For healthcare professionals
Professionals
Guidelines, decision tools and recent evidence for the recognition and treatment of sepsis, from out-of-hours primary care to intensive care.
We compare the Dutch guideline with the international Surviving Sepsis Campaign 2026, summarise the key trials of the past five years and show what each link in the chain of care can do. All recommendations are summarised; always consult the original guideline.
New
Learning hub: learning by doing
Calculate NEWS2, qSOFA and SOFA, explore the disease process from infection to organ failure and test your knowledge with seven cases.
Guidelines
Guidelines and reference
Dutch sepsis guideline (NIV)
Dutch guideline for adults: early recognition, biomarkers, oxygen, fluids, vasopressors, kidney replacement therapy, sedation, delirium, mobilisation, nutrition and aftercare.
Dutch guideline Sepsis in children
Recognition with PEWS, diagnostics, treatment and organisation of care in children (2021).
Surviving Sepsis Campaign 2026
International adult guideline: 129 statements, 46 of which are new compared with 2021.
NICE NG51 (United Kingdom)
Recognition, diagnosis and early management of sepsis, with risk stratification.
Evidence
Dutch guideline and Surviving Sepsis Campaign side by side
The Dutch guideline (phases I to III, 2019 to 2024) focuses mainly on in-hospital and ICU treatment; antibiotic choice is covered by the SWAB guideline. The Surviving Sepsis Campaign 2026 is broader and more recent. Where they overlap, they point in the same direction.
| Topic | Dutch guideline (NIV) | Surviving Sepsis Campaign 2026 |
|---|---|---|
| Screening | MEWS or NEWS when infection is suspected, plus the signal question "Could this be sepsis?". No qSOFA. | NEWS, NEWS2, MEWS or SIRS over qSOFA as a single tool (strong). Use a screening tool prehospital (suggestion). |
| Biomarkers | CRP to make infection more or less likely; PCT, IL-6 and presepsin add no value. | Clinical evaluation alone over PCT plus clinical evaluation to start antimicrobials (suggestion). Measure lactate (suggestion). |
| Antimicrobials: timing | Not covered in this guideline; choice according to SWAB. | Within 1 hour for probable or definite sepsis and for (possible) shock (recommendation); within 3 hours after rapid investigation for possible sepsis without shock (suggestion). Blood cultures before antimicrobials (recommendation). |
| Antimicrobials: administration and duration | Not covered. | Prolonged infusion of beta-lactams after a loading dose (recommendation, new). Shorter duration with adequate source control (suggestion). |
| Fluids: volume | At least 30 mL/kg crystalloid within 3 hours; first 500 mL in 10 to 30 minutes in shock; evaluate within 1 hour. | At least 30 mL/kg crystalloid within 3 hours in hypoperfusion or shock (suggestion, low certainty). |
| Fluids: type | Crystalloids; no albumin or other colloids; consider balanced solutions. | Balanced crystalloids over 0.9% saline (suggestion); no supplemental albumin (suggestion). |
| Guiding resuscitation | Lactate, at least every 6 hours and not more than every 2 hours, until normalised; preferably no other parameters. | Capillary refill time as an adjunct to other perfusion measures (suggestion). |
| Vasopressors and blood pressure | Norepinephrine first choice; vasopressin only for refractory hypotension. Inotropes: dobutamine or a PDE inhibitor. | Initial MAP of 65 mmHg (recommendation); 60 to 65 mmHg at age 65 and over (suggestion); peripheral start of vasopressors is acceptable (suggestion). |
| Adjunctive therapy | Not covered. | IV corticosteroids in septic shock (suggestion); no IV vitamin C (suggestion against). |
| Aftercare | Timely referral to information on long-term consequences; mention sepsis in the discharge letter; early mobilisation. | Written and verbal education, post-discharge follow-up, mental health support, rehabilitation after ventilation for more than 48 hours (suggestions). |
| Organisation | Local protocol: who is responsible for what, and on which ward. | Performance improvement programme with screening, standard operating procedures and quality measures (recommendation); code sepsis or sepsis huddle (suggestion). |
Summarised and translated by SepsisNet from the Dutch sepsis guideline and the SSC 2026 guideline SSC 2026. Strength per SSC: recommendation (strong) or suggestion (conditional).
Chain of care
Sepsis across the chain of care
Sepsis usually starts outside hospital. In a Dutch study, 48% of ICU patients with community-acquired sepsis had first contacted the out-of-hours GP service, and in 43% the GP had not suspected infection Loots, BMJ Open 2018. Recognition and handover of urgency before hospital are therefore the weak links.
