Antimicrobial prescribing: NHS Fife
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
Organ dysfunction can be identified using the quick Sequential Organ Failure Assessment (qSOFA) tool.
qSOFA score: 1 point for each of the following:
- Low blood pressure (systolic BP ≤ 100 mmHg)
- High respiratory rate (RR ≥ 22 breaths / min)
- Altered mentation (GCS ≤ 14)
A qSOFA score of 2 or 3, together with evidence of infection, is sufficient to diagnose sepsis and the patient should be managed as such.
Sepsis Six Screening Tool:
OR
Survival decreases as time to effective antibiotic therapy increases. Aim to carry out the following actions within 60 minutes of recognition of sepsis:
- Administer oxygen, aiming to keep SpO2 > 94%
- Take blood cultures (ideally prior to antibiotics, where this will not delay antibiotic therapy)
- IV antibiotic therapy according to guidance
- IV fluid challenge if hypotensive
- Measure serum lactate and Hb
- Measure urine output and consider catheterisation
Get a senior review and / or think about early referral to critical care, especially if the patient fails to respond to initial measures
Empirical management
If you can identify the affected body system, refer to that section of the guidance.
Meningitis / meningoencephalitis and meningococcal sepsis
Community-Acquired Pneumonia / Respiratory Sepsis
Urinary Sepsis / Pyelonephritis
Sepsis due to Bone and Joint Infection
Sepsis due to Skin and Soft Tissue Infection
Necrotising Fasciitis / Fournier's Gangrene
Review management as clinical situation evolves and investigation results are seen. Otherwise, treat empirically as below:
GENTAMICIN IV (dose as per calculator)
Plus
AMOXICILLIN IV 1g 8 hourly
If true penicillin allergy or if known / suspected MRSA:
VANCOMYCIN IV (dose as per calculator)
Plus
GENTAMICIN IV (dose as per calculator)
Do not continue Gentamicin beyond 3-4 days. If IV antibiotics are still required after this period, stop gentamicin and start Temocillin 2g 8 hourly (discuss patients allergic to penicillin with Microbiology).
Duration of treatment depends on diagnosis. If no source can be located and the patient improves, 5-7 days total antibiotic therapy is appropriate.