Antimicrobial prescribing: NHS Fife
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
Scoring tools like qSOFA are not routinely used in recognition of sepsis. Please refer to the NHS Fife Sepsis eLearning module on Turas for detailed guidance on recognising and managing sepsis.
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
Sepsis is not a diagnosis, it is a clinical description. It is important that antibiotics are chosen to treat the most likely source of infection which is giving rise to the septic picture.
- Medical devices, particularly catheters, are a common source of infection and should be considered the most likely source of sepsis unless there is an obvious alternative source
- Sepsis causes an acidosis and the respiratory rate will be elevated. This can lead to the misdiagnosis of a chest infection. If the CXR is normal then pneumonia is unlikely and an alternative diagnosis should be sought.
- All patients with sepsis need to be reviewed by a senior clinician within 24hr after starting antibiotics to review results, confirm the diagnosis and consider the empirical antibiotic choice.
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 4 days (96 hours). 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.