Sepsis and septic shock demand a standardized, time-sensitive pathway beginning with proactive screening of acutely ill, high-risk patients. Early recognition prioritizes identification of infection together with signs of organ dysfunction. The authors emphasize structured processes in acute care settings to detect sepsis promptly and trigger diagnostic and therapeutic bundles without delay.
Rapid assessment of the suspected infection focus and evaluation for sepsis-associated organ dysfunction are core diagnostic objectives. When feasible and prior to administration of antimicrobials, obtaining blood cultures is recommended as a key element to guide targeted therapy. The source article highlights this as a foundational step in the initial workup, while acknowledging time-critical needs to start therapy.
A rapid start of appropriate intravenous antimicrobials is central to initial sepsis management. The balance between urgent empiric therapy and obtaining diagnostic specimens is stressed; blood cultures should be taken before antimicrobials when this does not introduce harmful delay. The article also underscores the role of organized antibiotic stewardship (ABS) and antimicrobial stewardship (AMS) programs to optimize antimicrobial selection, duration, and de-escalation, and to limit adverse consequences of antimicrobial overuse.
Early hemodynamic stabilization is presented as another pillar of sepsis care. For initial fluid resuscitation, the authors recommend balanced crystalloids as the first-line intravenous fluid. These fluids are identified as the preferred initial choice in guideline-aligned resuscitation strategies to restore perfusion and support organ function while minimizing potential harms associated with unbalanced solutions.
When vasopressor support is needed, norepinephrine is described as the primary vasopressor of choice. If vasopressor requirements persist despite adequate norepinephrine titration, the article lists adjunctive options to consider according to the clinical context. These include vasopressin and corticosteroid therapy with hydrocortisone ± fludrocortisone. The recommendation is presented as context-dependent; adjuncts are to be applied based on ongoing circulatory failure and individualized patient factors.
Beyond acute management, the authors call attention to preventive measures as essential to reduce sepsis incidence and morbidity. This includes standard infection prevention practices and implementation of ABS/AMS programs to improve antimicrobial prescribing and limit resistance. Prevention efforts are portrayed as complementary to acute care, with system-level programs and performance improvement initiatives improving bundle compliance and outcomes.
Structured post-sepsis follow-up is recommended to address long-term sequelae that patients may experience after hospital discharge. The article notes that organized aftercare and surveillance can help identify and mitigate persistent physical, cognitive, and psychological consequences following sepsis, although specific follow-up protocols are not detailed in the source abstract.
The article aligns its recommendations with contemporary guideline documents and authoritative sources. The S3‑Leitlinie Sepsis – Update 2025 and the Surviving Sepsis Campaign 2021 international guidelines are cited as key references informing prevention, diagnosis, therapy, and follow-up practices described in the article. The source also references consensus sepsis definitions (Sepsis‑3) and systematic reviews relevant to screening and performance improvement programs.
This review article, authored by Matthias Kochanek and Jan‑Hendrik Naendrup, was published in Med Klin Intensivmed Notfmed and made available online ahead of print on 6 August 2026. Bibliographic identifiers provided in the source include PMID 42560494 and DOI 10.1007/s00063-026-01484-9. The article is presented in German with an English abstract and includes a conflict-of-interest statement and references to the guideline literature.
Note: The summary above reflects the content reported in the PubMed abstract and associated metadata. The source abstract does not provide detailed protocolized algorithms, dosing specifics, or new trial results; such details were not reported in the source document.