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Better targeting of antibiotics required for those at the highest risk of sepsis, says NICE

Updated guidance from the National Institute for Health and Care Excellence (NICE) on identifying and managing sepsis in over-16s recommends better targeting of antibiotics for suspected sepsis.

The updates specify that secondary care teams should target antibiotic use as more is learned about a patient’s condition to ensure the right people receive treatment as soon as possible but the medicines are not overused, which can lead to antibiotic resistance.

Clinicians should use the NEWS2 risk score to assess those with suspected sepsis in those aged over 16 who are not or have not been recently pregnant and are in an acute setting or ambulance, the guidelines state.

NICE said use of NEWS2 should lead to more people with suspected sepsis graded at a lower risk level where treatment should begin within one to three hours and the diagnosis clarified before antibiotics are given, targeted at a specific infection if possible.  

People graded by NEWS2 as being the most severely ill should be prioritised and continue to receive broad-spectrum antibiotics within an hour, the guideline adds.

The new NICE recommendations also aim to ensure better communication and inclusivity for patients with suspected sepsis if they have learning disabilities, autism or where English is not their first language.

This includes assessing these individuals at every stage of the healthcare journey with extra care if they cannot give a good history and tailoring the timing, content and delivery of information to the person’s needs and preferences.

Detail on identifying the source of infection and involving surgical teams have also been broadened to cover risk of sepsis in all parts of the body and a wider range of interventions.

This partial update to the 2016 guidelines also urges immediate hospital transfer for patients who meet any high-risk criteria for sepsis.

GPs or ambulance services must pre-alert secondary care when a patient with suspected sepsis is on their way, the new recommendations state.

And in remote and rural locations where transfer time to emergency department is likely to be more than an hour, GPs and ambulance services should have mechanisms in place to start antibiotics straightaway while ensuring due consideration is given to both patient safety and antimicrobial stewardship, NICE said.

Altered mental state, raised respiratory rate, new need for oxygen, low blood pressure, raised heart rate or not passing urine, a mottled or ashen appearance, cyanosis or a non-blanching rash are all listed as high-risk factors that primary healthcare professionals should look for.

Figures suggest there are at least 245,000 sepsis cases diagnosed in the UK every year.

Professor Jonathan Benger, NICE chief medical officer said the guidance would help ensure antibiotics are targeted to those at the greatest risk of severe sepsis, so they get rapid and effective treatment.

He said: ‘We know that sepsis can be difficult to diagnose so it is vital there is clear guidance on the updated NEWS2 so it can be used to identify illness, ensure people receive the right treatment in the right clinical setting and save lives.

‘This update is the latest part of the process to ensure NICE guidance is as current as possible. We recognise this is a vital and rapidly evolving area, so this is the latest in a series of planned updates to our guidance.’

UK Sepsis Trust founder Dr Ron Daniels welcomed the update and said: ‘We particularly support that the update continues to recommend the identification of high-risk factors, whilst reinforcing the importance of clinical judgement to prevent injudicious use of antibiotics.

‘The recommendation for GPs and ambulance services to consider how they give antibiotics to people that are at high risk of sepsis is increasingly relevant as transit times increase, and could be potentially transformational in terms of patient outcomes. 

He added: ‘We’re now presented with an opportunity to deliver a coordinated and cohesive approach to the recognition and management of sepsis across the NHS.’