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Art of Medicine           Volume-1 

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Art of Medicine International Medical Scientific journal 

 

Founder and Publisher Pascual Izquierdo-Egea 

Published science may 2021 year. Issued Quarterly.  

Internet address: http://artofmedicineimsj.us 

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The importance of the criteria of systemic inflammatory Responce syndrome of early 

diagnostics and detection of bloodstream infections  

1
Akhmedova D.R., 

1
Abdukhalilova G.K., 

1
Otamuratova N.Kh., 

2
Tadjieva N.U., 

1
Bektimirov A.M-

T., 
1
Akhmedov I.F., Tadjiev B.M. 

1
Republican Specialized Scientific and Practical Medical Center of Epidemiology, Microbiology 

Infectious and Parasitic Diseases, 
2
Tashkent Medical Academy Ministry of Health of Republic of 

Uzbekistan, Tashkent.  

For Corresponding 

1. Akhmedova Dilshoda Rakhmanberdievna, junior researcher, PhD student, RSPMCEMIPD. 

Tashkent, Uchtepa district, Zakovat st.,2. 100133. Dilyaahmedova85@mail.ru *Corresponding 

author 

2. Abdukhalilova Gulnora Kudratullaevna, Doctor of Medical Sciences, Head of the Center of 

Antimicrobial Resistance at RSPMCEMIPD, Tashkent, Uchtepa district, Zakovat st., 2. 100133. 

gula-abd@yandex.ru  

3. Otamuratova Nargiza Khasandjanovna, Ph.D., Senior Researcher, Epidemiologist of the Center 

of Antimicrobial Resistance at RSPMCEMIPD, Tashkent city, Uchtepa district, Zakovat Street, 

2. 100133. nargiza.otamuratova@gmail.com  

4. Tadjieva Nigora Ubaidullaevna, MD, DSc, Associate Professor of the Department of Infectious 

and Children's Infectious Diseases of the Tashkent Medical Academy, Olmazor distr ict, st. 

Farobi, 2. nigora1973@list.ru  

5. Bektimirov Amir Mangu-Temirovich, Ph.D., Senior Researcher, Bacteriologist at the Center of 

Antimicrobial Resistance at RSPMCEMIPD, Tashkent city, Uchtepa district, Zakovat st., 2. 

100133. amtbektimirov@gmail.com  

6. Akhmedov Ildar Farrukovich, junior researcher, bacteriologist of the Center of Antimicrobial 

Resistance at RSPMCEMIPD, Tashkent, Uchtepa district, Zakovat str., 2. 100133. 

a978da@yandex.com 

7. Tadjiev Batyr Mirkhashimovich, director of 
1
Republican Specialized Scientific and Practical 

Medical Center of Epidemiology, Microbiology Infectious and Parasitic Diseases. Tashkent, 

Uchtepa district, Zakovat str., 2. 100133.. infoniiemiz@minzdrav.uz  

 

  

mailto:Dilyaahmedova85@mail.ru
mailto:gula-abd@yandex.ru
mailto:nargiza.otamuratova@gmail.com
mailto:nigora1973@list.ru
mailto:amtbektimirov@gmail.com
mailto:a978da@yandex.com
mailto:infoniiemiz@minzdrav.uz


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Summary 

Purpose of study 

Determine the frequency of detection of patients with bloodstream infections (BSI) with 

applying systemic inflammatory response syndrome (SIRS) criteria, and analyze the clinical 

characteristics of patients with suspected BSI. 

Methods  

In the study were included 1,463 patients hospitalized in various departments according to 

their primary diagnosis. Indication for study inclusion and hemoculture collection of patients was 

the detection of at least 2 or more criteria of SIRS (ACCP/SCCM, Atlanta, 1992), in accordance 

with the protocol of the POP project "Proof-of-principle routine diagnostic project for a 

Antimicrobial Resistance Surveillance", with technical support from WHO, during the period from 

2019-2020. 

The obtained results 

The largest number of patients (376) was admitted to the intensive care unit, 293 patients 

each admitted to the pediatric and infectious disease units and 183 patients admitted to the 

diagnostic units. All characteristic clinical symptoms of SIRS occurred in the examined patients. 

