{"id":307,"date":"2025-03-30T13:36:33","date_gmt":"2025-03-30T12:36:33","guid":{"rendered":"https:\/\/sepsit.site.transip.me\/?page_id=307"},"modified":"2026-11-14T21:04:05","modified_gmt":"2026-11-14T20:04:05","slug":"professionals","status":"publish","type":"page","link":"https:\/\/www.sepsisnet.nl\/en\/professionals\/","title":{"rendered":"Professionals"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"307\" class=\"elementor elementor-307\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f0e2692 e-con-full e-flex e-con e-parent\" data-id=\"f0e2692\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element- elementor-widget elementor-widget-shortcode\" data-id=\"\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"snl-kb\" data-no-translation><section class=\"snl-kb-sec hero\" id=\"intro\"><div class=\"snl-kb-in\"><p class=\"lbl\">For healthcare professionals<\/p><h1>Professionals<\/h1><p class=\"lead\">Guidelines, decision tools and recent evidence for the recognition and treatment of sepsis, from out-of-hours primary care to intensive care.<\/p><p>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.<\/p><div class=\"snl-toc\"><a href=\"#richtlijnen\">Guidelines<\/a><a href=\"#vergelijking\">Dutch and SSC side by side<\/a><a href=\"#keten\">Sepsis across the chain<\/a><a href=\"#trials\">Recent trials<\/a><a href=\"#kennislacunes\">Knowledge gaps<\/a><a href=\"#instrumenten\">Scores and tools<\/a><a href=\"#implementatie\">Implementation<\/a><\/div><div class=\"snl-card\" style=\"margin:24px 0;border-left:4px solid #64BD99\"><p class=\"lbl\">New<\/p><h3>Learning hub: learning by doing<\/h3><p>Calculate NEWS2, qSOFA and SOFA, explore the disease process from infection to organ failure and test your knowledge with seven cases.<\/p><p><a href=\"\/en\/professionals\/leeromgeving\/\">Go to the learning hub<\/a><\/p><\/div><figure class=\"snl-fig snl-photo\"><img decoding=\"async\" src=\"https:\/\/www.sepsisnet.nl\/wp-content\/uploads\/2025\/03\/online-marketing-hIgeoQjS_iE-unsplash-1536x864.jpg\" alt=\"Physician with stethoscope\" loading=\"lazy\" style=\"width:100%;height:340px;object-fit:cover;border-radius:14px;display:block\"><figcaption>Photo via Unsplash<\/figcaption><\/figure><\/div><\/section><section class=\"snl-kb-sec alt\" id=\"richtlijnen\"><div class=\"snl-kb-in\"><p class=\"lbl\">Guidelines<\/p><h2>Guidelines and reference<\/h2><div class=\"snl-grid\"><div class=\"snl-card\"><h3>Dutch sepsis guideline (NIV)<\/h3><p>Dutch guideline for adults: early recognition, biomarkers, oxygen, fluids, vasopressors, kidney replacement therapy, sedation, delirium, mobilisation, nutrition and aftercare.<\/p><p><a href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis\/startpagina_-_sepsis.html\" target=\"_blank\" rel=\"noopener\">Go to guideline<\/a><\/p><\/div><div class=\"snl-card\"><h3>Dutch guideline Sepsis in children<\/h3><p>Recognition with PEWS, diagnostics, treatment and organisation of care in children (2021).<\/p><p><a href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis_bij_kinderen\/startpagina_-_sepsis_bij_kinderen.html\" target=\"_blank\" rel=\"noopener\">Go to guideline<\/a><\/p><\/div><div class=\"snl-card\"><h3>SWAB<\/h3><p>Empirical antibiotic therapy for sepsis, tailored to Dutch resistance patterns.<\/p><p><a href=\"https:\/\/swab.nl\/nl\/sepsis\" target=\"_blank\" rel=\"noopener\">Go to SWAB<\/a><\/p><\/div><div class=\"snl-card\"><h3>Surviving Sepsis Campaign 2026<\/h3><p>International adult guideline: 129 statements, 46 of which are new compared with 2021.<\/p><p><a href=\"https:\/\/www.sccm.org\/survivingsepsiscampaign\/guidelines-and-resources\/surviving-sepsis-campaign-adult-guidelines\" target=\"_blank\" rel=\"noopener\">Adults<\/a> \u00b7 <a href=\"https:\/\/www.sccm.org\/survivingsepsiscampaign\/guidelines-and-resources\/surviving-sepsis-campaign-pediatric-guidelines\" target=\"_blank\" rel=\"noopener\">Children<\/a><\/p><\/div><div class=\"snl-card\"><h3>NICE NG51 (United Kingdom)<\/h3><p>Recognition, diagnosis and early management of sepsis, with risk stratification.<\/p><p><a href=\"https:\/\/www.nice.org.uk\/guidance\/ng51\" target=\"_blank\" rel=\"noopener\">Go to NICE<\/a><\/p><\/div><div class=\"snl-card\"><h3>Practical tools<\/h3><ul><li><a href=\"https:\/\/www.hetacuteboekje.nl\/hoofdstuk\/algemene_infectieziekten\/sepsis.html\" target=\"_blank\" rel=\"noopener\">Het Acute Boekje: sepsis (Dutch)<\/a><\/li><li><a href=\"https:\/\/swabid.nl\" target=\"_blank\" rel=\"noopener\">SWAB-ID: national antibiotic guide (Dutch)<\/a><\/li><\/ul><\/div><\/div><\/div><\/section><section class=\"snl-kb-sec\" id=\"vergelijking\"><div class=\"snl-kb-in\"><p class=\"lbl\">Evidence<\/p><h2>Dutch guideline and Surviving Sepsis Campaign side by side<\/h2><p>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.<\/p><div class=\"snl-tw\"><table class=\"snl-table\"><thead><tr><th>Topic<\/th><th>Dutch guideline (NIV)<\/th><th>Surviving Sepsis Campaign 2026<\/th><\/tr><\/thead><tbody><tr><td><strong>Screening<\/strong><\/td><td>MEWS or NEWS when infection is suspected, plus the signal question \"Could this be sepsis?\". No qSOFA.<\/td><td>NEWS, NEWS2, MEWS or SIRS over qSOFA as a single tool (strong). Use a screening tool prehospital (suggestion).