Sepsis and Septic Shock

Definitions / Clinical Criteria

Sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection

Septic Shock

Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality.

Patients with septic shock present with:

Vasopressor requirements to maintain a mean arterial pressure (MAP) of at least 65mmHg
Serum lactate level over 2mmol/L
Absence of hypovolemia

Time of Presentation / Time Zero

Time of triage in the emergency department or, if referred from another care location, from the earliest chart annotation consistent with all elements of sepsis or septic shock ascertained through chart review.

Hour-1 Bundle of Care

Sepsis and septic shock are medical emergencies. Resuscitation and administration of IV antimicrobials must be initiated as soon as possible after recognition and within 1 hour for both sepsis and septic shock. Each hour delay in administration of appropriate antimicrobials is associated with an increase in mortality.

Empiric Antimicrobial Therapy

Treatment Notes

Choice of empiric broad-spectrum antimicrobials is based on the most likely source of infection.
Empiric therapy should be narrowed once culture results are available.
If no infection is proven to be present, antimicrobials should be discontinued.

More Information

References

Surviving Sepsis Campaign 2016
Surviving Sepsis Update 2018
UHN ASP Sepsis Algorithm Document (2014)
IDSA guide – meningitis
Johns Hopkins Guide to Antimicrobial Therapy