Hyperthermia was the most common in all age groups - in 47 patients in 74.60±1.08% of cases in 

the group of patients under one year of age, significantly more frequent in the group of 1 -5 years 

(594), 5-12 years (166), 12-18 and over 18 years (60; 486, respectively P<0.05). Tachycardia was 

also frequently observed in all age groups - almost in all patients (91.9±0.99%) in the group less 

than 1 year old, almost equally often in 75±0.66% and 73.90±0.38% of cases in the group 5 -12 and 

over 18 years old, respectively. This symptom was noted in more than 50% of cases in patients in 

the 1-5 (65%) and 12-18 (84%) age group.  Tachypnea and leukocytosis were most frequently 

observed in patients under 1 year of age (47.62±0.87% and 71.43±1.06%, respectively), whereas in 

the remaining groups (1-5, 5-12, 12-18, and over 18 years of age), leukocytosis was noted in 63%, 

50%, 59%, and 58% of cases, respectively, and tachypnea in 23%, 10%, 19%, and 25%, 

respectively. A combination of 2 symptoms (hyperthermia and tachycardia), a combination of 

hyperthermia and leukocytosis in 18.1% of cases, a triad of symptoms tachycardia, hyperthermia 

and leukocytosis in 23.9% of cases was the most common (41.5%) of the criteria for SSRIs. Also 

often enough (6.8%) were observed 4 symptoms hyperthermia, tachycardia, tachypnoea and 

leukocytosis. 

Conclusions  

The most frequent localization of infection in BSI was the upper respiratory tract, lower 

respiratory tract infections were detected twice as often. Predominantly, regardless of the 



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localization of infection, a combination of the criteria for SIRS of two symptoms was observed. 

Irrespective of the localization of infection, all patients had fever in various combinations, most 

frequently with tachycardia (26.8%) and leukocytosis (26.2%). 

Keywords Bloodstream infections, systemic inflammatory response syndrome, sepsis, 

hyperthermia, tachycardia, tachypnea, leukocytosis, neutrophilia. 

 

Introduction 

Bloodstream infections (BSIs) are defined as the presence of bacteria in the blood detected 

by hemoculture testing. This definition includes all clinical manifestations of BSI, including 

systemic inflammatory response syndrome (SIRS/SIRS, the initial manifestation of BSI), sepsis 

(life-threatening illness accompanied by organ dysfunction due to dysregulated host response to 

infection) and septic shock (sepsis accompanied by persistent pressure drop despite rehydration, 

plus impaired cellular metabolism) 1. Bloodstream infections are among the most common 

diagnoses treated in intensive care units. According to some author reports, 1.7 million patients 

develop BSIs each year in the United States, most of whom are over 65 years of age 2. Mortality, 

which reaches 10% in patients with sepsis and 40% in patients with septic shock, is usually the 

result of multiple organ dysfunction syndrome (MODS) 3. 

The introduction of the use of the SIRS criteria proposed at the consensus conference of the 

American College of Thoracic Surgeons and Society of Emergency Physicians would be an 

indication for hemoculture testing and would allow identification of patients at risk for sepsis and 

MODS, and would facilitate early intervention and appropriate management tactics .  

SIRSs are characterized by a wide range of conditions and may have a severe clinical 

course. The main clinical and laboratory indicators for the diagnosis of SIRS are body temperature 

above 38.3°C (fever) or below 36°C (hypothermia), heart rate more than 90 beats per minute 

(tachycardia), respiratory rate more than 20 breaths per minute (tachypnea), white blood cell count 

more than 12 × 109/L or less than 4 × 109/L or more than 10% immature neutrophils (stabial 

forms). SIRS criteria for children are presented in Table 1 according to the age of the child.  

Table 1. Specific age criteria for SIRS 

Age group 

body temperature 

(°C) 

heart rate (beats per 

minute) 

respiratory 

rate (breaths 

per minute) 

white blood 

cell count (in 

10
9
/L) fever hypothermia tachycardia bradycardia 

Newborn (0 days 
to 1 week) 

>38,3 <36,0 180 100 50 34 

Newborn (1 week 
to 1 month) 

>38,3 <36,0 180 100 40 19,5 or 5 



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Infant (1 month 
to 1 year) 

>38,3 <36,0 180 90 34 17,5 or 5 

Pre-school age 

(from 1 to 5 
years) 

>38,3 <36,0 140 НП 22 15,5 or 6 

School age (5 to 
12 years old) 

>38,3 <36,0 130 НП 18 13,5 or 4,5 

Teenagers (12 to 
18 years old) 

>38,3 <36,0 110 НП 14 11 or 4,5 

 The presence of two or more of the above signs against the background of infection and 

bacteremia is interpreted as a systemic inflammatory response to the infection, i.e., SIRS 4,5,6.  