<\/td><\/tr><tr><td><strong>Biomarkers<\/strong><\/td><td>CRP to make infection more or less likely; PCT, IL-6 and presepsin add no value.<\/td><td>Clinical evaluation alone over PCT plus clinical evaluation to start antimicrobials (suggestion). Measure lactate (suggestion).<\/td><\/tr><tr><td><strong>Antimicrobials: timing<\/strong><\/td><td>Not covered in this guideline; choice according to SWAB.<\/td><td>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).<\/td><\/tr><tr><td><strong>Antimicrobials: administration and duration<\/strong><\/td><td>Not covered.<\/td><td>Prolonged infusion of beta-lactams after a loading dose (recommendation, new). Shorter duration with adequate source control (suggestion).<\/td><\/tr><tr><td><strong>Fluids: volume<\/strong><\/td><td>At least 30 mL\/kg crystalloid within 3 hours; first 500 mL in 10 to 30 minutes in shock; evaluate within 1 hour.<\/td><td>At least 30 mL\/kg crystalloid within 3 hours in hypoperfusion or shock (suggestion, low certainty).<\/td><\/tr><tr><td><strong>Fluids: type<\/strong><\/td><td>Crystalloids; no albumin or other colloids; consider balanced solutions.<\/td><td>Balanced crystalloids over 0.9% saline (suggestion); no supplemental albumin (suggestion).<\/td><\/tr><tr><td><strong>Guiding resuscitation<\/strong><\/td><td>Lactate, at least every 6 hours and not more than every 2 hours, until normalised; preferably no other parameters.<\/td><td>Capillary refill time as an adjunct to other perfusion measures (suggestion).<\/td><\/tr><tr><td><strong>Vasopressors and blood pressure<\/strong><\/td><td>Norepinephrine first choice; vasopressin only for refractory hypotension. Inotropes: dobutamine or a PDE inhibitor.<\/td><td>Initial MAP of 65 mmHg (recommendation); 60 to 65 mmHg at age 65 and over (suggestion); peripheral start of vasopressors is acceptable (suggestion).<\/td><\/tr><tr><td><strong>Adjunctive therapy<\/strong><\/td><td>Not covered.<\/td><td>IV corticosteroids in septic shock (suggestion); no IV vitamin C (suggestion against).<\/td><\/tr><tr><td><strong>Aftercare<\/strong><\/td><td>Timely referral to information on long-term consequences; mention sepsis in the discharge letter; early mobilisation.<\/td><td>Written and verbal education, post-discharge follow-up, mental health support, rehabilitation after ventilation for more than 48 hours (suggestions).<\/td><\/tr><tr><td><strong>Organisation<\/strong><\/td><td>Local protocol: who is responsible for what, and on which ward.<\/td><td>Performance improvement programme with screening, standard operating procedures and quality measures (recommendation); code sepsis or sepsis huddle (suggestion).<\/td><\/tr><\/tbody><\/table><\/div><p class=\"snl-note\">Summarised and translated by SepsisNet from the <a class=\"snl-cite\" href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis\/startpagina_-_sepsis.html\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Richtlijn Sepsis. Richtlijnendatabase, modules 2020 tot 2024.\">Dutch sepsis guideline<\/a> and the SSC 2026 guideline <a class=\"snl-cite ssc\" href=\"https:\/\/doi.org\/10.1097\/CCM.0000000000007075\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med 2026. doi.\">SSC 2026<\/a>. Strength per SSC: recommendation (strong) or suggestion (conditional).<\/p><\/div><\/section><section class=\"snl-kb-sec alt\" id=\"keten\"><div class=\"snl-kb-in\"><p class=\"lbl\">Chain of care<\/p><h2>Sepsis across the chain of care<\/h2><p>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 <a class=\"snl-cite\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30224394\/\" target=\"_blank\" rel=\"noopener\" data-ref=\"Loots FJ, Smits M, van Steensel C, et al. Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit. BMJ Open 2018;8:e022832. PMID 30224394.\" data-pmid=\"30224394\">Loots, BMJ Open 2018<\/a>. Recognition and handover of urgency before hospital are therefore the weak links.<\/p><div class=\"snl-tw\"><table class=\"snl-table\"><thead><tr><th>Link<\/th><th>Recognition<\/th><th>Treatment and handover<\/th><th>Follow-up<\/th><\/tr><\/thead><tbody><tr><td><strong>Public and relatives<\/strong><\/td><td>Know the warning signs; when in doubt, call and use the word sepsis.<\/td><td>Get back in touch if things get worse.<\/td><td>Know when to seek help again.<\/td><\/tr><tr><td><strong>GP and out-of-hours service<\/strong><\/td><td>Consider sepsis in a rapidly deteriorating patient; measure vital signs; also without a clear infection.<\/td><td>Structured referral with pre-alert; hand over urgency explicitly.<\/td><td>Follow-up after sepsis; ask about symptoms.<\/td><\/tr><tr><td><strong>Ambulance<\/strong><\/td><td>Full set of vital signs; screening tool.<\/td><td>Pre-alert when sepsis is suspected; with long transport time and shock, consider antimicrobials (SSC).<\/td><td>Hand over context to the hospital.<\/td><\/tr><tr><td><strong>Emergency department<\/strong><\/td><td>Triage, MEWS or NEWS, lactate, cultures.<\/td><td>Antimicrobials within 1 hour in probable sepsis or shock; fluids; plan source control.<\/td><td>Discuss goals of care; admit to the right place.<\/td><\/tr><tr><td><strong>Ward and ICU<\/strong><\/td><td>Early warning and rapid response; reassessment.<\/td><td>Vasopressors, organ support, de-escalation and short duration.