Suspected sepsis: recognition, diagnosis and early management

Think 'could this be sepsis?' if a person presents with symptoms or signs that indicate possible infection. [2016]

Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature. [2016]

Pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour. [2016]

Assess people who might have sepsis with extra care if there is difficulty in taking their history, for example people with English as a second language or people with communication difficulties (such as learning disabilities or autism). [2016, amended 2024]

Assess people with any suspected infection to identify:

• possible source of infection (see the recommendations on finding and controlling the source of infection)

• factors that increase risk of sepsis (see people who are most vulnerable to sepsis)

• any indications of clinical concern, such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

During a remote assessment, when deciding whether to offer a face-to-face-assessment and, if so, on the urgency of it, identify:

• factors that increase risk of sepsis (see people who are most vulnerable to sepsis) and

• indications of clinical concern such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

Use a structured set of observations to assess people in a face-to-face setting to stratify risk if sepsis is suspected. (See the recommendations on face-to-face assessment and the recommendations on evaluating risk in people with suspected sepsis for the relevant population group). [2016]

Use the national early warning score (NEWS2) to assess people with suspected sepsis who are aged 16 or over, are not and have not recently been pregnant, and are in an acute hospital setting, acute mental health setting or ambulance. [2024]

Consider using an early warning score to assess people with suspected sepsis who are:

• under 16, in any setting

• pregnant or have recently been pregnant, in any setting

• 16 or over, in a community or custodial setting. [2016, amended 2024]

Suspect neutropenic sepsis in people who become unwell and:

• Are having or have had systemic anticancer treatment within the last 30 days

• Are receiving or have received immunosuppressant treatment for reasons unrelated to cancer. Use clinical judgement (based on the person's specific condition, medical history, or both, and on the treatment they received) to determine whether any past treatment may still be likely to cause neutropenia. [2016, amended 2024]

Refer patients with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care. [This recommendation is from NICE's guideline on neutropenic sepsis in people with cancer.] [2012]

Treat people with neutropenic sepsis, regardless of cause, in line with NICE's guideline on neutropenic sepsis in people with cancer. [2016, amended 2024]

Take into account that people in the following groups are at higher risk of developing sepsis:

• the very young (under 1 year) and older people (over 75 years), or people who are very frail

• people who have impaired immune systems because of illness or drugs, including:

  • people having treatment for cancer with chemotherapy

  • people who have impaired immune function (for example, people with diabetes, people who have had a splenectomy, or people with sickle cell disease)

  • people taking long-term steroids

  • people taking immunosuppressant drugs to treat non-malignant disorders such as rheumatoid arthritis

• people who have had surgery, or other invasive procedures, in the past 6 weeks

• people with any breach of skin integrity (for example, cuts, burns, blisters or skin infections)

• people who misuse drugs intravenously

• people with indwelling lines or catheters.
  
  See also recommendation 1.1.10 on when to suspect neutropenic sepsis. [2016]

Take into account that people who are pregnant, have given birth or had a termination of pregnancy or miscarriage in the past 6 weeks are in a high risk group for sepsis. In particular, people who:

• have impaired immune systems because of illness or drugs (see recommendation 1.2.1)

• have diabetes, gestational diabetes or other comorbidities

• needed invasive procedures (for example, caesarean section, forceps delivery, removal of retained products of conception)

• had prolonged rupture of membranes

• have or have been in close contact with people with group A streptococcal infection, for example, scarlet fever

• have continued vaginal bleeding or an offensive vaginal discharge. [2016]

Take into account the following risk factors for early-onset neonatal infection:

• Red flag risk factor:

  • Suspected or confirmed infection in another baby in the case of a multiple pregnancy.

• Other risk factors:

  • Invasive group B streptococcal infection in a previous baby or maternal group B streptococcal colonisation, bacteriuria or infection in the current pregnancy.

  • Pre-term birth following spontaneous labour before 37 weeks' gestation.

  • Confirmed rupture of membranes for more than 18 hours before a pre-term birth.

  • Confirmed prelabour rupture of membranes at term for more than 24 hours before the onset of labour.

  • Intrapartum fever higher than 38°C if there is suspected or confirmed bacterial infection.

  • Clinical diagnosis of chorioamnionitis.
    
    [This recommendation is from NICE's guideline on neonatal infection.] [2021]