Last reviewed: April 2019
Last updated: October  2018

Summary

Definition

History and exam

Key diagnostic factors

  • high (>101°F [>38°C]) or low (<96.8°F [<36°C]) temperature
  • tachycardia
  • tachypnea
  • acutely altered mental status
  • poor capillary refill, mottling of the skin, or ashen appearance
  • signs associated with specific source of infection
  • low oxygen saturation
  • arterial hypotension
  • decreased urine output
  • cyanosis

Other diagnostic factors

  • purpura fulminans
  • jaundice
  • ileus

Risk factors

  • underlying malignancy
  • age >65 years
  • immunocompromise
  • hemodialysis
  • alcoholism
  • diabetes mellitus
  • recent surgery or other invasive procedures
  • breached skin integrity
  • indwelling lines or catheters
  • intravenous drug misuse
  • pregnancy
  • urban residence
  • lung disease
  • male gender
  • non-white ancestry
  • winter season

Diagnostic investigations

1st investigations to order

  • CBC with differential
  • BUN and serum electrolytes
  • serum creatinine
  • LFT
  • coagulation studies (INR, aPTT)
  • serum glucose
  • lactate levels
  • CRP
  • blood culture
  • other cultures (e.g., of sputum, stool, urine, wounds, catheters, prosthetic implants, epidural sites, pleural or peritoneal fluid)
  • arterial blood gas (ABG) or venous blood gas (VBG)
  • chest x-ray
  • ECG
Full details

Investigations to consider

  • lumbar puncture
  • echocardiogram (transthoracic or transesophageal)
  • ultrasound scan
  • CT chest or abdomen
  • serum procalcitonin
Full details

Emerging tests

  • PhenoTest™ BC Kit
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

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

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 Organisation and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis.

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.

Specialty Registrar in Gastroenterology and General Medicine

Maidstone and Tunbridge Wells NHS Trust

UK

Disclosures

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.

Consultant in Emergency Medicine

Clinical Academic

University of Plymouth

Lead Doctor

Devon Air Ambulance Trust

Derriford Hospital

Plymouth

UK

Disclosures

TN is a clinical advisor to the UK Sepsis Trust.

Specialty Registrar in Emergency Medicine

Derriford Hospital

Plymouth

UK

Disclosures

EC declares that he has no competing interests.

Dr Ron Daniels, Dr Matt Inada-Kimand, Dr Aamir Saifuddin, Dr Tim Nutbeam, and Dr Edward Berry would like to gratefully acknowledge Dr Lewys Richmond and Dr Paul Kempen, previous contributors to this topic. LR and PK declare that they have no competing interests.

Peer reviewers VIEW ALL

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University

Providence

RI

Disclosures

SMO declares that he has no competing interests.

Associate Professor

NYU School of Medicine

Medical Director of Critical Care

Bellevue Hospital Center

New York

NY

Disclosures

LE serves as the guidelines co-chair and on the steering committee of the Surviving Sepsis Campaign.

Use of this content is subject to our disclaimer