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Comment & Response |

Definitions for Sepsis and Septic Shock—Reply

Clifford S. Deutschman, MD, MS1; Mervyn Singer, MD, FRCP2
[+] Author Affiliations
1Center for Pediatric Research, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
2Bloomsburg Institute of Intensive Care Medicine, University College London, London, United Kingdom
JAMA. 2016;316(4):458-459. doi:10.1001/jama.2016.6389.
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In Reply Drs Sprung and Reinhart and Dr Schneider-Lindner and colleagues believe that Sepsis-3 recommends abandoning SIRS. That is not the case. Rather, SIRS may be useful in the presumptive diagnosis of infection. However, SIRS is not specific nor particularly sensitive for infection. As an example, Churpek and colleagues1 reported that 50% of hospital inpatients have SIRS at least once in their hospital stay, and many of these patients will not have infection nor require antibiotic therapy. Conversely, 64% of the 66 522 non–intensive care unit (ICU) patients in the University of Pittsburgh Medical Center validation cohort had 0 or 1 SIRS criteria at the time they were cultured and treated for suspected infection. The article also did not suggest that what was previously called “sepsis” be eliminated from the diagnostic spectrum. Rather, it should be simply and correctly identified as “infection.”

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July 26, 2016
Shivinder Singh, MD; Sanil Mohan, MD; Ravi Singhal, MD
1Department of Anesthesiology and Critical Care, Command Hospital Western Command Chandimandir, Panchkula, Haryana, India
JAMA. 2016;316(4):458. doi:10.1001/jama.2016.6368.
July 26, 2016
Charles R. Wira III, MD; Kai E. Swenson, MD
1Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
2Department of Internal Medicine, Stanford University School of Medicine, Stanford, California
JAMA. 2016;316(4):460. doi:10.1001/jama.2016.6371.
July 26, 2016
Sean R. Townsend, MD; Emanuel Rivers, MD, MPH; Lemeneh Tefera, MD, MSc
1California Pacific Medical Center, San Francisco
2Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
3Quality Measurement and Value-Based Incentives Group, Centers for Medicare & Medicaid Services, Baltimore, Maryland
JAMA. 2016;316(4):457-458. doi:10.1001/jama.2016.6374.
July 26, 2016
Charles L. Sprung, MD; Konrad Reinhart, MD
1Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
2Jena University Hospital, Jena, Germany
JAMA. 2016;316(4):456-457. doi:10.1001/jama.2016.6377.
July 26, 2016
Verena Schneider-Lindner, MD, PhD; Holger A. Lindner, PhD; Manfred Thiel, MD
1Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
JAMA. 2016;316(4):457. doi:10.1001/jama.2016.6380.
July 26, 2016
Ellen L. Burnham, MD; Jesse Roman, MD
1Department of Medicine, University of Colorado School of Medicine, Aurora
2Department of Medicine, University of Louisville Health Sciences Center, Louisville, Kentucky
JAMA. 2016;316(4):460-461. doi:10.1001/jama.2016.6383.
July 26, 2016
Gentle S. Shrestha, MD, FCCP
1Department of Anesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
JAMA. 2016;316(4):459-460. doi:10.1001/jama.2016.6386.
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