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Guidelines
Septic Shock

Septic Shock

Clinical Pearls

Blood cultures before antibiotics (unless there is a significant delay)

IV antibiotics should be started within first hour of clinical signs of sepsis or septic shock

Definitions

Sepsis

Suspected infection AND at least 2 of:

  • Altered mental status

  • RR ≥22 breaths/min

  • SBP ≤100 mmHg (qSOFA)

  • Signs of organ dysfunction

Septic Shock

Sepsis AND

  • Persisting hypotension OR

  • Lactate >2 mmol/L despite a fluid bolus

Known Source

Treat as per empiric guidelines

Unknown Source - First Line

Pip/tazo 3.375g IV q6h
  • Consider 4.5g if P. aeruginosa suspected

AND

Vancomycin 20-25 mg/kg IV for first dose

THEN

Vancomycin 1g IV q12h

  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)

  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

+/-

Tobramycin 5 mg/kg IV x 1 dose

Unknown Source - Second Line

Vancomycin 20-25 mg/kg IV for first dose

THEN

Vancomycin 1g IV q12h

  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)

  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

AND

Cipro 400mg IV q12h

+/

Tobramycin 5 mg/kg IV x 1 dose

Tailor Therapy

  • On Day 3 or when culture and susceptibility results are available, tailor antimicrobial therapy to pathogen.

  • See: www.survivingsepsis.org