Systemic sepsis of UNKNOWN source
Sepsis = life-threatening organ dysfunction due to a dysregulated response to infection
Septic shock = sepsis with hypotension not corrected by fluid resuscitation
Severe sepsis or septic shock is a medical emergency requiring immediate treatment:
- Deliver Sepsis Six resuscitation bundle within 1 hour
- Discuss with ICU (intensive care unit) and Micro/ID if there are concerns or deterioration
- If known/suspected immunosuppression consult Micro/ID for advice
- Review antibiotics daily and consider early oral switch. Treat according to microbiology results.
- Review empirical treatment within 48-72 hours
- See also Sepsis Identification and Management
- Consider Delabelling of spurious penicillin allergy in patients who are low risk and are clinically stable.
For patients with high frailty scores see Frailty Functional Decline - Unclear Focus guideline
First 72 hours
gentamicin 5mg/kg iv (Gentamicin is for a maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
AND EITHER
amoxicillin 1g iv tds – review IV daily and consider early oral switch
OR
If penicillin allergy (non-severe or severe) or MRSA positive/suspected: teicoplanin iv 12mg/kg - See teicoplanin monograph for dose banding, dose frequency and monitoring.
If community-acquired pneumonia (CAP) with sepsis: ADD clarithromycin 500mg po bd (iv if NBM)
If intra-abdominal infection suspected: ADD metronidazole 400mg po tds (500mg iv tds if NBM)
If source of infection is suspected or identified, refer to organ specific sepsis guidelines:
After 72 Hours
Review according to culture results and sensitivities and treat accordingly
If source still unknown, and not improving: Consult Micro/ID for advice