Sepsis in adults

Last reviewed: 24 Apr 2022
Last updated: 25 Jan 2022

Summary

Definition

History and exam

Key diagnostic factors

  • risk factors
  • signs associated with specific source of infection
  • high early warning score (e.g., NEWS2 5 or more)
  • tachypnoea (NEWS2)
  • high or low temperature, sometimes with rigors (NEWS2)
  • tachycardia (NEWS2)
  • acutely altered mental status (NEWS2)
  • low oxygen saturation (NEWS2)
  • hypotension (NEWS2)
  • oliguria
  • poor capillary refill, mottling of the skin, or ashen appearance
  • cyanosis
Full details

Other diagnostic factors

  • malaise/lethargy
  • nausea/vomiting/diarrhoea
  • purpura fulminans
  • ileus
  • jaundice
Full details

Risk factors

  • age >65 years
  • immunocompromise
  • indwelling lines or catheters
  • recent surgery or other invasive procedures
  • haemodialysis
  • diabetes mellitus
  • intravenous drug misuse
  • alcohol dependency
  • pregnancy
  • breached skin integrity
  • urban residence
  • lung disease
  • male sex
  • non-white ancestry
  • winter season
Full details

Diagnostic investigations

1st investigations to order

  • blood cultures
  • serum lactate
  • hourly urine output
  • full blood count
  • urea and electrolytes (including creatinine)
  • serum glucose
  • C-reactive protein
  • serum procalcitonin
  • clotting screen
  • liver function tests
  • blood gas
  • ECG
Full details

Investigations to consider

  • urine analysis
  • chest x-ray
  • cultures from multiple sources
  • lumbar puncture
  • computed tomography
  • ultrasound
  • urine antigen testing
  • viral swabs
  • HIV screen
  • echocardiogram
Full details

Treatment algorithm

INITIAL

in hospital: sepsis highly suspected and unknown or unclear source of bacterial infection

in the community: sepsis highly suspected and bacterial infection confirmed or highly suspected

ACUTE

in hospital: sepsis highly suspected and clear source of bacterial infection identified

Contributors

Expert advisers

Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, Dip IMC RCSEd

Emergency Medicine Consultant

Physician Response Unit Consultant

Barts Health NHS Trust

London’s Air Ambulance

Royal London Hospital

London

UK

Disclosures

AA declares that he has no competing interests.

Clovis Rau, MBBS, BSc, FRCEM, DipIMC

Specialty Registrar Emergency Medicine (ST6)

Barnet Hospital

Royal Free NHS Foundation Trust

London

UK

Disclosures

CR declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Ron Daniels MBChB, FRCA

Chief Executive

United Kingdom Sepsis Trust

Chief Executive

Global Sepsis Alliance

Programme Director

Survive Sepsis

Consultant in Critical Care and Anaesthesia

Heart of England NHS Foundation Trust

Birmingham

UK

Matt Inada-Kim MBBS, FRCP

Consultant Acute Physician & Sepsis Lead

Department of Acute Medicine

Royal Hampshire County Hospital

Hampshire Hospitals NHS Foundation Trust

Winchester

UK

Aamir Saifuddin BMBCh, BA, MRCP, AFFMLM

Specialty Registrar in Gastroenterology and General Medicine

Maidstone and Tunbridge Wells NHS Trust

UK

Tim Nutbeam MSc, Dip IMC FRCEM

Consultant in Emergency Medicine

Clinical Academic

University of Plymouth

Lead Doctor

Devon Air Ambulance Trust

Derriford Hospital

Plymouth

UK

Edward Berry MBChB, MCEM

Specialty Registrar in Emergency Medicine

Derriford Hospital

Plymouth

UK

Disclosures

RD has received payment for consultancy on sepsis from Kimal Plc, manufacturers of vascular access devices, from the Northumbria Partnership, a patient safety collaborative, and, where annual leave or other income was compromised in fulfilling his charity duties, from the UK Sepsis Trust. RD has received sponsorship to attend and speak at one meeting from Abbott Diagnostics. He is CEO of the UK Sepsis Trust and Global Sepsis Alliance, and advises HM Government, the World Health Organization, and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis. MIK is a national clinical advisor on sepsis to NHS England and a national clinical advisor on deterioration to NHS Improvement. He was reimbursed for a slide set by Relias Learning. AS is the clinical fellow to the National Medical Director at NHS Improvement. AS has been sponsored on two occasions by Dr Falk Pharma UK to attend specialist gastroenterology conferences abroad; there was no contractual obligation to disseminate product information. TN is a clinical adviser to the UK Sepsis Trust. EB declares that he has no competing interests.

Peer reviewers

Matt Inada-Kim, MBBS, FRCP

Consultant Acute Physician & Sepsis Lead

Department of Acute Medicine

Royal Hampshire County Hospital

Hampshire Hospitals NHS Foundation Trust

Winchester

UK

Disclosures

MIK is a national clinical advisor on sepsis to NHS England and a national clinical advisor on deterioration to NHS Improvement. He was reimbursed for a slide set by Relias Learning.

Editors

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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