General approach to managing hospital-acquired sepsis or septic shock of unknown source in adults

The choice of antibiotics for hospital-acquired sepsis or septic shock in adults is complex. A regimen based on local protocols, or advice from a clinical microbiologist or infectious diseases physician improves outcomes. This is particularly important for patients in the intensive care unit. Mortality is decreased when appropriate antibiotics are given early.

Note: Empirical antibiotic choice for hospital-acquired sepsis or septic shock is complex – choice should be based on local protocols, or clinical microbiology or infectious diseases advice.

For advice on recognising sepsis and septic shock, see Identifying sepsis or septic shock, and for advice on early management, see Resuscitation of patients with sepsis and septic shock.

To find the right empirical antibiotic regimen for adults with hospital-acquired sepsis or septic shock of unknown source, use Finding the right empirical antibiotic regimen for adults with hospital-acquired sepsis or septic shock of unknown source.

The empirical antibiotic regimens in these guidelines can be used initially if local protocols are not available, or if clinical microbiology or infectious diseases advice is not immediately available. The empirical regimens may need to be modified according to local epidemiology, if known. Consideration should also be given to the patient’s recent culture and susceptibility test results, whether the patient has neutropenia or immune compromise, and whether toxic shock syndrome is suspected. Also consider the addition of an antifungal for patients at risk of invasive Candida infection.

Note: Empirical regimens are intended for initial therapy (up to 48 hours) when local protocols, or clinical microbiology or infectious diseases advice is not available.

Modify therapy as soon as additional information is available (eg source of infection, results of Gram stain, culture and susceptibility testing). Evaluate the appropriateness of antimicrobial therapy daily, with consideration given to the patient’s clinical status and the principles of antimicrobial stewardshipBurston, 2017.

Figure 1. Finding the right empirical antibiotic regimen for adults with hospital-acquired sepsis or septic shock of unknown source
Overview of multidrug-resistant gram-negative bacteria / Figure: Risk factors for infection with a multidrug-resistant gram-negative bacteriumHospital-acquired sepsis or septic shock in adults at risk of infection with multidrug-resistant gram-negative bacteriaDefinition of commonly used antimicrobial hypersensitivity termsDefinition of commonly used antimicrobial hypersensitivity termsPenicillin hypersensitivity regimens for hospital-acquired septic shock in adultsStandard regimen for hospital-acquired septic shockPenicillin hypersensitivity regimens for hospital-acquired sepsis without septic shock in adultsStandard regimen for hospital-acquired sepsis without septic shock in adults