<\/td><td>Early mobilisation; sepsis in the discharge letter; education.<\/td><\/tr><tr><td><strong>After discharge<\/strong><\/td><td>Recognise long-term problems.<\/td><td>Prevent readmission; treat new infections promptly.<\/td><td>Rehabilitation, psychological support, peer support.<\/td><\/tr><\/tbody><\/table><\/div><p class=\"snl-note\">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 <a class=\"snl-cite\" href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis\/startpagina_-_sepsis.html\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Richtlijn Sepsis. Richtlijnendatabase, modules 2020 tot 2024.\">Dutch guideline Sepsis<\/a> and the SSC guideline <a class=\"snl-cite ssc\" href=\"https:\/\/doi.org\/10.1097\/CCM.0000000000007075\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med 2026. doi.\">SSC 2026<\/a>.<\/p><\/div><\/section><section class=\"snl-kb-sec\" id=\"trials\"><div class=\"snl-kb-in\"><p class=\"lbl\">Evidence<\/p><h2>Key trials of the past five years<\/h2><p class=\"lead\">Randomised trials that changed or confirmed sepsis care since 2021. Phase 2 results are hypothesis-generating. Click a source label for the publication.<\/p><figure class=\"snl-fig\"><svg viewbox=\"0 0 900 225\" role=\"img\" aria-label=\"Timeline of landmark trials\" font-family=\"Helvetica,Arial,sans-serif\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><rect x=\"60\" y=\"56\" width=\"780\" height=\"8\" rx=\"4\" fill=\"#E3EDEE\"\/><circle cx=\"80\" cy=\"60\" r=\"9\" fill=\"#31575F\"\/><text x=\"80\" y=\"38\" text-anchor=\"middle\" font-size=\"16\" font-weight=\"700\" fill=\"#31575F\">2021<\/text><rect x=\"10\" y=\"92\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#8a9ba0\"\/><text x=\"80\" y=\"107\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">BaSICS<\/text><circle cx=\"228\" cy=\"60\" r=\"9\" fill=\"#31575F\"\/><text x=\"228\" y=\"38\" text-anchor=\"middle\" font-size=\"16\" font-weight=\"700\" fill=\"#31575F\">2022<\/text><rect x=\"158\" y=\"92\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#8a9ba0\"\/><text x=\"228\" y=\"107\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">CLASSIC<\/text><rect x=\"158\" y=\"118\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#8a9ba0\"\/><text x=\"228\" y=\"133\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">PLUS<\/text><rect x=\"158\" y=\"144\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#C1282D\"\/><text x=\"228\" y=\"159\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">LOVIT<\/text><circle cx=\"376\" cy=\"60\" r=\"9\" fill=\"#31575F\"\/><text x=\"376\" y=\"38\" text-anchor=\"middle\" font-size=\"16\" font-weight=\"700\" fill=\"#31575F\">2023<\/text><rect x=\"306\" y=\"92\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#8a9ba0\"\/><text x=\"376\" y=\"107\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">CLOVERS<\/text><rect x=\"306\" y=\"118\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#2E7668\"\/><text x=\"376\" y=\"133\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">CAPE COD<\/text><circle cx=\"524\" cy=\"60\" r=\"9\" fill=\"#31575F\"\/><text x=\"524\" y=\"38\" text-anchor=\"middle\" font-size=\"16\" font-weight=\"700\" fill=\"#31575F\">2024<\/text><rect x=\"454\" y=\"92\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#8a9ba0\"\/><text x=\"524\" y=\"107\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">BLING III<\/text><circle cx=\"672\" cy=\"60\" r=\"9\" fill=\"#31575F\"\/><text x=\"672\" y=\"38\" text-anchor=\"middle\" font-size=\"16\" font-weight=\"700\" fill=\"#31575F\">2025<\/text><rect x=\"602\" y=\"92\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#d08a00\"\/><text x=\"672\" y=\"107\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">ImmunoSep<\/text><rect x=\"602\" y=\"118\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#2E7668\"\/><text x=\"672\" y=\"133\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">BALANCE<\/text><rect x=\"602\" y=\"144\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#2E7668\"\/><text x=\"672\" y=\"159\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">ADAPT-Sepsis<\/text><rect x=\"602\" y=\"170\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#2E7668\"\/><text x=\"672\" y=\"185\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">ANDROMEDA-SHOCK-2<\/text><circle cx=\"820\" cy=\"60\" r=\"9\" fill=\"#31575F\"\/><text x=\"820\" y=\"38\" text-anchor=\"middle\" font-size=\"16\" font-weight=\"700\" fill=\"#31575F\">2026<\/text><rect x=\"750\" y=\"92\" width=\"140\" height=\"21\" rx=\"10.5\" fill=\"#8a9ba0\"\/><text x=\"820\" y=\"107\" text-anchor=\"middle\" font-size=\"11.5\" font-weight=\"700\" fill=\"#fff\">ARISE FLUIDS<\/text><circle cx=\"110\" cy=\"208\" r=\"7\" fill=\"#2E7668\"\/><text x=\"122\" y=\"213\" font-size=\"12.5\" fill=\"#31575F\">Positive or non-inferior<\/text><circle cx=\"310\" cy=\"208\" r=\"7\" fill=\"#8a9ba0\"\/><text x=\"322\" y=\"213\" font-size=\"12.5\" fill=\"#31575F\">Neutral<\/text><circle cx=\"510\" cy=\"208\" r=\"7\" fill=\"#C1282D\"\/><text x=\"522\" y=\"213\" font-size=\"12.5\" fill=\"#31575F\">Harmful<\/text><circle cx=\"710\" cy=\"208\" r=\"7\" fill=\"#d08a00\"\/><text x=\"722\" y=\"213\" font-size=\"12.5\" fill=\"#31575F\">Promising, phase 2<\/text><\/svg><\/figure><div class=\"snl-filter\" role=\"group\"><button type=\"button\" class=\"on\" data-f=\"all\">All<\/button><button type=\"button\" data-f=\"imm\">Immunotherapy<\/button><button type=\"button\" data-f=\"ab\">Antibiotics<\/button><button type=\"button\" data-f=\"flu\">Fluids and circulation<\/button><button type=\"button\" data-f=\"adj\">Adjunctive therapy<\/button><\/div><div class=\"snl-trials\"><article class=\"snl-trial prom\" data-t=\"imm\"><span class=\"tag prom\">Promising, phase 2<\/span><h4>ImmunoSep<\/h4><p class=\"meta\">Immunotherapy \u00b7 JAMA 2025 \u00b7 phase 2b, 6 European countries (incl. the Netherlands) \u00b7 281 randomised<\/p><p>Immunotherapy guided by immune phenotype: anakinra for macrophage activation-like syndrome (ferritin &gt; 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%).<\/p><p class=\"so\"><b>Implication:<\/b> 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.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2025.24175\" target=\"_blank\" rel=\"noopener\" data-ref=\"Giamarellos-Bourboulis EJ, Kotsaki A, Kotsamidi I, et al; ImmunoSep Study Group. Precision immunotherapy to improve sepsis outcomes: the ImmunoSep randomized clinical trial. JAMA 2026;335(9):775-786.\" data-pmid=\"41359996\">ImmunoSep, JAMA 2025<\/a><\/p><\/article><article class=\"snl-trial neu\" data-t=\"ab\"><span class=\"tag neu\">Neutral<\/span><h4>BLING III<\/h4><p class=\"meta\">Antibiotics \u00b7 JAMA 2024 \u00b7 7,031 ICU patients with sepsis<\/p><p>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).<\/p><p class=\"so\"><b>Implication:<\/b> SSC 2026 suggests prolonged infusion after a loading dose where feasible.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2024.9779\" target=\"_blank\" rel=\"noopener\" data-ref=\"Dulhunty JM, Brett SJ, De Waele JJ, et al. Continuous vs intermittent \u03b2-lactam antibiotic infusions in critically ill patients with sepsis: the BLING III randomized clinical trial. JAMA 2024;332:629-37. PMID 38864155.\" data-pmid=\"38864155\">BLING III, JAMA 2024<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2024.9803\" target=\"_blank\" rel=\"noopener\" data-ref=\"Abdul-Aziz MH, Hammond NE, Brett SJ, et al. Prolonged vs intermittent infusions of \u03b2-lactam antibiotics in adults with sepsis or septic shock: a systematic review and meta-analysis. JAMA 2024. PMID 38864162.\" data-pmid=\"38864162\">Abdul-Aziz, JAMA 2024<\/a> <a class=\"snl-cite ssc\" href=\"https:\/\/doi.org\/10.1097\/CCM.0000000000007075\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med 2026. doi.\">SSC 2026<\/a><\/p><\/article><article class=\"snl-trial pos\" data-t=\"ab\"><span class=\"tag pos\">Positive or non-inferior<\/span><h4>BALANCE<\/h4><p class=\"meta\">Antibiotics \u00b7 NEJM 2025 \u00b7 3,608 patients with bloodstream infection<\/p><p>7 versus 14 days of antibiotics for bloodstream infection: 90-day mortality 14.5% vs 16.1%, non-inferior.<\/p><p class=\"so\"><b>Implication:<\/b> Short courses are safe with clinical improvement and source control; exceptions such as S. aureus and endocarditis remain.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2404991\" target=\"_blank\" rel=\"noopener\" data-ref=\"BALANCE Investigators. Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections. N Engl J Med 2025;392:1065-78. PMID 39565030.\" data-pmid=\"39565030\">BALANCE, NEJM 2025<\/a><\/p><\/article><article class=\"snl-trial pos\" data-t=\"ab\"><span class=\"tag pos\">Positive or non-inferior<\/span><h4>ADAPT-Sepsis<\/h4><p class=\"meta\">Antibiotics \u00b7 JAMA 2025 \u00b7 2,760 hospitalised patients with suspected sepsis<\/p><p>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.<\/p><p class=\"so\"><b>Implication:<\/b> Procalcitonin can support stopping, not starting, antibiotics.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=Biomarker-guided%20antibiotic%20duration%20for%20hospitalized%20patients%20with%20suspected%20sepsis%20ADAPT-Sepsis\" target=\"_blank\" rel=\"noopener\" data-ref=\"Dark P, Hossain A, McAuley DF, et al. Biomarker-guided antibiotic duration for hospitalized patients with suspected sepsis: the ADAPT-Sepsis randomized clinical trial. JAMA 2025;333:682-93. PMID 39652885.\" data-pmid=\"39652885\">ADAPT-Sepsis, JAMA 2025<\/a><\/p><\/article><article class=\"snl-trial neu\" data-t=\"flu\"><span class=\"tag neu\">Neutral<\/span><h4>CLOVERS<\/h4><p class=\"meta\">Fluids and circulation \u00b7 NEJM 2023 \u00b7 1,563 patients with sepsis-induced hypotension<\/p><p>Restrictive (early vasopressors) versus liberal fluids: 90-day mortality 14.0% vs 14.9%, no difference.<\/p><p class=\"so\"><b>Implication:<\/b> Both strategies are reasonable; individualise according to perfusion and fluid responsiveness.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2212663\" target=\"_blank\" rel=\"noopener\" data-ref=\"CLOVERS Investigators (PETAL Network). Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med 2023;388:499-510. PMID 36688507.\" data-pmid=\"36688507\">CLOVERS, NEJM 2023<\/a><\/p><\/article><article class=\"snl-trial neu\" data-t=\"flu\"><span class=\"tag neu\">Neutral<\/span><h4>ARISE FLUIDS<\/h4><p class=\"meta\">Fluids and circulation \u00b7 NEJM 2026 \u00b7 1,000 ED patients with septic shock<\/p><p>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%.