The purpose of our study is to determine the frequency of detection of patients with 

bloodstream infections when applying the criteria of systemic inflammatory response 

syndrome, and to analyze the clinical characteristics of patients with suspected bloodstream 

infections. 

Materials and Methods 

In the study were included 1,463 patients hospitalized in various departments according to 

their primary diagnosis. Indication for study inclusion and hemoculture collection of patients was 

the detection of at least 2 or more criteria of SIRS (ACCP/SCCM, Atlanta, 1992), in accordance 

with the protocol of the POP project "Proof-of-principle routine diagnostic project for a 

Antimicrobial Resistance Surveillance", with technical support from WHO, during the period from 

2019-2020. 

From the total number of patients, 42% were female (615) and 58% male (848). The age of 

the patients ranged from a few months to 90 years (up to 1 year - 5%, 1-5 years - 45%, 5-12 years - 

12%, 12-18 years - 4%, and over 18 years - 34%).  

 In the selected patients we analyzed medical history data, clinical parameters in accordance 

with SIRS criteria, the fact of taking antibiotics at the time of blood sampling, empirical therapy 

before the bacteriological test result of hemoculture, and the tactics of antibiotic therapy after a 

positive result from the bacteriological laboratory. 

Obtained results 

All patients were hospitalized in different departments of huge multidisciplinary hospitals of 

Tashkent, Uzbekistan (Table 2). 

Table 2. Distribution of patients according to departments 

Departments n % 

1. Adults ICU  376 25,7±0,13 

2. Pediatric/Newborn 296 20,23±0,12 

3. Infectious Diseases 293 20,03±0,12 

4. Diagnostic 183 12,51±0,09 



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5. Pediatric/Newborn ICU 95 6,49±0,07 

6. Therapeutic 92 6,29±0,07 

7. Surgical 91 6,22±0,07 

8. Urologic 34 2,32±0,07 

9. Rehabilitation 3 0,21±0,04 

 

Comparative analysis of the obtained data showed that the largest number of patients (376) 

were hospitalized in the intensive care unit (p 0.05)/ Between the number of patients hospitalized 

in pediatric (293), infectious diseases (293) and diagnostic (183) departments significance was not 

noted.  Hospitalization of the examined patients in the neonatal intensive care unit, therapeutic and 

surgical departments was equally frequent (p0.05). Hospitalization of patients at the urologic 

department and rehabilitation department was significantly less frequent, and showed only in 

2.32±0.07%, 0.21±0.04% cases, respectively (p0.05). 

The distribution of patients according to SIRS clinical criteria at the time of hospitalization is 

shown in Table 3. 

Table 3. Clinical parameters of the whole group of patients according to age 

Clinical parameters Under 1 

year old 

1 - 5 years 

old 

6-12 years 

old 

13 – 18 years 

old 

Older than 18 

years old 

hyperthermia 74,60±1,08 90,69±0,37* 96,51±0,75*° 80,00±1,03*°˄ 97,597±0,44*° 

hypothermia 3,17±0,22 2,9±0,07 3,49±0,14° - 1,20±0,05*°˄ 

tachycardia 91,9±0,99 50,84±0,28* 75±0,66*° 61,33±0,90°˄ 73,90±0,38*° 

bradycardia - 0,46±0,03* 0,58±0,06* - 1,41±1,08*°˄ 

tachypnea 47,62±0,87 20,15±0,18* 8,72±0,23*° 16,00±0,46*°˄ 21,08±0,21*°˄ 

leukocytosis 71,43±1,06 59,69±0,30* 46,51±0,52*° 49,33±0,81*°˄ 55,02±0,33*°˄ 

leukopenia 4,76±0,27 1,37±0,05* 1,74±0,10*° 1,33±0,13* 1,20±0,05* 

neutrophilia 3,17±0,22 0,76±0,03* 1,16±0,08*° - 0,80±0,04*˄ 

Note: * Comparison of indicators with the group of patients under 1 year of age (p0.05) 

° Comparison of indicators with the group of 1-5 years, (p0.05) 

˄ Comparison of indicators with the group of 5-12 years, (p0.05) 

- Comparison of indicators with the group of 12-18 years, (p0.05) 

 

