Sepsis – still a dilemma
Reviewed by Arun K Sharma

Thousands of people die each year in the UK and worldwide due to types of sepsis, including urosepsis. Urologists are facing this scenario day in day out, so this is a vital article for every reader. We are all familiar with the NEWS score. In January 2024 the National Institute for Health & Care Excellence (NICE) guidelines were updated to include NEWS 2 to stratify the risk of serious illness and death from sepsis. Two important points are: urgency of antibiotics and identifying the source of infection. An easy to remember traffic light table is presented. The clinical groups are score 7 or more = serious illness + death; score 5–6 = moderate risk of illness + death; score 1–4 = low risk. In group one: antibiotics should be given within one hour along with support in the intensive care unit. In group 2 antibiotics should be given within three hours and in group three within six hours. Once the decision has been made to give antibiotics, it should be done immediately by either the doctor or duty nurse; do not leave the patient! It is not good enough just to write on drug charts. Of course, NEWS 2 should be interpreted / modified, carefully taking account of the patient’s past medical history and co-morbidities. Special guidance has been mentioned for patients in prisons / care homes / psychiatric institutions / rural and remote communities, etc. Any delay in transfer from these places to an acute hospital setting should be considered and ambulance crews / paramedics may require training / initiatives to administer the first dose of antibiotics. In England, 100% of ambulance trusts and 76% of acute NHS trusts seem to be using NEWS 2 , which hopefully will become more widespread.

Recognition, diagnosis, and early management of suspected sepsis: summary of updated NICE guidance.
Gildea A, Mulvihill C, McFarlane E, et al.
BMJ
2024;385:q1173