<\/p><p class=\"so\"><b>Implication:<\/b> Confirms CLOVERS: both strategies are reasonable. Less fluid caused less pulmonary oedema, without a survival benefit.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2516225\" target=\"_blank\" rel=\"noopener\" data-ref=\"ARISE FLUIDS Investigators. Vasopressors or Fluids in Early Septic Shock. N Engl J Med 2026. PMID 42274006.\" data-pmid=\"42274006\">ARISE FLUIDS, NEJM 2026<\/a><\/p><\/article><article class=\"snl-trial neu\" data-t=\"flu\"><span class=\"tag neu\">Neutral<\/span><h4>CLASSIC<\/h4><p class=\"meta\">Fluids and circulation \u00b7 NEJM 2022 \u00b7 1,554 ICU patients with septic shock<\/p><p>Restrictive versus standard IV fluid after initial resuscitation: 90-day mortality 42.3% vs 42.1%; median 1.8 vs 3.8 litres.<\/p><p class=\"so\"><b>Implication:<\/b> Less fluid after the initial phase is not harmful; routine continued fluid gives no benefit.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2202707\" target=\"_blank\" rel=\"noopener\" data-ref=\"Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med 2022;386:2459-70.\" data-pmid=\"35709019\">CLASSIC, NEJM 2022<\/a><\/p><\/article><article class=\"snl-trial pos\" data-t=\"flu\"><span class=\"tag pos\">Positive or non-inferior<\/span><h4>ANDROMEDA-SHOCK-2<\/h4><p class=\"meta\">Fluids and circulation \u00b7 JAMA 2025 \u00b7 early septic shock<\/p><p>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.<\/p><p class=\"so\"><b>Implication:<\/b> Supports capillary refill time as a simple, repeatable bedside perfusion target.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2025.20402\" target=\"_blank\" rel=\"noopener\" data-ref=\"ANDROMEDA-SHOCK-2 Investigators. Personalized hemodynamic resuscitation targeting capillary refill time in early septic shock. JAMA 2025;334:1988-99. doi.\" data-pmid=\"41159835\">ANDROMEDA-SHOCK-2, JAMA 2025<\/a><\/p><\/article><article class=\"snl-trial neu\" data-t=\"flu\"><span class=\"tag neu\">Neutral<\/span><h4>PLUS en BaSICS<\/h4><p class=\"meta\">Fluids and circulation \u00b7 NEJM 2022 (n = 5,037) and JAMA 2021 (n = 10,520) \u00b7 ICU patients<\/p><p>Balanced crystalloids versus 0.9% saline: no significant difference in 90-day mortality (21.8% vs 22.0% and 26.4% vs 27.2%).<\/p><p class=\"so\"><b>Implication:<\/b> Meta-analyses suggest a small probable benefit; SSC 2026 favours balanced solutions. Caution in traumatic brain injury.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2114464\" target=\"_blank\" rel=\"noopener\" data-ref=\"Finfer S, Micallef S, Hammond N, et al. Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med 2022;386:815-26.\" data-pmid=\"35041780\">PLUS, NEJM 2022<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2021.11684\" target=\"_blank\" rel=\"noopener\" data-ref=\"Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA 2021;326:818-29.\">BaSICS, JAMA 2021<\/a> <a class=\"snl-cite ssc\" href=\"https:\/\/doi.org\/10.1097\/CCM.0000000000007075\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med 2026. doi.\">SSC 2026<\/a><\/p><\/article><article class=\"snl-trial pos\" data-t=\"adj\"><span class=\"tag pos\">Positive or non-inferior<\/span><h4>CAPE COD<\/h4><p class=\"meta\">Adjunctive therapy \u00b7 NEJM 2023 \u00b7 800 ICU patients with severe pneumonia<\/p><p>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.<\/p><p class=\"so\"><b>Implication:<\/b> Consider hydrocortisone for severe pneumonia in the ICU; in septic shock the existing corticosteroid recommendation applies.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2215145\" target=\"_blank\" rel=\"noopener\" data-ref=\"Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med 2023;388:1931-41.\" data-pmid=\"36942789\">CAPE COD, NEJM 2023<\/a><\/p><\/article><article class=\"snl-trial harm\" data-t=\"adj\"><span class=\"tag harm\">Harmful<\/span><h4>LOVIT<\/h4><p class=\"meta\">Adjunctive therapy \u00b7 NEJM 2022 \u00b7 872 ICU patients with sepsis on vasopressors<\/p><p>High-dose intravenous vitamin C: more death or persistent organ dysfunction at day 28 (44.5% vs 38.5%; RR 1.21).<\/p><p class=\"so\"><b>Implication:<\/b> Vitamin C should not be used to treat sepsis.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2200644\" target=\"_blank\" rel=\"noopener\" data-ref=\"Lamontagne F, Masse MH, Menard J, et al. Intravenous vitamin C in adults with sepsis in the intensive care unit. N Engl J Med 2022;386:2387-98.\" data-pmid=\"35704292\">LOVIT, NEJM 2022<\/a> <a class=\"snl-cite ssc\" href=\"https:\/\/doi.org\/10.1097\/CCM.0000000000007075\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med 2026. doi.\">SSC 2026<\/a><\/p><\/article><\/div><p class=\"snl-note\">Overview compiled by SepsisNet; not a substitute for the guideline. Last checked: November 2026.<\/p><\/div><\/section><section class=\"snl-kb-sec alt\" id=\"kennislacunes\"><div class=\"snl-kb-in\"><p class=\"lbl\">Research<\/p><h2>Knowledge gaps in sepsis care<\/h2><p class=\"lead\">Where is evidence lacking? An overview based on Dutch guidelines, the knowledge agendas of professional societies and the Surviving Sepsis Campaign research priorities.