Possible sepsis: a clock that runs either way

Review and sources

Not clinically reviewed. No clinician has signed this scenario.

• Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. Published 2026-03-23. doi:10.1097/CCM.0000000000007075. Tiered antimicrobial timing: septic shock and probable or definite sepsis without shock, immediately and ideally within 1 hour, strong recommendation, very low certainty; possible sepsis without shock, a time-limited course of rapid investigation and, if concern persists, antimicrobials within 3 hours, conditional recommendation, very low certainty; low likelihood of infection without shock, defer while continuing close monitoring, conditional. Sepsis is a clinical diagnosis and should not be ruled in or out using a single biomarker or diagnostic test. Statement numbers were not retrievable; wording taken from the issuing society guideline page.
• Infectious Diseases Society of America. Practice guideline listing: Surviving Sepsis Campaign 2026 adult and children guidelines, endorsed. IDSA declined to endorse the 2016 edition and published a position paper in 2021 seeking to restrict the SEP-1 measure to septic shock; it endorses the 2026 edition, whose tiered structure addresses that objection.
• Rhee C, Chiotos K, Cosgrove SE, et al. Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure. Clin Infect Dis. 2021;72(4):541-552. doi:10.1093/cid/ciaa059. Argues the time-zero definition is not evidence based and is prone to inter-observer variation, and that the measure risks driving antimicrobial overuse because it ignores sepsis overdiagnosis.