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Septicaemia - Draft

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Overview

Septicaemia (Sepsis) is a life threatening condition (1).

If suspected in the community then 999 should be called to arrrange immediate transfer to hospital (although this may not always be appropriate in patients approaching end of life where a ReSPECT plan is in place).

Sepsis can be difficult to spot but should be considered in all patients with symptoms or signs of an infection.

Risk factors for sepsis include extremes of age; people who are frail, immunocompromised or immunosuppressed; people who have had recent trauma or surgery; people with a breach in skin integrity; and women who are pregnant, are post-partum, or have had a recent termination of pregnancy or miscarriage.

Sepsis in Adults

Assessment

Symptoms or signs may be non-specific and non-localized, such as general malaise, agitation, or behavioural change. The following mnemonic may be a helpful screen in adults (2):

Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in a day)
Severe breathlessness
It feels like you’re going to die
Skin mottled or discoloured

About Sepsis | Sepsis Symptoms | The UK Sepsis Trust

In addition the following quick links to guides are also available:

National Early Warning Score (NEWS) 2 (mdcalc.com) - for use only in adults (aged 16 years and over).
Sepsis Screening Tool General Practice - age 16+.pdf (3)

Pre-hospital antibiotics for sepsis in adults (aged 16 and over)

Full guidance document is available in the BNSSG formulary - Infection Guidelines page or can be accessed directly: community-administration-of-ceftriaxone-for-sepsis-guideline-10.pdf

Key points:

Antibiotic therapy should not delay transfer to hospital, and should only be given if patient is at high risk of sepsis or sepsis is the most likely diagnosis.
Call 999 (Patient with high-risk sepsis will be triaged to category 2 response. If meningococcal sepsis suspected, please communicate this to team as they can prioritise this within the category 2 calls)
Give IM Ceftriazone 2g IM (split across 2 different sites). It is recommended to reconstitute with lidocaine to reduce pain of injection although can also be reconstituted with water. Further advice on administration is given within the guideline document above.
Allergy – avoid cephalosporins in patients with anaphylaxis to either penicillin or cephalosporins. If rash to penicillin then consider giving. Cephalosporins cross reactivity is extremely unlikely.

Sepsis in Children

Assessment

A child may have sepsis if they (2):

Are breathing very fast
Have a ‘fit’ or convulsion
Look mottled, bluish, or pale – on darker pigmented skin, colour changes may show on the inside of the forearms or palms
Have a rash that does not fade when you press it
Are very lethargic or difficult to wake
Feel abnormally cold to touch

A child under 5 may have sepsis if they (2):

Are not feeding
Are vomiting repeatedly
Have not passed urine for 12 hours

The UK Sepsis Trust has tools for use in children (3):

See also the Remedy page below for advice on assessment in primary care:

Assessment of acutely unwell children

Management of Suspected Meningitis or Meningococcal disease:

Do not delay transfer to hospital to give antibiotics to people with suspected or strongly suspected bacterial meningitis or meningococcal disease.
Give intravenous or intramuscular ceftriaxone or benzylpenicillin to people with strongly suspected:
- Bacterial meningitis if there is likely to be a clinically significant delay in transfer to hospital.
- Meningococcal disease as soon as possible, unless this will delay transfer to hospital.

Meningitis or meningococcal disease | Management | Meningitis - bacterial meningitis and meningococcal disease | CKS | NICE (includes advice on doses of antibiotics for children and adults)

Resources

(1) Symptoms of sepsis - NHS (www.nhs.uk)

(2) About Sepsis | Sepsis Symptoms | The UK Sepsis Trust

(3) Clinical tools - The UK Sepsis Trust

(4) Sepsis | Health topics A to Z | CKS | NICE

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.