Sepsis Management Guidelines

Immediate Antimicrobial Therapy

• Administer effective IV antimicrobials within the first hour of recognition of sepsis as this is the most critical intervention 1, 2
• Initial empiric therapy should include one or more drugs with activity against all likely pathogens (bacterial and/or fungal or viral) 2, 3
• Obtain appropriate cultures before starting antibiotics, but do not delay antimicrobial therapy if obtaining cultures would cause substantial delay 3, 4

Antimicrobial Selection Guidelines

• Use broad-spectrum beta-lactam for community-acquired sepsis 1, 5
• Consider coverage for resistant organisms based on local antibiograms for healthcare-associated sepsis 5
• For suspected MRSA, add vancomycin or linezolid 5
• For suspected Pseudomonas, consider combination therapy with an extended-spectrum beta-lactam plus either an aminoglycoside or fluoroquinolone 2, 6

Special Circumstances

• For neutropenic patients, use combination empirical therapy 2, 4
• For suspected fungal infection, consider echinocandin or fluconazole based on local patterns 5
• For suspected viral etiology, initiate appropriate antiviral therapy as early as possible 2, 4

Hemodynamic Support

• Begin norepinephrine when diastolic blood pressure is critically low or after initial fluid resuscitation fails to restore blood pressure 7
• Target a mean arterial pressure (MAP) of 65 mmHg 7
• Consider adding vasopressin if hypotension persists despite norepinephrine 7

Initial Fluid Resuscitation

• Administer crystalloids at 30 mL/kg within the first 3 hours for patients with sepsis-induced hypoperfusion 7
• Continue fluid administration as long as hemodynamic parameters improve 7

Optimization and De-escalation

• Reassess antimicrobial regimen daily for potential de-escalation 1, 3
• Empiric combination therapy should not be administered for more than 3-5 days 2, 6
• De-escalate to the most appropriate single therapy once susceptibility profile is known 3
• Typical duration of therapy is 7-10 days 2, 4

Common Pitfalls to Avoid

• Delaying antimicrobial administration beyond one hour 1
• Failing to obtain appropriate cultures before starting antibiotics 3, 4
• Using inadequate dosing strategies that don't account for altered pharmacokinetics in sepsis 2
• Continuing broad-spectrum antibiotics unnecessarily when a pathogen is identified 3
• Relying solely on fluid resuscitation in profound shock 7
• Using low-dose dopamine for renal protection 7