Sepsis with no clear source

In sepsis, timing of antibiotics is crucial.
Every hour in delay of antibiotics increases the patient risk of mortality ~10%.
The first dose of antibiotics should be administered within 1 hour from the time of presentation.

UCLA Sepsis Bundle

For proper bundle compliance, use the physician Sepsis Order set in CareConnect

The following are required:

Blood cultures x 2 sets PRIOR to antibiotics
Lactate
Broad spectrum antibiotics
IV Fluids of 30 ml/kg bolus, unless direct contraindication.

Medicare core measures also requires the following within 6 hours of time of presentation as part of the sepsis bundle:

Repeat lactate level if the initial lactate level is elevated
If hypotension persists after IVF administration:
Vasopressors
Repeat volume status and tissue perfusion assessment consisting of either a focused physical exam or 2 of the following: CVP measurement, central venous oxygen measurement, bedside ultrasound, fluid challenge or passive leg raise.

Empiric therapy should be broad-spectrum and should be guided by patient’s allergies, recent antibiotic exposure (if applicable), risk factors for multidrug resistant pathogens, local susceptibility patterns (see individual antimicrobial or pathogen info pages), suspected source of infection, etc.