Hospital-based systems-level sepsis interventions in diagnostic testing, antimicrobial stewardship, and program infrastructure can improve outcomes across the continuum of care, according to a new position paper from the Infectious Diseases Society of America (IDSA) and other medical organizations.

“Sepsis remains a leading cause of morbidity and mortality despite substantial efforts over the past decade to improve early recognition and treatment in hospitals,” said corresponding author Chanu Rhee, MD, MPH, FCCM, FIDSA, FSHEA, associate professor of population medicine and medicine at Harvard Medical School, Boston.

“While early sepsis care remains critically important, we felt there was an opportunity to broaden the focus beyond the first few hours of care to a wider range of hospital-level strategies that can improve the diagnosis, treatment, and prevention of infections throughout the patient’s course,” said Rhee, who also serves as medical director of Infection Control at Brigham and Women’s Hospital, and director of the Center for Sepsis Epidemiology and Prevention Studies (SEPSIS) at the Harvard Pilgrim Health Care Institute, both in Boston.

Hospital systems can support timely treatment when needed concurrently with ongoing diagnostic reassessment and antimicrobial stewardship. The paper calls for the use of multiplex nucleic acid amplification tests for positive blood cultures, in combination with active antimicrobial stewardship, and the optimization of blood culture ordering practices.

Goals of Sepsis Treatment

Top priorities for antibiotics include optimizing time from recognition of septic shock to the first administration of antibiotics to less than 1 hour; another goal is to keep the time from antibiotic order to the start of infusion to less than 30 minutes in patients with septic shock. In addition, the paper advises monitoring inadequate and unnecessary use of broad, empiric antibiotics in patients with suspected sepsis, and monitoring de-escalation of antipseudomonal therapy and anti-methicillin-resistant Staphylococcus aureus therapy in those with suspected sepsis.

Recommendations for adjunctive care include the use of corticosteroids for appropriate patients with severe community-acquired pneumonia and those with refractory septic shock.

Contributors to the statement came from the American College of Emergency Physicians, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America (SHEA), Society of Hospital Medicine, Society of Infectious Diseases Pharmacists, Society of Critical Care Medicine, American Thoracic Society, and the American Society for Microbiology, as well as the Sepsis Alliance, a patient advocacy organization.

The paper, published in Clinical Infectious Diseases, outlines strategies for improvement in six key areas, geared toward hospitals in the US: diagnostic testing and pathogen detection, antimicrobial management and delivery, surveillance and performance metrics, adjunctive therapy, program infrastructure and organizational support, and infection prevention.

Key recommendations for infrastructure include the establishment of a multidisciplinary sepsis management structure and the integration of antimicrobial stewardship into routine ICU rounds. Finally, with regard to infection prevention, adherence to the SHEA/IDSA Compendium for healthcare-associated infections remains the primary recommendation for hospitals.

The paper represents a new framework, rather than an update to previous recommendations, and is intended to complement the existing Surviving Sepsis Campaign guidelines, which primarily focus on the clinical management of individual patients with sepsis, Rhee noted.

“Another important theme is balancing urgency with precision,” she said. “Timely antibiotics are critical for patients with sepsis, particularly those with septic shock; however, sepsis is a heterogeneous syndrome, and many patients initially suspected of having sepsis ultimately have nonbacterial infections or noninfectious conditions,” she said.

“Creating shared workflows, responsibilities, and priorities across these groups takes sustained institutional commitment,” said Rhee. The authors recognize that hospital resources vary, and the paper is a guide, not a checklist, intended to help hospitals assess their current programs to identify the greatest opportunities for improvement, and prioritize strategies that are feasible and relevant to their local needs, she said.

Evolving Strategies and Next Steps

“Although many of the interventions we recommend have a strong evidence base, there is still much to learn about how best to implement and optimize them across different hospital settings, including which approaches are most effective, scalable, and cost-effective,” Rhee emphasized.

In addition, emerging strategies that could substantially change practice but require more evidence include host-response and immune diagnostics, AI-based approaches to diagnosis and clinical decision support, and broader molecular methods for identifying pathogens directly from clinical specimens, Rhee added.

Looking ahead, the paper encourages hospitals to adopt expanded sepsis performance measures to assess quality and appropriateness of care, said Rhee. “For example, whether initial antibiotics adequately cover the causative pathogen, whether unnecessarily broad antibiotics are avoided or de-escalated, and whether source control is performed promptly when needed,” she said. “We hope to see hospitals adopt and test these types of measures and generate evidence about whether using them to guide quality improvement leads to better care and outcomes. Ultimately, the goal is not just faster sepsis care but more effective, precise, and patient-centered sepsis care,” she said.

Narrowing the Gap

The new paper attempts to fill the gaps in the sepsis care story by addressing systems-level recommendations.

“Some systems level challenges in sepsis management include early recognition, timely initiation of appropriate treatment, and effective communication across different care teams,” said Shirin Mazumder, MD, an infectious diseases specialist and an associate professor at the University of Tennessee Health Science Center, Memphis, Tennessee, who was not involved in the paper.

“The variability in protocols across systems can cause delays in the escalation of care, and gaps in transitions between different care teams such as the emergency department, inpatient teams, and critical care can also affect patient outcomes,” Mazumder said.

The absence of a multidisciplinary sepsis committee and other resource limitations at some hospitals present challenges to implementing the recommended strategies, said Mazumder. “A potential solution includes using a tiered approach, starting with the most important recommendations and seeking additional support including partnerships or telemedicine,” she said.

“Additional research is needed regarding assessing the real-world impact and cost effectiveness of newer strategies, such as rapid diagnostics and advanced surveillance methods,” Mazumder said. Evaluation of how the strategies can be implemented in diverse hospital settings, especially smaller or resource-limited hospitals, is necessary as well, she added.

Disclosure information for the authors is available in the original study publication. Mazumder had no financial conflicts to disclose.