National Kidney and DEPARTMENT OF MEDICINE

Division of Internal Medicine

Transplant Institute
MANAGEMENT GUIDELINES FOR MEDICAL
QUALITY PROCEDURE EMERGENCIES AND COMMON MEDICAL
CONDITIONS

INFECTIOUS DISEASES
SEPSIS
Sepsis 1. Suspected (or documented) infection
2. Acute organ dysfunctions: increase in ≥2
sepsis related organ failure assessment
(SOFA) points or SIRS criteria
Septic Shock 1. Sepsis, plus:
2. need for vasopressor therapy to elevate mean
arterial pressure to ≥65 mmHg
3. serum lactate concentration >2.0 mmol/L
despite adequate fluid resuscitation
SIRS 1. Fever >38C (>100.4F) or <36C (<96.8F)
2. Tachypnea with >20 breaths per min
3. Tachycardia with heart rate >90 beats/min
4. Leukocytosis with white blood cell count
>12,000/μL or leukopenia (<4000/μL) or >10%
bands

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Revision No. 5 Revision Date: January 20, 2023
 National Kidney and DEPARTMENT OF MEDICINE
Division of Internal Medicine
Transplant Institute
MANAGEMENT GUIDELINES FOR MEDICAL
QUALITY PROCEDURE EMERGENCIES AND COMMON MEDICAL
CONDITIONS

Document No. MED – QP - 002 Page Control 2 of 3

Revision No. 5 Revision Date: January 20, 2023
 National Kidney and DEPARTMENT OF MEDICINE
Division of Internal Medicine
Transplant Institute
MANAGEMENT GUIDELINES FOR MEDICAL
QUALITY PROCEDURE EMERGENCIES AND COMMON MEDICAL
CONDITIONS

Antimicrobial of choice:
• For adults with sepsis or septic shock and high risk for multidrug resistant (MDR)
organisms:
• two antimicrobials with gram-negative coverage for empiric treatment is
suggested
• For adults with sepsis or septic shock and low risk for MDR organisms
• Single agent against gram-negative organism is suggested

Factors to guide antimicrobial decision:

1. Proven infection or colonization with antibiotic-resistant organisms within the preceding
year
2. Local prevalence of antibiotic-resistant organisms
3. Hospital-acquired/healthcare−associated (versus community- acquired infection)
4. Broad-spectrum antibiotic use within the preceding 90 days
5. Travel to a highly endemic country within the preceding 90 days
6. Hospitalization abroad within the preceding 90 days

Reference: Harrison’s Principles of Internal Medicine, 21st Edition,

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

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Revision No. 5 Revision Date: January 20, 2023

IDSA CPG on the Diagnosis and Management of Skin and Soft Tissue Infections (2014).