Sepsis - Source Unknown

Micro-organism

Wide range of possible pathogens

Duration

Depends on source and patient response.

Notes

If NEWS ≥ 5 or clinical concern of systemic infection or neutropenia suspected refer to ED Sepsis Screening tool [intranet only].

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

For clinical use and measurement, organ dysfunction can be represented by an increase in the SOFA score of 2 points or more. These patients have SEPSIS and an in-hospital mortality >10%.

  • Take blood (2 sets - 20mL per set) and urine cultures before starting treatment, plus swabs from any other focus of infection, e.g. sputum, wound etc
  • Give antibiotics as soon as possible, within 1 hour of diagnosis of sepsis
  • Prompt diagnosis is vital to allow early rationalisation of treatment.
  • The most common causes of sepsis are urinary or respiratory sources which should be treated according to the relevant sections in this guideline (oral co-trimoxazole will cover both in cases where no IV is required).
  • Seek advice from Medical Microbiology or Infection Unit.
  • Sepsis may be masked in immunosuppression, the elderly and in the presence of anti-inflammatory drugs and beta-blockers.
  • Consider immune deficiency and testing for HIV.
Sepsis - Source Unknown

Amoxicillin 1g IV 8 hourly

plus

Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

+/-

Metronidazole 500mg IV 8 hourly (add if anaerobic cover required)

 

Note:

# Consider aztreonam IV as an alternative to gentamicin if eGFR<30mL/min (CKD>4) or known/ suspected AKI.   

 

Refer to Guidance on the use of aztreonam [intranet only] for more information

Sepsis - Source Unknown - if penicillin allergy or known MRSA

Gentamicin#  IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app.

plus

Vancomycin IV as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing.

+/-

Metronidazole 500mg IV 8 hourly (add if anaerobic cover required)

# Consider aztreonam IV as an alternative to gentamicin if eGFR<30mL/min (CKD>4) or known/ suspected AKI. 

Refer to Guidance on the use of aztreonam [intranet only] for more information