What is the initial treatment for a patient with sepsis?

From the Guidelines

The initial treatment for a patient with sepsis involves rapid administration of broad-spectrum antibiotics within one hour of recognition, along with aggressive intravenous fluid resuscitation, typically 30 mL/kg of crystalloid fluids within the first three hours, as recommended by the Surviving Sepsis Campaign guidelines 1.

Key Components of Initial Treatment

• Administration of effective IV antimicrobials within the first hour of recognition of septic shock and severe sepsis without septic shock, with the goal of covering all likely pathogens (bacterial, fungal, or viral) 1.
• Initial empiric anti-infective therapy should include one or more drugs that have activity against all likely pathogens and penetrate in adequate concentrations into tissues presumed to be the source of sepsis 1.
• Aggressive intravenous fluid resuscitation with crystalloids as the initial fluid of choice, aiming for at least 30 mL/kg within the first 3 hours, and further fluid administration guided by frequent reassessment of hemodynamic status 1.
• Vasopressors, such as norepinephrine, should be initiated if hypotension persists despite fluid resuscitation, with the goal of maintaining adequate blood pressure and perfusion of vital organs.
• Source control measures, such as draining abscesses or removing infected devices, must be implemented promptly when applicable.
• Continuous monitoring of vital signs, urine output, lactate levels, and organ function is essential to guide ongoing treatment and adjust the therapeutic approach as needed.

Rationale for Recommendations

The recommendations are based on the strongest and most recent evidence from the Surviving Sepsis Campaign guidelines, which emphasize the importance of prompt and effective treatment to reduce morbidity, mortality, and improve quality of life in patients with sepsis. The guidelines provide a framework for the initial management of sepsis, including the administration of broad-spectrum antibiotics, fluid resuscitation, and vasopressor support, as well as the importance of source control and ongoing monitoring. By following these guidelines, healthcare providers can provide evidence-based care that is tailored to the individual needs of each patient with sepsis.

From the Research

Initial Treatment for Sepsis

The initial treatment for a patient with sepsis involves the administration of broad-spectrum antimicrobials within the first hour of diagnosis 2, 3, 4. This is crucial in reducing mortality and improving outcomes.

Key Considerations

• Broad-spectrum antibiotics should be selected based on the likely pathogens involved and the patient's previous risk of multidrug-resistant (MDR) pathogens 2.
• The initial drugs should have activity against typical gram-positive and gram-negative causative micro-organisms, and anaerobic coverage should be provided for intra-abdominal infections or others where anaerobes are significant pathogens 4.
• Empiric antifungal or antiviral therapy may be warranted in certain cases 4.
• The choice of antimicrobial agents should take into account patient factors, common local pathogens, hospital antibiograms and resistance patterns, and the suspected source of infection 4.

Timing of Antibiotic Administration

• Antibiotics should be administered as soon as possible, and within one hour of recognizing severe sepsis and septic shock 3, 4.
• The risk of progression from severe sepsis to septic shock increases 8% for each hour before antibiotics are started 4.
• However, aggressive time-to-antibiotic targets may risk promoting antibiotic overuse and antibiotic-associated harms for patients who are not infected 5.

Reevaluation and De-escalation

• Antimicrobial therapy should be reevaluated daily to optimize efficacy, prevent resistance, avoid toxicity, and minimize costs 3.
• De-escalation of antimicrobial therapy should be considered as soon as possible, and the duration of antibiotic therapy typically should be limited to 7 to 10 days 3, 4.