Approach to managing sepsis and septic shock from a biliary or gastrointestinal tract source

For patients with sepsis or septic shock from a biliary or gastrointestinal tract source, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock. For additional assessment considerations, see Assessment of intra-abdominal infections.

For patients with sepsis or septic shock associated with acute infected pancreatitis, see Acute infected pancreatitis.

Empirical regimens for sepsis and septic shock from a biliary or gastrointestinal tract source are included in this topic; see:

The empirical regimens in this topic may not be appropriate for the following patients:

For neonates, treatment is complex and should be based on local protocols, or clinical microbiology or infectious diseases advice. Prompt antibiotic initiation in sepsis and septic shock improves outcomes; if local protocols or expert advice are not immediately available, follow the regimens for sepsis or septic shock of unknown source.
For patients with risk factors for infection with a multidrug-resistant gram-negative bacterium, the empirical regimen may need to be modified – seek clinical microbiology or infectious diseases advice.
For patients with hospital-acquired infection, follow local protocols if available.

The empirical regimens in this topic may require adjustment in the following circumstances:

Patients with sepsis or septic shock from a biliary or gastrointestinal tract source may be at increased risk of invasive candidiasis – see Empirical treatment for invasive Candida infection to assess whether empirical antifungal therapy is required.
Patients who will undergo surgery may require adjustments to empirical therapy.

The rationale for antibiotic choice for intra-abdominal infections, including sepsis or septic shock from a biliary or gastrointestinal tract source, is described here.