Sepsis is one of the leading causes of mortality in intensive care units and is particularly more severe in immunocompromised patients, in whom the systemic inflammatory response is profoundly altered due to acquired or therapy-induced immunosuppression. The severity of sepsis in this patient profile imposes substantial diagnostic and therapeutic challenges, whose understanding requires in-depth knowledge of the underlying pathophysiological mechanisms, as well as the clinical and laboratory limitations for early recognition of the syndrome. This work aims to analyze, through a narrative review of the scientific literature, the main diagnostic, pathophysiologic, and therapeutic challenges of sepsis in immunocompromised patients. The methodology consisted of critical selection of English-language scientific articles from indexed databases such as PubMed, ScienceDirect, SpringerLink, Nature, Scopus, and JAMA Network, in addition to analysis of recognized international guidelines, including those from the Surviving Sepsis Campaign and the Infectious Diseases Society of America. The results were organized into thematic axes that structure the review chapters: conceptual and historical foundations of sepsis; epidemiology of the syndrome in immunosuppressed populations; specific pathophysiologic mechanisms; diagnostic difficulties; applicable therapeutic strategies; preventive measures and multidisciplinary management; and critical analysis of the literature. The synthesized content shows that immunocompromised patients are at higher risk of progression to severe sepsis and septic shock, with atypical clinical manifestations, high burden of multidrug-resistant pathogens, and often silent inflammatory responses. Traditional diagnostic tools such as Sepsis-3 clinical criteria, SOFA score, and inflammatory markers (procalcitonin, C-reactive protein) show reduced sensitivity in this group, requiring careful clinical evaluation integrated with microbiologic data. Regarding treatment, early empirical interventions based on adapted protocols are essential, with special attention to antimicrobial toxicity and altered pharmacokinetics. New therapies, such as β-lactamase inhibitors and immunomodulators, have emerged as promising alternatives, though still limited in availability.
Leandro Correa Machado (Sun,) studied this question.