Sepsis in adults

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 19 Aug 2025

Last updated: 26 Mar 2025

Sepsis can progress rapidly to multiorgan failure and shock, and is often fatal. Survival is dependent on a high index of suspicion of sepsis, early recognition, and timely intervention.

Findings are generally nonspecific and secondary to primary infection. They include leukocytosis, tachypnea, tachycardia, and altered mental status.

Patients with evidence of sepsis, including signs of organ dysfunction, require immediate hospital assessment.

Empiric broad-spectrum antibiotic therapy (based on the most probable pathogens and site of infection) should be administered as soon as possible, and preferably within the first hour if the patient is progressing to shock.

Blood cultures, as well as cultures of all potentially infected body fluids, should be obtained as indicated by symptoms and the risk profile of the patient, ideally before the initiation of antimicrobial treatment.

Any source of infection should be controlled as a matter of urgency within 6-12 hours following recognition.

Evidence of shock should be identified and treated with immediate intravenous fluid challenges, if present. Shock that fails to respond to fluid challenges necessitates consideration of vasopressors and/or inotropes and urgent critical care admission.

Definition

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.[1] The definition of sepsis was updated in 2016 following publication of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).[1] This recommended that organ dysfunction should be defined using the Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) criteria or the "quick" (q)SOFA criteria. However, these are late indicators of deterioration and evidence does not support use of these as single screening tools for sepsis.[2][3][4] In practice, it is important to diagnose suspected sepsis at an earlier stage in any patient with presumed infection who is evaluated as being at risk of deterioration based on clinical assessment and/or an early warning score or risk stratification tool.[3][5][6]

The widely-accepted 2016 consensus definitions marked a shift away from the previous systemic inflammatory response syndrome (SIRS) definition and the first 1991 international consensus definition, which described severe sepsis as sepsis associated with organ dysfunction, hypoperfusion, or hypotension; and septic shock as sepsis with hypotension despite adequate fluid replacement.[7]

The 2016 Third International Consensus Group (Sepsis-3) definitions state that the term "severe sepsis" should be made redundant in light of the revisions to the definition of sepsis.[1] Septic shock has also been redefined as a subset of sepsis in which there is co-existence of: persistent hypotension requiring vasopressors to maintain mean arterial pressure ≥65 mmHg; and serum lactate >2 mmol/L (>18 mg/dL).[1]

Septic shock indicates profound circulatory, cellular, and metabolic deterioration, and is associated with a greater risk of mortality than with sepsis alone.[1]

Anamnesis y examen

Principales factores de diagnóstico

tachycardia
tachypnea
high (>101°F [>38°C]) or low (<96.8°F [<36°C]) temperature
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

Todos los datos

Otros factores de diagnóstico

purpura fulminans
jaundice
ileus

Todos los datos

Factores de riesgo

age >65 years
immunocompromised state
indwelling intravenous lines or urinary catheters
recent surgery or other invasive procedures
hemodialysis
diabetes mellitus
intravenous drug use
alcohol use disorder
breached skin integrity
pregnancy
urban residence
lung disease
male sex
non-white ancestry
winter season

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

blood culture
lactate levels
CBC with differential
blood urea nitrogen (BUN) and serum electrolytes
serum creatinine
liver function tests
coagulation studies (INR, activated PTT)
serum glucose
CRP
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

Todos los datos

Pruebas diagnósticas que deben considerarse

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

Todos los datos

Algoritmo de tratamiento

Agudo

presumed or confirmed sepsis

Colaboradores

Consejeros especializados

Andre C. Kalil, MD, MPH, FACP, FIDSA, FCCM

Professor

Department of Internal Medicine

Division of Infectious Diseases

University of Nebraska Medical Center

Omaha

Divulgaciones

ACK declares that he has no competing interests.

Kelly Cawcutt, MD, MS, FACP, FIDSA, FCCM

Associate Professor

Department of Internal Medicine

Division of Pulmonary, Critical Care, Sleep & Allergy

University of Nebraska Medical Center

Omaha

Divulgaciones

KC has received payment for medical writing from IDSA and CloroxPro. KC has received honoraria for creation of educational materials from the Society for Healthcare Epidemiology of America (SHEA) and payment from BD. KC has received honoraria and travel expenses from NAPA. KC has received payment for book proposal review from Elsevier. KC has participated as author, lecturer, and committee member for the Society of Critical Care Medicine (SCCM) course and book, providing content on controversies in sepsis.

Agradecimientos

Professor Andre Kalil and Dr Kelly Cawcutt would like to gratefully acknowledge Dr Ron Daniels, Dr Matt Inada-Kim, Dr Aamir Saifuddin, Dr Tim Nutbeam, Dr Edward Berry, Dr Lewys Richmond, and Dr Paul Kempen, previous contributors to this topic.

Divulgaciones

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, LR, and PK declare that they have no competing interests.

Revisores por pares

Steven M. Opal, MD, FIDSA

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University

Providence

Divulgaciones

SMO declares that he has no competing interests.

Laura Evans, MD, MSc, FCCP, FCCM

Associate Professor

NYU School of Medicine

Medical Director of Critical Care

Bellevue Hospital Center

New York

Divulgaciones

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.Texto completo Resumen

Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.Texto completo Resumen

National Institute for Health and Care Excellence. Suspected sepsis: recognition, diagnosis and early management. March 2024 [internet publication].Texto completo

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Differentials
- Noninfectious causes of systemic inflammatory response syndrome (SIRS)
- Myocardial infarction (MI)
- Pericarditis
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Guidelines
- Suspected sepsis: recognition, diagnosis and early management
- Society of Critical Care Medicine and the Infectious Diseases Society of America guidelines for evaluating new fever in adult patients in the ICU
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Calculators
National Early Warning Score 2 (NEWS2)
Sequential Organ Failure Assessment: SOFA Score
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Videos
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Sepsis in adults

Summary

Definition

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

presumed or confirmed sepsis

Colaboradores

Consejeros especializados

Andre C. Kalil, MD, MPH, FACP, FIDSA, FCCM

Divulgaciones

Kelly Cawcutt, MD, MS, FACP, FIDSA, FCCM

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Steven M. Opal, MD, FIDSA

Divulgaciones

Laura Evans, MD, MSc, FCCP, FCCM

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Differentials

Guidelines

Calculators

Videos

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice