Evaluation and Management of Suspected Sepsis and Septic Shock in Adult Patients

Authors

  • Azwar Iwan
    Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Universitas Sumatera Utara General Hospital, Medan, Indonesia

Abstract

Introduction: Sepsis and septic shock represent critical medical emergencies with persistently high global mortality, ranging from 20% to 40% in severe cases. Prompt evaluation and early, time-sensitive management are essential to improve outcomes. This review highlights a pragmatic, evidence-based approach to the evaluation and management of suspected sepsis and septic shock in adults, aligned with current international guidelines and key clinical trials.


Case Description: A 68-year-old man with a history of diabetes mellitus presented with fever, hypotension (mean arterial pressure 58 mmHg), tachycardia, and altered mental status. Laboratory investigations revealed leukocytosis and markedly elevated serum lactate levels (4.8 mmol/L). A urinary tract infection was identified as the potential source. Peripheral blood cultures were obtained from two sites prior to antimicrobial therapy. Broad-spectrum antibiotics (piperacillin–tazobactam and vancomycin) were initiated within 45 minutes, followed by resuscitation with 30 mL/kg balanced crystalloid solution. Persistent hypotension necessitated norepinephrine infusion, achieving a target mean arterial pressure ≥65 mmHg. Serial lactate monitoring guided ongoing resuscitation. Procalcitonin levels supported antibiotic de-escalation after seven days. The patient recovered without requiring organ support.


Conclusion: Effective evaluation and management of suspected sepsis rely on early identification, rapid diagnostic assessment, prompt antimicrobial therapy, and timely hemodynamic resuscitation. Although early goal-directed therapy initially demonstrated benefit, contemporary trials indicate that individualized, high-quality usual care yields comparable outcomes in well-resourced settings. Procalcitonin-guided antibiotic stewardship may reduce treatment duration without adversely affecting survival. Early, tailored intervention remains pivotal in reducing sepsis-related mortality.