| Link | Recognition | Treatment and handover | Follow-up |
|---|---|---|---|
| Public and relatives | Know the warning signs; when in doubt, call and use the word sepsis. | Get back in touch if things get worse. | Know when to seek help again. |
| GP and out-of-hours service | Consider sepsis in a rapidly deteriorating patient; measure vital signs; also without a clear infection. | Structured referral with pre-alert; hand over urgency explicitly. | Follow-up after sepsis; ask about symptoms. |
| Ambulance | Full set of vital signs; screening tool. | Pre-alert when sepsis is suspected; with long transport time and shock, consider antimicrobials (SSC). | Hand over context to the hospital. |
| Emergency department | Triage, MEWS or NEWS, lactate, cultures. | Antimicrobials within 1 hour in probable sepsis or shock; fluids; plan source control. | Discuss goals of care; admit to the right place. |
| Ward and ICU | Early warning and rapid response; reassessment. | Vasopressors, organ support, de-escalation and short duration. | Early mobilisation; sepsis in the discharge letter; education. |
| After discharge | Recognise long-term problems. | Prevent readmission; treat new infections promptly. | Rehabilitation, psychological support, peer support. |
Based on the chain-of-care matrix in the National Sepsis Action Plan by SepsisNet and Sepsis Nederland (draft, 2026) (National Sepsis Action Plan, draft 2026), the Dutch sepsis guideline Dutch guideline Sepsis and the SSC guideline SSC 2026.
Evidence
Key trials of the past five years
Randomised trials that changed or confirmed sepsis care since 2021. Phase 2 results are hypothesis-generating. Click a source label for the publication.
ImmunoSep
Immunotherapy guided by immune phenotype: anakinra for macrophage activation-like syndrome (ferritin > 4420 ng/mL), interferon-gamma for immunoparalysis (low monocyte HLA-DR). Greater improvement in organ dysfunction (SOFA) by day 9 than placebo (OR 2.48; 95% CI 1.42 to 4.32). No significant difference in 28-day mortality (43.5% vs 49.7%).
Implication: First randomised evidence that biomarker-guided immunotherapy can modify organ dysfunction. Not yet standard care: 355 of 672 screened patients could not be classified with these two markers and rapid HLA-DR testing is not widely available. Phase 3 confirmation with hard outcomes is needed.
BLING III
Continuous versus intermittent beta-lactam infusion: 90-day mortality 24.9% vs 26.8%, not significant. The concurrent meta-analysis of 18 trials showed lower mortality with prolonged infusion (RR 0.86).
Implication: SSC 2026 suggests prolonged infusion after a loading dose where feasible.
BALANCE
7 versus 14 days of antibiotics for bloodstream infection: 90-day mortality 14.5% vs 16.1%, non-inferior.
Implication: Short courses are safe with clinical improvement and source control; exceptions such as S. aureus and endocarditis remain.
ADAPT-Sepsis
Daily procalcitonin-guided stopping advice shortened antibiotic duration by almost one day with non-inferior 28-day mortality. CRP-guided advice did not shorten duration.
Implication: Procalcitonin can support stopping, not starting, antibiotics.
CLOVERS
Restrictive (early vasopressors) versus liberal fluids: 90-day mortality 14.0% vs 14.9%, no difference.
Implication: Both strategies are reasonable; individualise according to perfusion and fluid responsiveness.
ARISE FLUIDS
Early vasopressors with restricted fluids versus more fluids and later vasopressors: days alive and out of hospital to day 90 equal (median 76 vs 76). Median about 1.1 litres less fluid in 24 hours; pulmonary oedema 0.6% vs 5.0%.
Implication: Confirms CLOVERS: both strategies are reasonable. Less fluid caused less pulmonary oedema, without a survival benefit.
CLASSIC
Restrictive versus standard IV fluid after initial resuscitation: 90-day mortality 42.3% vs 42.1%; median 1.8 vs 3.8 litres.
Implication: Less fluid after the initial phase is not harmful; routine continued fluid gives no benefit.
ANDROMEDA-SHOCK-2
Personalised resuscitation targeting capillary refill time improved a hierarchical composite outcome (mortality, duration of organ support, length of stay), without a significant difference in mortality alone.
Implication: Supports capillary refill time as a simple, repeatable bedside perfusion target.
PLUS en BaSICS
Balanced crystalloids versus 0.9% saline: no significant difference in 90-day mortality (21.8% vs 22.0% and 26.4% vs 27.2%).
Implication: Meta-analyses suggest a small probable benefit; SSC 2026 favours balanced solutions. Caution in traumatic brain injury.
CAPE COD
Hydrocortisone 200 mg daily in severe community-acquired pneumonia: 28-day mortality 6.2% vs 11.9%. Patients with septic shock and influenza were excluded.
Implication: Consider hydrocortisone for severe pneumonia in the ICU; in septic shock the existing corticosteroid recommendation applies.
LOVIT
High-dose intravenous vitamin C: more death or persistent organ dysfunction at day 28 (44.5% vs 38.5%; RR 1.21).
Implication: Vitamin C should not be used to treat sepsis.
Overview compiled by SepsisNet; not a substitute for the guideline. Last checked: November 2026.
Research
Knowledge gaps in sepsis care
Where is evidence lacking? An overview based on Dutch guidelines, the knowledge agendas of professional societies and the Surviving Sepsis Campaign research priorities.
Early recognition
What is the best strategy to screen for and recognise sepsis, and can predictive models or AI support real-time recognition? Scores used in hospitals are not validated in primary care, where many patients first present. During out-of-hours home visits GPs counted the respiratory rate in 25% of patients; when estimating, they recognised a raised rate in 43%.