<\/p><div class=\"snl-grid\"><div class=\"snl-card\"><h3>Early recognition<\/h3><p>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%.<\/p><p class=\"cs\"><a class=\"snl-cite ssc\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38240508\/\" target=\"_blank\" rel=\"noopener\" data-ref=\"De Backer D, Deutschman CS, Hellman J, et al. Surviving Sepsis Campaign Research Priorities 2023. Crit Care Med 2024;52:268-96.\" data-pmid=\"38240508\">SSC Research Priorities 2023<\/a> <a class=\"snl-cite\" href=\"https:\/\/www.internisten.nl\/wp-content\/uploads\/2023\/03\/NIV-kennisagenda-def.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Kennisagenda Interne Geneeskunde 2022-2025 (top 24 kennisvragen). Utrecht: NIV, 2023.\">NIV Knowledge agenda 2022-2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/henw.org\/system\/files\/download\/2297_OnlinePDF.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Loots F. Een nieuwe, eenvoudige score voor sepsis. Huisarts en Wetenschap.\">Loots, H&amp;W<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.3399\/BJGPO.2022.0029\" target=\"_blank\" rel=\"noopener\" data-ref=\"Loots FJ, Dekker I, Wang RC, et al. The accuracy and feasibility of respiratory rate measurements in acutely ill adult patients by GPs: a mixed-methods study. BJGP Open 2022;6. PMID 35944945.\" data-pmid=\"35944945\">Loots, BJGP Open 2022<\/a><\/p><\/div><div class=\"snl-card\"><h3>Sepsis in children<\/h3><p>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?<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/assets.nvk.nl\/p\/491522\/files\/NVK%20Kennisagenda_20200618_def.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Vereniging voor Kindergeneeskunde. Kennisagenda Algemene Kindergeneeskunde, top 10 kennishiaten. Utrecht: NVK, 2020.\">NVK Knowledge agenda<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2024.0179\" target=\"_blank\" rel=\"noopener\" data-ref=\"Schlapbach LJ, Watson RS, Sorce LR, et al. International consensus criteria for pediatric sepsis and septic shock. JAMA 2024;331:665-74.\" data-pmid=\"38245889\">Phoenix, JAMA 2024<\/a><\/p><\/div><div class=\"snl-card\"><h3>Individualised fluids and vasopressors<\/h3><p>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.<\/p><p class=\"cs\"><a class=\"snl-cite ssc\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38240508\/\" target=\"_blank\" rel=\"noopener\" data-ref=\"De Backer D, Deutschman CS, Hellman J, et al. Surviving Sepsis Campaign Research Priorities 2023. Crit Care Med 2024;52:268-96.\" data-pmid=\"38240508\">SSC Research Priorities 2023<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2212663\" target=\"_blank\" rel=\"noopener\" data-ref=\"CLOVERS Investigators (PETAL Network). Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med 2023;388:499-510. PMID 36688507.\" data-pmid=\"36688507\">CLOVERS, NEJM 2023<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2202707\" target=\"_blank\" rel=\"noopener\" data-ref=\"Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med 2022;386:2459-70.\" data-pmid=\"35709019\">CLASSIC, NEJM 2022<\/a><\/p><\/div><div class=\"snl-card\"><h3>Precision medicine<\/h3><p>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.<\/p><p class=\"cs\"><a class=\"snl-cite ssc\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38240508\/\" target=\"_blank\" rel=\"noopener\" data-ref=\"De Backer D, Deutschman CS, Hellman J, et al. Surviving Sepsis Campaign Research Priorities 2023. Crit Care Med 2024;52:268-96.\" data-pmid=\"38240508\">SSC Research Priorities 2023<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2025.24175\" target=\"_blank\" rel=\"noopener\" data-ref=\"Giamarellos-Bourboulis EJ, Kotsaki A, Kotsamidi I, et al; ImmunoSep Study Group. Precision immunotherapy to improve sepsis outcomes: the ImmunoSep randomized clinical trial. JAMA 2026;335(9):775-786.\" data-pmid=\"41359996\">ImmunoSep, JAMA 2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1038\/s41591-025-03964-5\" target=\"_blank\" rel=\"noopener\" data-ref=\"Scicluna BP, Cano-Gamez K, Burnham KL, et al. A consensus blood transcriptomic framework for sepsis. Nat Med 2025;31:4119-4130. PMID 41028542.\" data-pmid=\"41028542\">Scicluna, Nat Med 2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1038\/s41591-025-03956-5\" target=\"_blank\" rel=\"noopener\" data-ref=\"Moore AR, Zheng H, Ganesan A, et al. A consensus immune dysregulation framework for sepsis and critical illnesses. Nat Med 2025;31:4084-4096. PMID 41028543.\" data-pmid=\"41028543\">Moore, Nat Med 2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1016\/j.ebiom.2024.105414\" target=\"_blank\" rel=\"noopener\" data-ref=\"Giamarellos-Bourboulis EJ, Antonelli M, Bloos F, et al. Interferon-gamma driven elevation of CXCL9: a new sepsis endotype independently associated with mortality. EBioMedicine 2024;109:105414. PMID 39447386.\" data-pmid=\"39447386\">IFN-\u03b3 endotype, EBioMedicine 2024<\/a><\/p><\/div><div class=\"snl-card\"><h3>Mechanisms of organ injury<\/h3><p>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.<\/p><p class=\"cs\"><a class=\"snl-cite ssc\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38240508\/\" target=\"_blank\" rel=\"noopener\" data-ref=\"De Backer D, Deutschman CS, Hellman J, et al. Surviving Sepsis Campaign Research Priorities 2023. Crit Care Med 2024;52:268-96.