From the Guidelines
Sepsis treatment requires immediate intervention with broad-spectrum antibiotics and supportive care, prioritizing administration of effective IV antimicrobials within the first hour of recognition and initial fluid resuscitation with at least 30 mL/kg of IV crystalloid fluid within the first 3 hours. The treatment plan should include:
- Starting empiric antibiotics within one hour of recognition, selecting coverage based on suspected source, local resistance patterns, and patient factors, as recommended by the Surviving Sepsis Campaign guidelines 1.
- Administering IV fluids (30ml/kg crystalloid) for hypotension or elevated lactate, with ongoing assessment for fluid responsiveness, as suggested by the guidelines 1.
- For persistent hypotension, initiating vasopressors, typically norepinephrine (starting at 0.05 mcg/kg/min, titrating to maintain MAP ≥65 mmHg), as recommended by the guidelines 1.
- Monitoring vital signs, urine output, lactate clearance, and organ function closely.
- Identifying and controlling the infection source through procedures like abscess drainage or device removal when applicable, as recommended by the guidelines 1.
- Reassessing antibiotic therapy within 48-72 hours to narrow coverage based on culture results, as suggested by the guidelines 1. Some key points to consider:
- The use of broad-spectrum antibiotics and supportive care is crucial in the treatment of sepsis, as it can help prevent progression to septic shock and improve survival, as noted in the guidelines 1.
- The administration of effective IV antimicrobials within the first hour of recognition is a strong recommendation, with moderate quality of evidence, as stated in the guidelines 1.
- The initial fluid resuscitation with at least 30 mL/kg of IV crystalloid fluid within the first 3 hours is a strong recommendation, with low quality of evidence, as suggested by the guidelines 1.
- The use of norepinephrine as the first-choice vasopressor is a strong recommendation, with moderate quality of evidence, as recommended by the guidelines 1.
- The monitoring of vital signs, urine output, lactate clearance, and organ function closely is crucial in the management of sepsis, as it can help identify any potential complications early on, as noted in the guidelines 1.
From the Research
Treatment Plan for Sepsis
The treatment plan for sepsis involves a combination of antimicrobials, fluids, vasoactive agents, and steroids 2. The mainstay of treatment is early recognition of the patient and early start of antimicrobials. Patients with suspected infection and any two of: an altered mental state, more than 22 breaths per minute and systolic blood pressure below 100 mmHg should receive early intervention with broad-spectrum antimicrobials and fluids.
Key Components of Treatment
- Antimicrobials: remain the mainstay of treatment 2
- Fluids: early intervention with fluids is crucial 2, 3
- Vasoactive agents: used to support organ function 2
- Steroids: low dose hydrocortisone replacement and fludrocortisone seem promising for the patient at septic shock 2
- Source control: identification and control of the source of infection is essential 3
Emerging Management Strategies
- Immunomodulation: focuses on modulating the host's immune response to infection 3
- Artificial intelligence: may be used to improve early recognition and treatment of sepsis 3
- Multi-omics approaches: may be used to develop personalized therapy for sepsis 3
- Non-invasive treatment strategies: including non-antimicrobial agents 4
- Invasive approaches: may be necessary in severe cases of sepsis 4
Rules of Anti-Infection Therapy
The 6Rs rule for sepsis and septic shock management includes:
- Right patients: identifying patients at risk of sepsis 5
- Right time: early recognition and treatment of sepsis 5
- Right target: identifying the correct pathogen 5
- Right antibiotics: selecting appropriate antibiotics 5
- Right dose: formulating a scientifically based antibiotic dosage regimen 5
- Right source control: adequate control of infectious foci 5