JAMA Clinical Guidelines Synopsis <\/p>\n\n\n\n
Guideline title<\/strong>\u00a0Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026<\/p>\n\n\n\n Release date<\/strong> March 23, 2026<\/p>\n\n\n\n Developer<\/strong> European Society of Intensive Care Medicine (ESICM) and Society of Critical Care Medicine (SCCM)<\/p>\n\n\n\n Target population<\/strong> Adults with or at risk for sepsis and septic shock<\/p>\n\n\n\n Selected Recommendations<\/strong><\/p>\n\n\n\n Summary of the Clinical Problem<\/p>\n\n\n\n Sepsis, a life-threatening condition characterized by acute organ dysfunction from a dysregulated response to infection, affects more than 40 million people annually worldwide. The European Society of Intensive Care Medicine (ESICM) and Society of Critical Care Medicine (SCCM) have updated the Surviving Sepsis Campaign (SSC) guidelines from 2021. This synopsis summarizes selected recommendations for adults with sepsis.1<\/a><\/sup><\/a><\/p>\n\n\n\n Characteristics of the Guideline Source<\/p>\n\n\n\n The 2026 guidelines were funded by SCCM and ESICM without industry support and were endorsed by 24 sponsoring professional societies. The guideline panel included 69 clinicians with diverse expertise from 23 countries (eTable in the Supplement<\/a>), as well as a patient and family advisory panel. The guidelines, which used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology, received methodological support from the Guidelines in Intensive Care Development and Evaluation (GUIDE) group, and required at least 80% agreement among panelists for all statements and remarks. Recommendations were classified as strong (\u201cwe recommend\u201d) or conditional (\u201cwe suggest\u201d) and graded for COE as high, moderate, low, or very low.<\/a><\/p>\n\n\n\n Evidence Base<\/p>\n\n\n\n Early antimicrobial therapy is a key intervention of care for patients with sepsis or septic shock.1<\/a><\/sup> In an observational study of 273\u202f255 patients admitted with community-onset sepsis, those who received antibiotics within 3 hours of emergency department arrival had lower overall mortality vs those who received antibiotics 3 to 12 hours after arrival (absolute mortality reduction, 1.20% [95% CI, 0.98%-1.41%]; relative risk [RR], 0.91 [95% CI, 0.89-0.93]; P<\/em>\u2009<\u2009.001).2<\/a><\/sup> The effect may be greatest in septic shock, as a meta-analysis of 2 nonrandomized studies showed reduced mortality (odds ratio, 0.63 [95% CI, 0.42-0.94]) for those receiving antibiotics within 3 hours of presentation vs more than 3 hours with an absolute reduction in mortality of 10.1% (95% CI, 17.5% to 0.014% less).1<\/a><\/sup> The SSC guideline recommends (with very low COE) antibiotic administration immediately (ideally within 1 hour) for patients with definite or probable infection with or without hypoperfusion (eg, lactate >2 mmol\/L after adequate fluid resuscitation) or hypotension requiring vasopressor support.1<\/a><\/sup><\/a><\/p>\n\n\n\n During prehospital care, the guidelines suggest administering antimicrobial therapy in ambulance or during flight for adults with definite or probable sepsis and hypotension (ie, septic shock) who have an anticipated time to in-hospital medical evaluation of more than 60 minutes. A meta-analysis (2 randomized clinical trials [RCTs]) suggested that prehospital antibiotics may decrease 28-day mortality (mortality 9.9% for prehospital administration vs 12.1% without; RR, 0.85 [95% CI, 0.66-1.09]).1<\/a><\/sup><\/a><\/p>\n\n\n\n For adults with sepsis or septic shock, the SSC guideline discourages using empirical antifungal therapy. In a meta-analysis of 7 RCTs (990 patients) that compared empirical antifungal therapy with no empirical antifungal therapy, no difference in mortality was observed (28.7% vs 29.2%; RR,\u20090.93 [95% CI, 0.66-1.32]).1<\/a><\/sup> However, empirical antifungal therapy may be considered for patients with risk factors for fungal infection, such as immunocompromised states.<\/a><\/p>\n\n\n\n Several studies show that after a causative organism is identified, antibiotic deescalation strategies are at least comparable to continuation of broad-spectrum antibiotics with respect to clinical cure among patients with sepsis. For example, in a noninferiority trial of 2030 patients with Enterobacterales<\/em> species bacteremia, those randomized to a ranked-order list of nonantipseudomonal \u03b2-lactam antibiotics had similar cure rates as those who continued an antipseudomonal \u03b2-lactam antibiotic (90% vs 89%; risk difference, 1.6% [95% CI, \u22125.0% to 8.2%]).3<\/a><\/sup> Furthermore, meta-analyses suggested deescalation strategies may reduce mortality (24 observational studies and 2 RCTs; RR, 0.77 [95% CI, 0.64-0.92]; very low COE) and hospital length of stay (4 studies; 1.7 days fewer [95% CI, 1.8-1.6 days fewer]; very low COE).1<\/a><\/sup><\/a><\/p>\n\n\n\n The 2026 guideline suggests SDD, which involves topical and short-term broad-spectrum IV antibiotics administered