\" data-pmid=\"38240508\">SSC Research Priorities 2023<\/a><\/p><\/div><div class=\"snl-card\"><h3>Antibiotics<\/h3><p>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.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/www.internisten.nl\/wp-content\/uploads\/2023\/03\/NIV-kennisagenda-def.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Kennisagenda Interne Geneeskunde 2022-2025 (top 24 kennisvragen). Utrecht: NIV, 2023.\">NIV Knowledge agenda 2022-2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1056\/NEJMoa2404991\" target=\"_blank\" rel=\"noopener\" data-ref=\"BALANCE Investigators. Antibiotic treatment for 7 versus 14 days in patients with bloodstream infections. N Engl J Med 2025;392:1065-78. PMID 39565030.\" data-pmid=\"39565030\">BALANCE, NEJM 2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=Biomarker-guided%20antibiotic%20duration%20for%20hospitalized%20patients%20with%20suspected%20sepsis%20ADAPT-Sepsis\" target=\"_blank\" rel=\"noopener\" data-ref=\"Dark P, Hossain A, McAuley DF, et al. Biomarker-guided antibiotic duration for hospitalized patients with suspected sepsis: the ADAPT-Sepsis randomized clinical trial. JAMA 2025;333:682-93. PMID 39652885.\">ADAPT-Sepsis, JAMA 2025<\/a><\/p><\/div><div class=\"snl-card\"><h3>Supportive ICU care<\/h3><p>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.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis\/mobilisatie.html\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging \/ NVIC. Richtlijn Sepsis, module Mobilisatie, 2022.\">Dutch guideline: mobilisation<\/a> <a class=\"snl-cite\" href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis\/nierfunctievervangende_therapie\/nierfunctievervangende_therapie_modaliteit.html\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging \/ NVIC. Richtlijn Sepsis, module Nierfunctievervangende therapie: modaliteit, 2022.\">Dutch guideline: renal replacement<\/a><\/p><\/div><div class=\"snl-card\"><h3>Recovery and aftercare<\/h3><p>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.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/www.internisten.nl\/wp-content\/uploads\/2023\/03\/NIV-kennisagenda-def.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Kennisagenda Interne Geneeskunde 2022-2025 (top 24 kennisvragen). Utrecht: NIV, 2023.\">NIV Knowledge agenda 2022-2025<\/a> <a class=\"snl-cite\" href=\"https:\/\/scholar.google.com\/scholar?q=%22Development+of+a+research+agenda+for+critical+care+medicine+in+the+Netherlands%22\" target=\"_blank\" rel=\"noopener\" data-ref=\"Juffermans NP, Heunks L, Pickkers P, et al. Development of a research agenda for critical care medicine in the Netherlands: the time is now. Neth J Crit Care 2021;29:246-52.\">NVIC research agenda 2021<\/a> <a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2017.17687\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Angus DC. Enhancing recovery from sepsis: a review. JAMA 2018;319:62-75.\" data-pmid=\"29297082\">Prescott, JAMA 2018<\/a><\/p><\/div><div class=\"snl-card\"><h3>Data and infrastructure<\/h3><p>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.<\/p><p class=\"cs\"><span class=\"snl-note\">National Sepsis Action Plan, draft 2026<\/span><\/p><\/div><\/div><h3>Knowledge agendas of professional societies<\/h3><div class=\"snl-tw\"><table class=\"snl-table\"><thead><tr><th>Agenda<\/th><th>Relevance to sepsis<\/th><th>Source<\/th><\/tr><\/thead><tbody><tr><td><b>NIV Knowledge agenda 2022-2025<\/b><\/td><td>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).<\/td><td><a class=\"snl-cite\" href=\"https:\/\/www.internisten.nl\/wp-content\/uploads\/2023\/03\/NIV-kennisagenda-def.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Kennisagenda Interne Geneeskunde 2022-2025 (top 24 kennisvragen). Utrecht: NIV, 2023.\">NIV Knowledge agenda 2022-2025<\/a><\/td><\/tr><tr><td><b>NVIC research agenda<\/b><\/td><td>Knowledge gaps in eight domains, including haemodynamics, infection, inflammation, post-intensive care syndrome and artificial intelligence; no clear priority between domains.<\/td><td><a class=\"snl-cite\" href=\"https:\/\/scholar.google.com\/scholar?q=%22Development+of+a+research+agenda+for+critical+care+medicine+in+the+Netherlands%22\" target=\"_blank\" rel=\"noopener\" data-ref=\"Juffermans NP, Heunks L, Pickkers P, et al. Development of a research agenda for critical care medicine in the Netherlands: the time is now. Neth J Crit Care 2021;29:246-52.\">NVIC research agenda 2021<\/a><\/td><\/tr><tr><td><b>NVK Knowledge agenda<\/b><\/td><td>Top 10 gaps in general paediatrics, including identification of newborns at risk of early-onset neonatal sepsis and recognition of serious illness by parents.<\/td><td><a class=\"snl-cite\" href=\"https:\/\/assets.nvk.nl\/p\/491522\/files\/NVK%20Kennisagenda_20200618_def.pdf\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Vereniging voor Kindergeneeskunde. Kennisagenda Algemene Kindergeneeskunde, top 10 kennishiaten. Utrecht: NVK, 2020.\">NVK Knowledge agenda<\/a><\/td><\/tr><tr><td><b>Surviving Sepsis Campaign 2023<\/b><\/td><td>Five clinical priorities (recognition, organ injury, fluids, vasopressors, precision medicine) and five basic science priorities (animal models, translatable outcomes, brain, microbiome, (epi)genetics).