Sepsis Management Guidelines

Initial Assessment and Antimicrobial Therapy

The American College of Critical Care Medicine recommends administering IV antimicrobials as soon as possible and within one hour of recognition of sepsis or septic shock in patients with suspected infection, with a strength of evidence of high 1, 4
The Society of Critical Care Medicine suggests obtaining appropriate cultures before starting antimicrobial therapy if this does not significantly delay administration (>45 minutes) in patients with sepsis, with a strength of evidence of moderate 5
The Intensive Care Medicine journal recommends using empiric broad-spectrum therapy with one or more antimicrobials to cover all likely pathogens (including bacterial and potentially fungal or viral coverage) in patients with sepsis or septic shock, with a strength of evidence of high 1, 4
For patients with septic shock, the Critical Care Medicine journal recommends using empiric combination therapy (using at least two antibiotics of different antimicrobial classes) aimed at the most likely bacterial pathogens, with a strength of evidence of high 1, 6
The Intensive Care Medicine journal recommends optimizing antimicrobial dosing based on pharmacokinetic/pharmacodynamic principles and specific drug properties in patients with sepsis or septic shock, with a strength of evidence of high 1, 2

The Intensive Care Medicine journal recommends identifying a specific anatomic diagnosis of infection requiring source control as rapidly as possible in patients with sepsis or septic shock, with a strength of evidence of high 3, 7
The Critical Care Medicine journal suggests implementing source control intervention as soon as medically and logistically practical, within the first 12 hours after diagnosis in patients with sepsis or septic shock, with a strength of evidence of high 3, 7
The Intensive Care Medicine journal recommends promptly removing intravascular access devices that are a possible source of sepsis or septic shock after other vascular access has been established in patients with sepsis or septic shock, with a strength of evidence of high 3, 6

The Intensive Care Medicine journal recommends narrowing antimicrobial therapy once pathogen identification and sensitivities are established and/or adequate clinical improvement is noted in patients with sepsis or septic shock, with a strength of evidence of high 1, 4
The Intensive Care Medicine journal suggests performing daily assessment for de-escalation of antimicrobial therapy in patients with sepsis or septic shock, with a strength of evidence of high 1, 3
The Critical Care Medicine journal recommends considering using procalcitonin levels to support shortening the duration of antimicrobial therapy or discontinuing empiric antibiotics in patients with limited clinical evidence of infection, with a strength of evidence of moderate 3, 6

The Intensive Care Medicine journal recommends an antimicrobial treatment duration of 7 to 10 days for most serious infections associated with sepsis and septic shock, with a strength of evidence of high 1, 3
The Critical Care Medicine journal suggests considering longer courses for patients with slow clinical response, undrainable foci of infection, bacteremia with Staphylococcus aureus, some fungal and viral infections, or immunologic deficiencies including neutropenia, with a strength of evidence of moderate 3, 7

The Intensive Care Medicine journal recommends against using antimicrobial agents in patients with severe inflammatory states determined to be of noninfectious cause, with a strength of evidence of high 1