to patients receiving mechanical ventilation, to decrease risk of ventilator-associated pneumonia and bacteremia in hospitals with low prevalence of antimicrobial resistance. A meta-analysis of 32 RCTs (24\u202f389 patients receiving mechanical ventilation) suggested a probable reduction in short-term mortality with SDD (30 trials; RR, 0.91 [95% CI, 0.82-0.99]; moderate COE), more days alive out of the intensive care unit (ICU) (1 trial; 1.75 days more [95% CI, 0.62-4.12 days more]; moderate COE), and more days alive out of the hospital (1 trial; 1.34 days more [95% CI, 0.89 fewer to 3.58 days more]; moderate COE).1<\/a><\/sup><\/a><\/p>\n\n\n\n The SSC guidelines suggest administration of at least 30 mL\/kg of IV crystalloid within 3 hours of presentation for adults with sepsis-induced hypoperfusion (defined as mean arterial pressure <65 mm Hg, SBP <90 mm Hg, relative hypotension [SBP markedly below baseline], or lactate >2 mmol\/L) or septic shock. Data supporting 30 mL\/kg of IV crystalloid are extrapolated primarily from observational studies.1<\/a><\/sup> In a pre- and postimplementation study of 18\u202f122 hemodynamically stable patients with sepsis and serum lactate of 2 to 4 mmol\/L, implementation of a sepsis bundle that included 30 mL\/kg of IV fluids and antibiotics administered within 3 hours of presentation to the emergency department, and repeat lactate testing within 1 to 4 hours, was associated with decreased hospital mortality (7.9% in the year post implementation vs 8.8% and 9.3% in the 2 years prior to implementation; adjusted odds ratio, 0.79 [95% CI, 0.65-0.98]; P<\/em>\u2009=\u2009.02).4<\/a><\/sup><\/a><\/p>\n\n\n\n Fluid overload in patients with sepsis and septic shock is associated with greater mortality in observational studies.1<\/a><\/sup> However, whether active fluid removal (eg, using diuretics or mechanical ultrafiltration) leads to improved outcomes following the acute resuscitation phase is unknown. A systematic review and meta-analysis including 8030 patients in 13 trials, 5 of which were RCTs, demonstrated uncertain effects of active fluid removal vs usual care with respect to mortality among critically ill patients (RR, 0.93 [95% CI, 0.82-1.05]) and ICU length of stay (mean difference, 0.3 days longer [95% CI, 1.07 days shorter to 1.66 days longer]).5<\/a><\/sup> The SSC guideline suggestion for active fluid removal was influenced by patient representatives who valued avoiding edema.<\/a><\/p>\n\n\n\n Discussion<\/p>\n\n\n\n The 2026 SSC guidelines issued 99 graded recommendations, of which 18 are strong and 81 are conditional recommendations, and an additional 19 good practice statements. Of the 18 strong recommendations, 4 were based on high-certainty evidence, 10 on moderate-certainty evidence, and 4 on low- or very low-certainty evidence.1<\/a><\/sup><\/a><\/p>\n\n\n\n Interventions Not Recommended for Sepsis or Septic Shock<\/p>\n\n\n\n In a notable change from the 2021 SSC guidelines, the current guidelines suggest against use of empirical antibiotics with anaerobic coverage for septic patients without risk factors for anaerobic infection. In a meta-analysis of 2 RCTs (182 adults with sepsis or septic shock), 90-day mortality was similar among those randomized to empirical metronidazole vs placebo (5.4% vs 3.4%; RR, 1.56 [95% CI, 0.39-6.25]).6<\/a><\/sup> However, antibiotics with anaerobic activity (eg, piperacillin-tazobactam or carbapenems) are appropriate for patients with intra-abdominal, deep-seated gynecologic or obstetric sources of infection, necrotizing soft tissue infection, head and neck infection, central nervous system abscess, empyema, or when coverage of multidrug-resistant pathogens is appropriate.<\/a><\/p>\n\n\n\n The guidelines suggest against the following: (1) \u03b2-blockers in septic shock, (2) antipyretic therapy for the purpose of improving clinical outcomes, (3) IV vitamin C, (4) IV immunoglobulins, (5) blood purification techniques such as hemoperfusion or hemofiltration, (6) vitamin D, (7) XueBiJing injection (a traditional Chinese preparation containing 5 different herbs) outside of jurisdictions where it has regulatory approval, (8) probiotics, (9) kidney replacement therapy in the absence of a definitive indication, and (10) sodium bicarbonate therapy to improve hemodynamics or reduce vasopressor requirements.1<\/a><\/sup><\/p>\n","protected":false},"excerpt":{"rendered":" JAMA Clinical Guidelines Synopsis Caring for Adul […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30543"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30543"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30543\/revisions"}],"predecessor-version":[{"id":30544,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30543\/revisions\/30544"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30543"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30543"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30543"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n