- The Infectious Diseases Society of America (IDSA) has recommended a key revision to the severe sepsis and septic shock early management bundle (SEP-1).
- The recommendations leave hemodynamic aspects to other societies.
Why this matters
- The SEP-1 bundle was implemented in the United States in 2015 and changed in later years to make it simpler and more clinically useful.
- These authors say that the aim of these recommendations is to achieve a balance between immediate and aggressive treatment in patients stratified by potential to benefit from antibiotics.
- IDSA says that it and 5 other societies have concerns about antibiotic overuse with implementation of SEP-1.
- The high rate of overdiagnosis of sepsis in patients with sepsis-mimicking conditions complicates decisions about aggressive antibiotic treatment.
- The time-zero definition of the SEP-1 protocol lacks an evidence base and suffers from variation from clinic to clinic.
- The authors delineate recommendations to reduce unintended outcomes with SEP-1 implementation.
- The key recommendation is limiting SEP-1 to septic shock only, and to not default to use in sepsis without shock.
- Guidance on how to manage sepsis without shock should be consigned to other guidelines.
- Taking sepsis without shock out of the target range of aggressive antibiotic treatment can reduce unnecessary antibiotic use and emphasize the appropriate clinical population.
- The focus of SEP-1 should be on blood cultures and antibiotic administration within 1 hour of establishing the presence of septic shock.