Suspected sepsis in people aged 16 or over: recognition, assessment and early management

Think 'could this be sepsis?' if a person presents with symptoms or signs that indicate possible infection. [2016]

Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature. [2016]

Pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour. [2016]

Assess people who might have sepsis with extra care if there is difficulty in taking their history, for example people with English as a second language or people with communication difficulties (such as neurodiversity, cognitive impairment, learning difficulties, severe mental health conditions or brain injury). [2016, amended 2025]

Assess people with any suspected infection to identify:

• possible source of infection (see the recommendations on finding and controlling the source of infection)

• factors that increase risk of sepsis (see people who are most vulnerable to sepsis)

• any indications of clinical concern, such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

During a remote assessment, when deciding whether to offer a face-to-face assessment and, if so, on the urgency of it, identify:

• factors that increase risk of sepsis (see people who are most vulnerable to sepsis) and

• indications of clinical concern such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

Use a structured set of observations to assess people in a face-to-face setting to stratify risk if sepsis is suspected. (See the recommendations on face-to-face assessment and the recommendations on evaluating risk). [2016]

Use the national early warning score (NEWS2) to assess people with suspected sepsis who are aged 16 or over, are not and have not recently been pregnant, and are in an acute hospital setting, acute mental health setting or ambulance. [2024]

Consider using an early warning score to assess people with suspected sepsis who are 16 or over, in a community or custodial setting. [2016, amended 2024]

Suspect neutropenic sepsis in people who become unwell and:

• are having or have had systemic anticancer treatment within the last 30 days

• are receiving or have received immunosuppressant treatment for reasons unrelated to cancer; use clinical judgement (based on the person's specific condition, medical history, or both, and on the treatment they received) to determine whether any past treatment may still be likely to cause neutropenia. [2016, amended 2024]

Refer patients with suspected neutropenic sepsis immediately for assessment in secondary or tertiary care. [This recommendation is from NICE's guideline on neutropenic sepsis in people with cancer.] [2012]

Treat people with neutropenic sepsis, regardless of cause, in line with NICE's guideline on neutropenic sepsis in people with cancer. [2016, amended 2024]

Take into account the factors that may increase the risk of developing sepsis or sepsis not being identified promptly. These include:

• age: being 75 or over

• ethnicity: being from an ethnic minority background

• clinical features such as:

  • frailty

  • multimorbidities or severe chronic conditions

  • impaired immune function because of illness or medical treatment

  • surgery or invasive procedures in the past 6 weeks

  • indwelling catheters

  • repeated antibiotic use

  • breach of skin integrity

• communication difficulties, such as with people:

  • with learning difficulties

  • with cognitive impairment

  • who need an interpreter

• drugs or alcohol misuse

• social, economic or environmental factors such as:

  • homelessness

  • living in deprived areas.
    
    See also recommendation 1.1.10 on when to suspect neutropenic sepsis. [2025]