The examined patients had all clinical symptoms of SIRS. The most common in all age 

groups was hyperthermia: in the 1-5 years group and in over 18 year’s group it amounted 

significantly more frequent 594 (p<0.05) and 486 of cases (p<0.05), respectively. In the 6-12 years 

group – in 166 of cases, in the 13-18 – in 60 of cases, and in the group of patients under one year of 

age it amounted 47 patients (74.60±1.08% of cases), which shows that it was not had significant 

difference. Tachycardia were also frequently observed in all age groups - nearly all patients 

(91.9±0.99%, p0.05) in the group less than 1 year old, almost equally often in 75±0.66% and 



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73.90±0.38% of cases in the group 5-12 and over 18 years old, respectively. In more than 50% of 

cases this symptom was observed in patients in the age group of 1-5 (65%) and 12-18 (84%) years 

old.  Such symptoms as tachypnoea and leukocytosis were most frequently observed in patients 

under 1 year of age (47.62±0.87% and 71.43±1.06%, respectively), whereas in the remaining 

groups (1-5, 5-12, 12-18 and over 18 years old), leukocytosis was noted in 63%, 50%, 59% and 

58%, respectively, and tachypnoea in 23%, 10%, 19% and 25%, respectively. 

We divided all the examined patients into groups according to combinations of symptom 

occurrence. The results showed that the most common combination of 2 characteristic clinical 

symptoms was registered in 758 patients (51.8%), in 590 patients (40.3%) of 3 symptoms, and in 

115 cases (7.9%) 4 symptoms were encountered. But there was no statistical reliability in the 

distribution of patients into groups.  (p0.05). 

Table 4. Distribution of patients into groups according to combinations of SIRS criteria  

Groups Combinations of SIRS criteria Quantity (n, %) 

1 group 2 symptoms 758 (51,8%) 

2 group 3 symptoms 590 (40,3%) 

3 group  4 symptoms 115 (7,9%) 

 

Table 5. Combination of SIRS criteria 

Combination of SIRS criteria 
Quantity 

(%) 

Quantity 

(n) 

Hyperthermia + tachycardia 26,8% 392 

hyperthermia + tachycardia + leucocytosis 26,2% 384 

hyperthermia+leukocytosis 20,6% 301 

hyperthermia+tachycardia+tachypnoea 9,0% 132 

hyperthermia+tachycardia+tachypnoea+leukocytosis 6,7% 98 

tachycardia+tachypnoea+leukocytosis 3,3% 48 

hyperthermia+tachycardia+leukocytosis+neutrophilia 1,0% 15 

hyperthermia+tachypnoea 1,0% 15 

tachycardia+tachypnea 0,6% 9 

leukocytosis+tachypnea 0,5% 8 

tachycardia+tachypnoea+hypothermia 0,5% 7 

 

Combinations of SIRS criteria depending on the presumed localization of infection are 

shown in Fig.1a, and Fig.1b 



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Analysis of the occurrence of various combinations of SIRS criteria in the surveyed group of 

patients showed that the most frequent was a combination of two symptoms: in 62.2% for 

localization on the skin and soft tissues, in 61.7% in the upper respiratory tract, and in 52.5% for a 

source of infection in the gastrointestinal tract. The greatest combination of three SSRI criteria was 

observed in the lower respiratory tract (53.1%) and gastrointestinal tract (42.4%). 

Combinations of SSRS criteria of hyperthermia, tachycardia and tachypnoea were observed in 

26.6% of cases with localization of infection in the lower respiratory tract (301), 22.6% of 

hyperthermia, tachycardia and leucocytosis, 9.6% of hyperthermia, tachypnoea and leucocytosis, in 

20.3% of cases there was a combination of 2 symptoms - hyperthermia and leucocytosis, and in 

14.3% of hyperthermia and tachycardia.  

Figure 1a - Combinations of SIRS  

Figure 1b - Combinations of SIRS  

When we analyzed the localization of infection in our patients with suspected BSI, the most 

frequent was in the upper respiratory tract (703), accounting for 48.1%; in the lower respiratory 

tract - 301 patients, accounting for 20.6%. Gastrointestinal diseases accounted for 10.8% (158) of 

the cases (p≥0,05) Fig.2a, 2b, 2c.  

