Approach to assessing sepsis or septic shock in adults
The Antibiotic Expert Group recommends that all patients with suspected infection are assessed clinically for indications of life-threatening organ dysfunction, including measurement of blood lactate concentration1. If any of the features in Signs of life-threatening organ dysfunction in adults are present in an adult with suspected infection, rapid implementation of sepsis management (including obtaining blood samples for culture and prompt administration of antibiotics) is vital to optimise survival.
- impaired consciousness
- tachypnoea (respiratory rate 22 breaths per minute or more) or hypoxaemia
- hypotension (systolic blood pressure less than 90 mmHg)
- blood lactate concentration more than 2 mmol/L [NB1]
- poor peripheral perfusion or mottled skin
- acute oliguria or elevated serum creatinine (above baseline)
NB1: Blood lactate concentration can be measured with arterial or venous blood gas analysis. Venous blood gas analysis is acceptable for quick lactate assessment.
Recognising a patient with sepsis can be challenging. The signs of sepsis may be subtle, especially in older people. Signs may include hypo- or hyperthermia, tachycardia, reduced urine output or, in older adults, functional decline. Patients may also have symptoms associated with a serious infection (eg headache and neck stiffness may indicate meningitis). Patients with suspected infection but without signs of life-threatening organ dysfunction require close monitoring in case of deterioration.
Patients who are most vulnerable to sepsis includes a list of people who are most vulnerable to sepsis and are at increased risk of poor outcomes. Rapid assessment for signs and symptoms of sepsis and septic shock in these patients is essential because it allows for rapid management if sepsis or septic shock is identified.
In patients with sepsis or suspected sepsis, early consultation with an emergency department physician or other senior medical or nursing staff is crucial to ensure appropriate, timely initiation of antibiotic therapy, source control and fluid therapy.
Australian Commission on Safety and Quality in Health Care (ACSQHC), 2022National Institute for Health and Care Excellence (NICE), 2016
Patients who are most vulnerable to sepsis and are at increased risk of poor outcomes include:
- very young and older people
- Aboriginal and Torres Strait Islander people [NB1]
- people with immune compromise, including those:
- with autoimmune conditions
- with primary immunodeficiency
- taking immunosuppressant drugs such as disease-modifying antirheumatic drugs (DMARDs) or high-dose corticosteroids
- with cancer or taking cancer therapy
- who have received a solid organ or haematopoietic stem cell transplant
- with HIV infection
- on long-term haemodialysis or peritoneal dialysis
- with functional or anatomical asplenia
- people who have recently (eg in the past 6 weeks) had an invasive procedure or surgery
- people with any break of skin integrity (eg burns, skin infections)
- people who inject drugs
- people with indwelling lines or catheters
- people who are pregnant, have given birth or had a termination of pregnancy or miscarriage in the past 6 weeks.
Rapid assessment for signs and symptoms of sepsis and septic shock in these patients is essential because it allows for rapid management if sepsis or septic shock is identified.
NB1: Health outcomes are significantly impacted by geographical, historical, socioeconomic, spiritual, emotional and cultural determinants. In Aboriginal and Torres Strait Islander peoples, the incidence of infection and increased risk of poor health outcomes can be linked to complex socioeconomic factors, including poverty, reduced access to health services, incarceration, discrimination and intergenerational trauma. A shared strengths–based approach to healthcare that recognises each patient's unique cultural determinants and circumstances is essential