Sepsis recognition and escalation from primary care

Also known as Sepsis · Septic shock · Bacterial infection emergency

GP-fellowship guide to sepsis recognition and escalation from primary care: Sepsis-3 definitions and what infection plus organ dysfunction means at the bedside, qSOFA's limits as a screening tool, NEWS2 escalation thresholds, red flags that demand same-hour action, the hour-1 bundle with cultures before antibiotics where possible without delay, balanced crystalloid resuscitation, source-directed antibiotics, ISBAR ambulance handover, and post-sepsis follow-up.

high7 referencesUpdated 21 Aug 20264 min readVerification in progress

Practise this topic

Key points

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection — operationally, infection with a SOFA increase of 2 points or more, which carries roughly 10% in-hospital mortality.^[1]
qSOFA (respiratory rate 22/min or more, altered mentation, systolic BP 100 mmHg or less) flags risk in non-ICU settings but is not a screening rule; NEWS2 scores of 5 or more, or 3 in one parameter, trigger urgent review.^[2]
Antibiotic delay costs lives: in the New York mandated-care cohort, each hour to antibiotics carried OR 1.04 for in-hospital mortality. Give cultures before antibiotics when this causes no delay, and the first dose before ambulance transfer whenever possible.^[3]
Septic shock means vasopressors plus lactate above 2 mmol/L despite fluids — hospital mortality exceeds 40%. SMART sepsis data: 255 patients (31.2%) in the saline group had 30-day in-hospital mortality compared with the balanced crystalloids group.^[1]^[4]

Overview

Sepsis begins as an infection that looks ordinary and turns lethal through the body's own response.^[1] In general practice it hides inside urinary infections, chest infections, cellulitis and belly pain — and its first hour decides much of its outcome. Sepsis-3 defined it precisely: life-threatening organ dysfunction from a dysregulated host response to infection, operationalised as an infection plus a SOFA increase of two points or more, carrying about 10% in-hospital mortality.^[1] Septic shock adds vasopressor dependence and lactate above 2 mmol/L after fluids, with mortality above 40% in the derivation cohorts.^[1]

References7Show

[1]Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903338
[2]Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903335
[3]Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis N Engl J Med, 2017.PMID 28528569
[4]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 Crit Care Med, 2021.PMID 34605781
[5]Rudd KE, Seymour CW, Aluisio AR, et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries JAMA, 2018.PMID 29800114
[6]Brown RM, Wang L, Coston TD, et al. Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical Trial Am J Respir Crit Care Med, 2019.PMID 31454263
[7]Melero-Guijarro L, Sanz-García A, Martín-Rodríguez F, et al. Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study Front Med (Lausanne), 2023.PMID 37144037