 

0,0%

50,0%

100,0%

6,8% 3,8% 4,2% 
20,0% 

3,5% 5,7% 9,3% 
33,3% 

5,3% 
5,0% 4,4% 3,2% 1,8% 

11,4% 
25,6% 

3,2% 

23,5% 
9,5% 

28,4% 

66,7% 

50,9% 
8,6% 

22,6% 100,0% 69,5% 
0,4% 

22,2% 
1,1% 

2,3% 
0,3% 

4,4% 
1,8% 

2,9% 

1,3% 

Hyperthermia, tachycardia, leukocytosis, neutrophilia hyperthermia, tachycardia tachypnoea, leukocytosis

hyperthermia, tachycardia tachypnoea Hyperthermia, tachycardia, leucocytosis

0,0%

50,0%

100,0%

42,1% 
8,9% 

25,3% 
6,7% 8,8% 

28,6% 
14,0% 

33,3% 
9,5% 

17,6% 

30,4% 

34,7% 

28,1% 

31,4% 

19,6% 

33,3% 

7,4% 

0,3% 

3,8% 

1,1% 

1,8% 

8,6% 

2,0% 

0,0% 

2,1% 

0,1% 
4,4% 

2,9% 

Hyperthermia + tachycardia Hyperthermia+leukocytosis Hyperthermia+tachypnoea



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Fig. 2a, 2b, 2c Combinations of SIRS criteria depending on the presumed localization of infection  

In this group of patients, a combination of 2 symptoms (hyperthermia and tachycardia), in 

18.1% of cases a combination of hyperthermia and leukocytosis, and in 23.9% of cases a triad of 

symptoms - tachycardia, hyperthermia and leukocytosis - was observed most frequently. The 4 

symptoms of hyperthermia, tachycardia, tachypnoea and leucocytosis were also common (6.8%).  

In the gastrointestinal tract, a combination of hyperthermia and leucocytosis (30.4%) was 

more frequent, hyperthermia, tachycardia with leucocytosis was shown in 9.5% of cases, and less 

frequent were the criteria of SIRS such as hyperthermia with tachycardia, in 8.9% (p≤0.05). 



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Fig.3a, 3b, 3c. Combinations of SIRS criteria depending on the presumed localization of infection  

More than half of the cases (51.8%) showed a combination of three symptoms: 

hyperthermia, tachycardia and leucocytosis, and 28.6% showed a combination of 2 symptoms: 

hyperthermia and leucocytosis,  if the infection was localized in the urogenital tract (Fig. 3b). 

A comparative analysis of the results showed that irrespective of the localisation of 

infection, all patients had fever in various combinations, most frequently with tachycardia (26.8%) 

and leucocytosis (26.2%).   

Thus, all the characteristic clinical symptoms of SIRS were mostly present. Hyperthermia was 

the most common in all age groups. The most frequent localization of infection in BSI was in the 

upper respiratory tract (702), accounting for 48.1%, (p0.05); almost half as many were in the 

lower respiratory tract, 301 patients, accounting for 20.6%, (p0.05). In 10.8% (158) of cases, the 

development of septic conditions was observed in gastrointestinal diseases. Analysis of the 

occurrence of various combinations of SIRS criteria in the examined group of patients showed that 

the most frequent was a combination of two symptoms: in 62.2% for localization in the skin and 

soft tissues, in 61.7% in the upper respiratory tract, and in 52.5% for a source of infection in the 

gastrointestinal tract (p<0.05). The most frequent combination of three SIRS criteria was observed 

in the lower respiratory tract (53.1%) and gastrointestinal tract (42.4%). A comparative analysis of 

the findings showed that irrespective of the localisation of infection, all patients had fever in 

varying combinations, most frequently with tachycardia (26.8%) and leucocytosis (26.2%), p0.05. 



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Conclusions.  

1. The upper respiratory tract, lower respiratory tract infections was the most frequent localization 

of infection in BSI. 

2. Predominantly, irrespective of the localization of infection, a combination of the criteria for 

SIRSs of two symptoms was observed. 

3. Irrespective of the localization of infection, all patients present with fever in varying 

combinations, most commonly with tachycardia (26.8%) and leucocytosis (26.2%). 

Conflict of interest 

The authors declare no conflict of interest. 

Financial support 

The study was conducted by the "Proof-of-principle routine diagnostic project for a Antimicrobial 

Resistance Surveillance" with technical and financial support of WHO. WHO was involved in the 

development of the POP-project protocol. WHO was not involved in the conduct of the study; data 

collection, management, analysis and interpretation, or in the preparation, review or approval of the 

manuscript. 

 

  



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