Fever, sepsis and septic shock
Sepsis-3 and SOFA-2, why qSOFA is no longer a screening tool, the tiered antibiotic timing of Surviving Sepsis 2026 and Therapeutic Guidelines 2025, empirical regimens by source, and the adjuncts that do and don't work.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (Sepsis-3). Septic shock is sepsis needing vasopressors for a MAP of 65 mmHg or more with lactate over 2 mmol/L despite adequate fluid.
- Screen with NEWS2, MEWS or SIRS. Surviving Sepsis 2026 recommends against qSOFA as a single screening tool.
- Antibiotic timing is tiered: within 1 hour for shock or probable sepsis; a time-limited work-up and antibiotics within 3 hours for possible sepsis without shock.
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Sources
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026Society of Critical Care Medicine and European Society of Intensive Care Medicine, 2026
- Therapeutic Guidelines: Antibiotic. Sepsis and septic shockAU/NZTherapeutic Guidelines Limited (eTG complete), Revised March 2025 (tiered antimicrobial timing); febrile neutropenia revised April 2026
- Sepsis Clinical Care StandardAU/NZAustralian Commission on Safety and Quality in Health Care, 2022
- Singer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10JAMA, 2016
- Ranzani OT et al. Development and validation of the Sequential Organ Failure Assessment (SOFA)-2 score. JAMA 2025;334(23):2090-2103JAMA, 2025
- Dulhunty JM et al. Continuous vs intermittent beta-lactam antibiotic infusions in critically ill patients with sepsis (BLING III). JAMA 2024JAMA, 2024
- Lamontagne F et al. Intravenous vitamin C in adults with sepsis in the intensive care unit (LOVIT). N Engl J Med 2022;386:2387-98New England Journal of Medicine, 2022
- Leone M et al. Clinical criteria for the definition of refractory septic shock: a joint Delphi consensus from SCCM and ESICM. Intensive Care Med 2026;52(5):984-1000Intensive Care Medicine, 2026
- Last updated
- 14 November 2026
What changed
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