{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T02:07:23Z","timestamp":1793412443624,"version":"4.5.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sepsis is a challenging condition increasingly managed in medical wards, however literature and clinical evidence in this hospital setting are lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the computational i2b2 framework, we retrospectively analyzed data from patients admitted to internal medicine units of four hospitals in Lombardy (Italy) between January 2012 and December 2023, with a discharge diagnosis of sepsis, septic shock, or septicemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 4,375 patients were recruited. Median length of stay (LOS) was 14\u202fdays, 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 1\u202fyear. 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<jats:sup>+<\/jats:sup>) and\/or polymicrobial sepses showed longer stays and higher mortality (complicated course) compared to drug-sensitive or 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<jats:sup>+<\/jats:sup> sepsis, while further ferritin elevation and decreased platelet counts predicted death. From 2016 to 2023, MDR<jats:sup>+<\/jats:sup> sepsis frequency declined, due 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This work provides novel insights into sepsis management in internal medicine units, highlighting the need for validated biomarkers and implemented therapies in this scenario.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1503868","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T12:06:11Z","timestamp":1738238771000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Sepsis in Internal Medicine: blood culture-based subtypes, hospital outcomes, and predictive biomarkers"],"prefix":"10.3389","volume":"12","author":[{"given":"Gaetano","family":"Zizzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Guazzardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Bompane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Di Terlizzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Rotola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilario","family":"Stefani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Medugno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Bucalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Mazzone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1056\/NEJMp1707170","article-title":"Recognizing sepsis as a global health priority\u2014a WHO resolution","volume":"377","author":"Reinhart","year":"2017","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"325","DOI":"10.21037\/atm.2016.08.59","article-title":"Epidemiologic trends of sepsis in western countries","volume":"4","author":"Suarez De La Rica","year":"2016","journal-title":"Ann Transl Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of global incidence and mortality of hospital-treated sepsis. 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