Immediate Management of Acute Sepsis in Hospitalized Patients

Initial Assessment and Risk Stratification

The National Institute for Health and Care Excellence recommends calculating a NEWS2 (National Early Warning Score) immediately upon hospital arrival 1
Documenting Glasgow Coma Scale (GCS) is essential for both prognostic value and monitoring deterioration, as recommended by the Society of Critical Care Medicine 2, 3, 4
High risk criteria, such as a NEWS2 score ≥7, requires urgent assessment by a team with critical care competencies, according to the American College of Emergency Physicians 1, 2, 3
Moderate risk, defined as a NEWS2 score 5-6 or a score of 3 in any single physiological parameter, requires urgent clinician review, as stated by the European Society of Intensive Care Medicine 2, 3

Blood cultures should be obtained as soon as possible and always within 1 hour of hospital arrival, before antibiotics if this causes no delay >45 minutes, as recommended by the Infectious Diseases Society of America 2, 3, 4, 6
Lactate level is essential for assessing tissue hypoperfusion and monitoring resuscitation endpoints, with a target <2 mmol/L, according to the Society of Critical Care Medicine 2, 3, 8
A complete blood count with differential, comprehensive metabolic panel, and coagulation studies are necessary for diagnosing and managing sepsis, as recommended by the American College of Chest Physicians 5, 7

The American College of Emergency Physicians recommends administering IV antibiotics within 1 hour of recognition for high-risk patients (NEWS2 ≥7 or septic shock) 1, 5, 7
The Infectious Diseases Society of America suggests administering antibiotics within 3 hours for moderate-risk patients (NEWS2 5-6) and within 6 hours for low-risk patients (NEWS2 <5) 1

The Society of Critical Care Medicine recommends administering a 500 ml crystalloid bolus rapidly for patients with signs of shock or severe sepsis, and giving at least 30 ml/kg IV crystalloid within the first 3 hours for sepsis-induced hypoperfusion 2, 3, 4, 6, 8
Targeting mean arterial pressure ≥65 mmHg, capillary refill time <2 seconds, and urine output >0.5 ml/kg/hour are essential resuscitation endpoints, as stated by the American College of Chest Physicians 2, 3, 5, 7, 8

The Infectious Diseases Society of America recommends identifying the anatomic source of infection requiring source control as rapidly as possible, and addressing urinary tract obstruction or anatomical abnormality within 12 hours of diagnosis 5, 7
Removing or replacing indwelling urinary catheters before starting antimicrobials is essential, according to the Centers for Disease Control and Prevention 5

The American College of Emergency Physicians suggests re-calculating NEWS2 and re-evaluating high-risk patients every 30 minutes, moderate-risk patients every hour, and low-risk patients every 4-6 hours 1
Daily antimicrobial stewardship, including reassessing antimicrobial therapy and de-escalating to narrower spectrum antibiotics, is crucial, as recommended by the Infectious Diseases Society of America 1, 5