New multisociety position paper details hospital strategies to close gaps in sepsis care

The Infectious Diseases Society of America and 8 partner societies have released a consensus position paper identifying hospital-level strategies intended to reduce sepsis-related morbidity and mortality, addressing gaps left by existing bedside guidelines and federal quality measures.¹ The paper, published in Clinical Infectious Diseases, was developed by a 24-member multidisciplinary panel spanning infectious diseases, critical care, emergency medicine, pharmacy, microbiology, and patient advocacy.²

“Early recognition and treatment remain a cornerstone of sepsis care, but they are only part of the solution,” said Chanu Rhee, MD, MPH, FIDSA, associate professor at Harvard Medical School, director of the Center for Sepsis Epidemiology & Prevention Studies at the Harvard Pilgrim Health Care Institute, and chair of the panel.¹ “Hospitals also need systems that support timely and accurate diagnosis, optimal antimicrobial management, timely source control, infection prevention and continuous quality improvement,” he said.¹

Position paper scope and methodology for hospital sepsis strategies

The panel used a modified Delphi process, scoring candidate strategies on potential impact, feasibility, cost, and risk of unintended consequences before sorting recommendations into Tier 1 (high priority) and Tier 2 (moderate priority) categories.² The scope excludes general hemodynamic and ventilatory critical care management, focusing instead on infection-related aspects of sepsis care, and was developed primarily for US hospital settings, though the authors note that many principles may translate to other well-resourced systems.²

Six domains of hospital-based sepsis recommendations

The recommendations span diagnostic testing and pathogen detection, antimicrobial management and delivery, surveillance and performance metrics, adjunctive therapy, program infrastructure, and infection prevention.² Tier 1 recommendations include pairing multiplex nucleic acid amplification testing of positive blood cultures with active stewardship support, optimizing workflows to deliver antibiotics within 1 hour of septic shock recognition, minimizing order-to-infusion time to under 30 minutes, defaulting antipseudomonal β-lactams to prolonged infusion in critically ill patients, and prioritizing β-lactam administration before vancomycin when both are ordered.² Tier 2 recommendations include adopting the CDC's Adult Sepsis Event definition for surveillance, tracking de-escalation of empiric MRSA and antipseudomonal therapy, implementing corticosteroid protocols for severe community-acquired pneumonia and refractory septic shock, and standardizing daily toothbrushing and chlorhexidine bathing to reduce hospital-acquired infections.²

Clinical rationale behind the recommendations

Several recommendations rest on evidence the panel itself characterized as imperfect. The blood-culture diagnostics recommendation draws on a meta-analysis of 88 studies showing rapid diagnostics paired with stewardship reduced mortality (odds ratio, 0.72), though the panel noted heterogeneity in study designs and platforms.² The prolonged β-lactam infusion recommendation is grounded in the BLING III trial and an accompanying meta-analysis reporting a 99.1% posterior probability of mortality benefit, despite BLING III itself missing statistical significance in its primary analysis.² The β-lactam-before-vancomycin recommendation, by contrast, rests on retrospective data alone, which the panel acknowledged is subject to residual confounding.²

Limitations and pediatric considerations

Many Tier 2 recommendations, particularly around program infrastructure, are supported by expert consensus and national frameworks rather than direct outcome data.² The panel also flagged emerging strategies — including automated sepsis prediction tools, host immune response diagnostics, and procalcitonin-guided antibiotic duration — as not yet ready for routine implementation pending further validation.¹ Pediatric-specific caveats accompany several recommendations; evidence for extended β-lactam infusion and corticosteroids in refractory shock is notably weaker in children than in adults, and neonatal sepsis was excluded from the paper's scope entirely.²

References

1. Infectious Diseases Society of America. New multisociety recommendations outline hospital strategies to improve sepsis outcomes. Published August 25, 2026. Accessed August 25, 2026. https://www.idsociety.org/news--publications-new/articles/2026/new-multisociety-recommendations-outline-hospital-strategies-to-improve-sepsis-outcomes/

2. Rhee C, Masur H, Klompas M, et al. IDSA/ACEP/ASM/PIDS/SCCM/SHEA/SHM/SIDP multisociety position paper: hospital strategies to improve sepsis outcomes. Clin Infect Dis. Published online August 25, 2026. doi:10.1093/cid/ciag438