SSC Research Priorities 2023 NIV Knowledge agenda 2022-2025 Loots, H&W Loots, BJGP Open 2022
Sepsis in children
How can newborns at risk of early-onset neonatal sepsis be identified better, and how can parents recognise serious illness in time after discharge or an ED visit?
Individualised fluids and vasopressors
How should fluid therapy be individualised in the first hours and beyond, and which vasopressor strategy fits which phase of septic shock? Large trials of restrictive versus liberal strategies were neutral.
SSC Research Priorities 2023 CLOVERS, NEJM 2023 CLASSIC, NEJM 2022
Precision medicine
Can endotypes or biomarkers determine which patient benefits from which (immuno)therapy? In ImmunoSep more than half of screened patients could not be classified with ferritin and HLA-DR. Consensus frameworks for transcriptomic and immunological subtypes are a first step towards shared definitions.
SSC Research Priorities 2023 ImmunoSep, JAMA 2025 Scicluna, Nat Med 2025 Moore, Nat Med 2025 IFN-γ endotype, EBioMedicine 2024
Mechanisms of organ injury
What causes organ injury in sepsis and how can it be detected early? Animal models and outcome measures translate poorly to human sepsis; the roles of the brain, microbiome and (epi)genetics remain poorly understood.
Antibiotics
Optimal duration and timing of the switch from intravenous to oral therapy, including patients with impaired immunity; optimal diagnostic work-up of S. aureus bacteraemia; role of biomarkers in stopping antibiotics.
NIV Knowledge agenda 2022-2025 BALANCE, NEJM 2025 ADAPT-Sepsis, JAMA 2025
Supportive ICU care
When and how should patients with sepsis be mobilised? Does the choice between continuous and intermittent renal replacement affect outcome? The Dutch guideline found insufficient evidence.
Dutch guideline: mobilisation Dutch guideline: renal replacement
Recovery and aftercare
How should post-intensive care syndrome (PICS) be treated, and which aftercare works after sepsis outside the ICU? Patient representatives prioritised long-term outcomes, aftercare and relatives.
NIV Knowledge agenda 2022-2025 NVIC research agenda 2021 Prescott, JAMA 2018
Data and infrastructure
The Netherlands has no complete sepsis registry following the whole care pathway, from first contact to recovery. The National Sepsis Action Plan calls for a national research agenda and a dedicated sepsis call at ZonMw and NWO.
National Sepsis Action Plan, draft 2026
Knowledge agendas of professional societies
| Agenda | Relevance to sepsis | Source |
|---|---|---|
| NIV Knowledge agenda 2022-2025 | Top 24 questions; none explicitly on sepsis. Related: oral versus intravenous treatment of pneumonia (question 11), work-up of S. aureus bacteraemia (12), big-data bedside decision support in the ICU (13) and treatment of PICS (14). | NIV Knowledge agenda 2022-2025 |
| NVIC research agenda | Knowledge gaps in eight domains, including haemodynamics, infection, inflammation, post-intensive care syndrome and artificial intelligence; no clear priority between domains. | NVIC research agenda 2021 |
| NVK Knowledge agenda | Top 10 gaps in general paediatrics, including identification of newborns at risk of early-onset neonatal sepsis and recognition of serious illness by parents. | NVK Knowledge agenda |
| Surviving Sepsis Campaign 2023 | Five clinical priorities (recognition, organ injury, fluids, vasopressors, precision medicine) and five basic science priorities (animal models, translatable outcomes, brain, microbiome, (epi)genetics). | SSC Research Priorities 2023 |
| National Sepsis Action Plan | Domain 7, Data and research: pathway-based core registry, national research agenda, a sepsis call and use of existing infrastructure, such as hospital cohorts and national quality registries. | draft 2026 |
Working on one of these questions? Register your research in the SepsisNet research network, so we can connect initiatives and advocate for funding together.
Tools
Scores and calculators
Want to practise? Calculate NEWS2, qSOFA and SOFA with instant explanations in the learning hub.
NEWS2
Recommended for screening acutely ill patients (Dutch guideline and SSC).
SOFA
Measures organ dysfunction; an increase of 2 points or more with infection is consistent with sepsis (Sepsis-3).
SOFA-2
Revised SOFA score (2025), developed and validated in large international cohorts, with updated criteria per organ system.
Implementation
Organising sepsis care
Surviving Sepsis Campaign 2026 recommendation
Hospitals should use a sepsis performance improvement programme, including screening of acutely ill high-risk patients, standard operating procedures and quality measures. Consider a "code sepsis" or sepsis huddle after a positive screen.
Summarised from SSC 2026
Dutch sepsis guideline Organisation of care
Record in a local protocol who is responsible for each part of sepsis care and on which ward it takes place.
Summarised from the Dutch sepsis guideline Dutch guideline Sepsis
The Dutch VMS sepsis programme showed that coordinated improvement works: structured screening and bundles improved bundle compliance and were associated with lower adjusted mortality in participating ICUs (National Sepsis Action Plan, draft 2026). SepsisNet and Sepsis Nederland are working on national minimum standards for recognition, handover and aftercare. Would you like to join a working group? Email info@sepsisnet.nl.