsis .
(B) Other sites of infection :
(5) Heart valves : transthoracic or transessophageal echocardiogram .
(6) Meninges : Lumbar puncture but check coagulation and platlet count first . (7) Joint and bones : x-ray , gallium or technatium white cell scan
(8) Nasal sinuses ,ears,oropharyngeal space : diagnosis clinical examination , plain x-ray , CT.
(9) Genito urinary tract (particularly post partum) : PV examination ,ultrasound . (10) Gastro intestinal tract : PR examination ,stool culture , clostridium difficile toxin assay , sigmoidscopy