Updated NICE guidance on sepsis 

NICE has updated its guidance for the management of sepsis, with the aim of improving antibiotic stewardship.

The updated guidance includes new recommendations around ensuring better targeting of antibiotics for suspected sepsis to ensure the right people receive treatment as soon as possible but the medicines are not overused. 

National Early Warning Score (NEWS2) is the NHS England endorsed system to identify acutely ill patients, including those with sepsis. NICE guidance recommends using NEWS2 to help assess people with suspected sepsis who are aged 16 or over, are not and have not recently been pregnant, and are in an acute hospital setting, acute mental health setting or ambulance.  

This recommendation is included in a partial update of NICE’s recognition, diagnosis, and early management of suspected sepsis guideline alongside further advice on assessing patients most at risk, when to give antibiotics and identifying the source of infection.  

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

As a result of the updated NEWS2 warning scores, it is expected that more people will be graded at a lower risk level where treatment should begin within 1-3 hours and the diagnosis clarified before antibiotics are given, targeted at a specific infection if possible.  

This will help to reduce the risk of antibiotic resistance and give healthcare professionals more time to investigate those who are less severely ill, so they receive the right treatment.  

There are at least 245,000 sepsis cases diagnosed in the UK every year. An analysis of data by the UK Sepsis Trust in 2017 showed that there were 200,000 admissions to hospitals in England where sepsis was diagnosed.   

Professor Jonathan Benger, NICE chief medical officer said: “This useful and useable guidance will help ensure antibiotics are targeted to those at the greatest risk of severe sepsis, so they get rapid and effective treatment. It also supports clinicians to make informed, balanced decisions when prescribing antibiotics.   

“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.”  

The updated guidance aligns with the Academy of Medical Royal Colleges (AoMRC) statement on the initial antimicrobial treatment of sepsis.  

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

UK Sepsis Trust Founder and Joint CEO, Dr. Ron Daniels, said: “We welcome that NICE have provided this important update to their national guidance. We particularly support that the update continues to recommend the identification of high-risk factors, while 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.

"These revisions help end a period of instability, with healthcare professionals previously facing varying guidance from the Academy of Medical Royal Colleges. We’re now presented with an opportunity to deliver a coordinated and cohesive approach to the recognition and management of sepsis across the NHS. We’re delighted to be supporting the updated NICE guideline with a suite of clinical tools, which we hope will be used by healthcare practitioners to save lives.” 

Read the full update on the NICE website at: https://www.nice.org.uk/guidance/NG51

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