International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach
In brief
Consensus backs NEWS-2 and procalcitonin for early sepsis, norepinephrine first-line
A Delphi panel of 164 experts from 22 countries reached agreement on 40 sepsis-code statements, strongly endorsing the NEWS-2 score and procalcitonin testing for rapid recognition, urgent source control within six hours, and norepinephrine as the preferred vasopressor. The guidance highlights physiology-driven fluid and antibiotic strategies, but leaves the choice of sepsis definitions and MAP targets unresolved.
- Journal
- Journal of internal medicine (Q1)
- Published
- 12 August 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- M Borges-Sa, A Giglio, I Martin-Loeches, J Nates, J M González Del Castillo, Y Cárdenas, et al.
- PMID
- 42590856
- DOI
- 10.1111/joim.70145
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 16 August 2026): International consensus on sepsis code guidelines
- Picked for Internal Medicine (paper of the day, 14 August 2026): International consensus on sepsis code management
Abstract
BACKGROUND: Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high-income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs. METHODS: A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1-2) and binary format (Round 3). RESULTS: Consensus was achieved for 40 statements. Strong endorsement (82%-95%) was reached for structured hospital sepsis programs, NEWS-2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first-line vasopressor therapy. Experts also supported pharmacokinetic- and pharmacodynamic-guided antibiotic dosing, prolonged infusion of time-dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis-2, Sepsis-3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy. CONCLUSIONS: These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high- and middle-income healthcare systems.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.