Obtain blood cultures for microbiological testing for patients with suspected sepsis before administering antimicrobials, where this does not delay urgent treatment. For adults, this includes two sets of blood cultures, and for children one set of blood cultures. Other relevant microbiological cultures should also be collected, ideally before administering antimicrobials. In the community setting, if this is outside the scope of clinical practice, refer the patient to hospital immediately.
Do not wait for blood test results if someone is clearly unwell. Urgent antimicrobial therapy should start as soon as possible. Do not withhold antimicrobials while awaiting the results of microbiological (for example, blood, urine, pus, sputum microscopy or culture) or other tests.
Start antimicrobials within 60 minutes of recognising infection-related organ dysfunction, and as soon as possible if shock is present. In an adult patient without shock, where there is uncertainty about the likelihood of an infectious cause, rapidly investigate alternative diagnoses. Escalate care to a clinician with experience in recognising and managing sepsis, if required. If concern for infection persists after appropriate evaluation, start antimicrobial therapy as soon as possible, no later than three hours from initial clinical review (Figure 1). Closely monitor all patients who may have sepsis and ensure their care is escalated in the event of deterioration, such as evolving or worsening signs of organ dysfunction (refer to Quality statement 2 – Time-critical management).
Arrange consultation with an infectious diseases physician or clinical microbiologist if there is uncertainty about the appropriate antimicrobial therapy or local sepsis guidelines, ideally when initiating therapy, or else on review. As patients with sepsis often require higher doses of antimicrobials, the patient’s other medicines should be reviewed by an experienced clinician, preferably a pharmacist, to avoid interactions and enable the safe and appropriate administration of antimicrobial therapy.
When prescribing antimicrobials for Aboriginal or Torres Strait Islander peoples, consider the higher prevalence of multidrug-resistant organisms. Refer to the Central Australian Rural Practitioners Association guidelines, or other guidelines based on local resistance data, where appropriate.
If the patient with sepsis is being transferred to another healthcare service or unit, take blood cultures and start the first dose of antimicrobials before transfer.
Prompt communication of critical test results is essential to inform timely antimicrobial treatment decisions. If microbiological tests are ordered, review the results as soon as available and at least daily while concerns about sepsis persist. Use this information to consider whether review, adjustment or cessation of antimicrobials and other therapy is needed. Investigate and manage the source of infection, which may require surgery. Multidisciplinary input may be needed to choose appropriate investigations for the suspected infection.
Laboratories or microbiologists should call positive blood culture results through to the doctor caring for the patient as soon as these results are available, and document the discussion.
