Clinical Infectious Diseases (CID)IDSA/ACEP/ASM/PIDS/SCCM/SHEA/SHM/SIDP Multisociety Position Paper: Hospital Strategies to Improve Sepsis Outcomes

✅ Guideline Update

Despite years of focus on early sepsis recognition and SEP-1 bundle compliance, sepsis remains a major cause of mortality, disability, and healthcare utilization. This multisociety position paper was developed through a modified Delphi process involving infectious diseases, emergency medicine, critical care, microbiology, pharmacy, hospital medicine, and patient-advocacy experts. Rather than revisiting bedside sepsis management recommendations contained in Surviving Sepsis Campaign guidelines, the document focuses on hospital-level operational strategies intended to improve infection-related aspects of sepsis care. Recommendations span six domains: diagnostic testing, antimicrobial management, surveillance, adjunctive therapy, infrastructure, and infection prevention, with interventions categorized as Tier 1 (high priority), Tier 2 (moderate priority), or emerging approaches requiring further validation.

Clinical Considerations

• Tier 1 recommendations include rapid multiplex nucleic acid testing for positive blood cultures paired with active antimicrobial stewardship support.
• Hospitals should target antibiotic administration within 1 hour of septic shock recognition and monitor order-to-infusion times below 30 minutes when feasible.
• The panel recommends default prolonged-infusion antipseudomonal β-lactams for critically ill patients after an initial loading dose.
• Clinical workflows should prioritize β-lactam administration before vancomycin when both agents are empirically ordered for suspected sepsis.
• Stewardship metrics should track inadequate empiric therapy, unnecessarily broad therapy, antibiotic de-escalation, and timeliness of source control.
• Additional recommendations include EHR-based sepsis surveillance, multidisciplinary sepsis governance, ICU stewardship integration, chlorhexidine bathing, and daily tooth brushing programs to reduce hospital-acquired infections.
• Automated sepsis prediction tools, host-response diagnostics, culture-independent bloodstream diagnostics, respiratory multiplex panels, and procalcitonin-guided therapy were classified as emerging approaches rather than routine recommendations.

Practice Applications

• Review sepsis workflows to identify delays between shock recognition, antibiotic ordering, and infusion initiation.
• Evaluate opportunities to expand antimicrobial stewardship involvement in blood-culture diagnostics, ICU rounds, and antibiotic optimization.
• Monitor both undertreatment and overtreatment metrics to balance rapid therapy with antimicrobial stewardship goals.
• Integrate pharmacy expertise into prolonged-infusion β-lactam protocols, allergy assessment pathways, therapeutic drug monitoring programs, and dosing optimization strategies.
• Consider the recommendations as a hospital quality framework rather than a bedside clinical guideline, recognizing that implementation feasibility will vary across institutions.