<\/td><td><a class=\"snl-cite ssc\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/38240508\/\" target=\"_blank\" rel=\"noopener\" data-ref=\"De Backer D, Deutschman CS, Hellman J, et al. Surviving Sepsis Campaign Research Priorities 2023. Crit Care Med 2024;52:268-96.\" data-pmid=\"38240508\">SSC Research Priorities 2023<\/a><\/td><\/tr><tr><td><b>National Sepsis Action Plan<\/b><\/td><td>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.<\/td><td>draft 2026<\/td><\/tr><\/tbody><\/table><\/div><p>Working on one of these questions? Register your research in the SepsisNet research network, so we can connect initiatives and advocate for funding together.<\/p><p><a class=\"snl-btn\" href=\"https:\/\/www.sepsisnet.nl\/?page_id=652\">Go to the research network<\/a><\/p><\/div><\/section><section class=\"snl-kb-sec\" id=\"instrumenten\"><div class=\"snl-kb-in\"><p class=\"lbl\">Tools<\/p><h2>Scores and calculators<\/h2><p>Want to practise? Calculate NEWS2, qSOFA and SOFA with instant explanations in the <a href=\"\/en\/professionals\/leeromgeving\/#lo-scores\">learning hub<\/a>.<\/p><div class=\"snl-grid\"><div class=\"snl-card\"><h3>NEWS2<\/h3><p>Recommended for screening acutely ill patients (Dutch guideline and SSC).<\/p><p><a href=\"https:\/\/www.rcp.ac.uk\/improving-care\/resources\/national-early-warning-score-news-2\/\" target=\"_blank\" rel=\"noopener\">Royal College of Physicians<\/a><\/p><\/div><div class=\"snl-card\"><h3>MEWS<\/h3><p>Alternative to NEWS; set thresholds and measurement frequency locally.<\/p><p><a href=\"https:\/\/www.mdcalc.com\/calc\/1875\/modified-early-warning-score-mews-clinical-deterioration\" target=\"_blank\" rel=\"noopener\">MDCalc<\/a><\/p><\/div><div class=\"snl-card\"><h3>SOFA<\/h3><p>Measures organ dysfunction; an increase of 2 points or more with infection is consistent with sepsis (Sepsis-3).<\/p><p><a href=\"https:\/\/www.mdcalc.com\/calc\/691\/sequential-organ-failure-assessment-sofa-score\" target=\"_blank\" rel=\"noopener\">MDCalc<\/a><\/p><\/div><div class=\"snl-card\"><h3>qSOFA<\/h3><p>Predicts mortality but is not sensitive enough: do not use as a single screening tool.<\/p><p><a href=\"https:\/\/www.mdcalc.com\/calc\/2654\/qsofa-quick-sofa-score-sepsis\" target=\"_blank\" rel=\"noopener\">MDCalc<\/a><\/p><\/div><div class=\"snl-card\"><h3>Dutch PEWS<\/h3><p>Paediatric early warning score, including parental concern.<\/p><p><a href=\"https:\/\/nivel.nl\/sites\/default\/files\/bestanden\/Infographic_Dutch_PEWS.pdf\" target=\"_blank\" rel=\"noopener\">Nivel infographic<\/a><\/p><\/div><div class=\"snl-card\"><h3>Phoenix Sepsis Score<\/h3><p>Definition of sepsis and septic shock in children (2024).<\/p><p><a href=\"https:\/\/doi.org\/10.1001\/jama.2024.0179\" target=\"_blank\" rel=\"noopener\">JAMA 2024<\/a><\/p><\/div><div class=\"snl-card\"><h3>SOFA-2<\/h3><p>Revised SOFA score (2025), developed and validated in large international cohorts, with updated criteria per organ system.<\/p><p class=\"cs\"><a class=\"snl-cite\" href=\"https:\/\/doi.org\/10.1001\/jama.2025.20516\" target=\"_blank\" rel=\"noopener\" data-ref=\"Ranzani OT, Singer M, Salluh JIF, et al. Development and Validation of the Sequential Organ Failure Assessment (SOFA)-2 Score. JAMA 2025;334:2090-2103. PMID 41159833.\" data-pmid=\"41159833\">Ranzani, JAMA 2025<\/a><\/p><\/div><\/div><\/div><\/section><section class=\"snl-kb-sec alt\" id=\"implementatie\"><div class=\"snl-kb-in\"><p class=\"lbl\">Implementation<\/p><h2>Organising sepsis care<\/h2><div class=\"snl-ev ssc\"><p class=\"src\">Surviving Sepsis Campaign 2026 <span class=\"pill\">recommendation<\/span><\/p><p>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.<\/p><p class=\"ref\">Summarised from <a class=\"snl-cite ssc\" href=\"https:\/\/doi.org\/10.1097\/CCM.0000000000007075\" target=\"_blank\" rel=\"noopener\" data-ref=\"Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Crit Care Med 2026. doi.\">SSC 2026<\/a><\/p><\/div><div class=\"snl-ev\"><p class=\"src\">Dutch sepsis guideline <span class=\"pill\">Organisation of care<\/span><\/p><p>Record in a local protocol who is responsible for each part of sepsis care and on which ward it takes place.<\/p><p class=\"ref\">Summarised from the Dutch sepsis guideline <a class=\"snl-cite\" href=\"https:\/\/richtlijnendatabase.nl\/richtlijn\/sepsis\/startpagina_-_sepsis.html\" target=\"_blank\" rel=\"noopener\" data-ref=\"Nederlandse Internisten Vereniging. Richtlijn Sepsis. Richtlijnendatabase, modules 2020 tot 2024.\">Dutch guideline Sepsis<\/a><\/p><\/div><p>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.<\/p><\/div><\/section><\/div><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-307","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/pages\/307","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/comments?post=307"}],"version-history":[{"count":46,"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/pages\/307\/revisions"}],"predecessor-version":[{"id":984,"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/pages\/307\/revisions\/984"}],"wp:attachment":[{"href":"https:\/\/www.sepsisnet.nl\/en\/wp-json\/wp\/v2\/media?parent=307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}