Table 1 Examples of diagnostic–therapeutic paths for the control and eradication of septic sources

Complicated urinary tract infections

 Fever, dysuria, pollakiuria, stranguria, lower back pain

Blood culture, physicochemical urine examination, urine culture

Ultrasound, contrast-enhancement US (CEUS), or CT abdomen pelvis

Antibiotic therapy; nephrostomy (if hydronephrosis); evaluation of urinary device removal

Severe pneumonia

 Fever, cough, dyspnoea

Blood cultures, respiratory secretion sampling (bronchoaspirate or bronchial lavage); urinary antigens for pneumococcus or legionella; swab for influenza virus identification (epidemic period)

Chest X-ray, thoracic ultrasound, or CT scan

Antibiotics, with or without antiviral therapy; possible drainage of pleural empyema

Complicated skin and soft tissue infections (± osteomyelitis)

 Fever, erythema, pain, oedema, suppuration, or necrosis

Blood cultures and microbiological examination of biopsy samples

Soft tissue ultrasound + bone X-ray; soft tissue + bone CT scan; soft tissue + bone MRI (magnetic Resonance imaging) (osteomyelitis*)

*MRI is often the most appropriate second study, as it is highly sensitive and can detect bone marrow changes within days of infection

Antibiotic therapy; surgical therapy evaluation; hyperbaric therapy evaluation

Complicated intra-abdominal infections

 Fever, abdominal pain, signs of sepsis

Blood cultures and cultures from in situ drainage < 24 h

Abdominal ultrasound or CT scan

Antibiotic + antifungal therapy; surgical evaluation; interventional radiology evaluation

Central nervous system infections

 Fever, altered state of consciousness, signs of meningeal irritation

Blood cultures and the chemical and microbiological examination of the liquor

Head CT

Antibiotic therapy, subdural empyema drainage, or liquor derivation (hydrocephalus)

Central nervous system infections

 Fever, signs of sepsis/septic shock, local inflammation

Blood cultures and microbiological examinations of any secretions

CT scan or echocardiogram (depending on the type of infection, location, and severity)

Antibiotic + antifungal therapy; Evaluation of device removal