NICE updates sepsis guidance in a bid to reduce antibiotic resistance

NICE has recommended that people with suspected sepsis graded by NEWS2 as being the most severely ill should be prioritised to receive broad-spectrum antibiotics within an hour.

The updated guidance provides clearer advice on when and who to administer antibiotics to, and recommends that clinicians use the National Early Warning Score (NEWS2) to identify acutely ill patients.

The NEWS2 should be used to assess people with suspected sepsis who are in an ambulance or acute hospital/mental health setting, are aged 16 or over, and are not or have not recently been pregnant.

Professor Jonathan Benger, NICE chief medical officer, 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.”

245,000 cases of sepsis per year in the UK

In the UK, there are at least 245,000 sepsis cases per year, with 48,000 people losing their lives due to sepsis-related illnesses. In 2017, there were 200,000 hospital admissions where sepsis was diagnosed, according to the UK Sepsis Trust.

If sepsis is suspected, broad-spectrum antibiotics are given first. This is because there won’t be time to wait until a specific type of infection has been identified.

While this practice may benefit severely ill patients, for others it could have detrimental consequences. Schinkel et al say the increasingly shortened timeframe in which administration of antibiotics is recommended has forced physicians to sacrifice diagnostic accuracy for speed, encouraging the overuse of antibiotics.

This new guidance is designed 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.

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.

The revisions help end a “period of instability”

The UK Sepsis Trust has welcomed the ‘important update’ to national guidance and says it supports NICE in its recommendation to identify high-risk factors, whilst reinforcing the importance of clinical judgement to prevent ‘injudicious’ use of antibiotics.

Dr Ron Daniels founder and CEO of the UK Sepsis Trust said: “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.”