International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach

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dc.contributor.authorBorges-Sa, Marcio
dc.contributor.authorGiglio, Andrés
dc.contributor.authorMartin-Loeches, Ignacio
dc.contributor.authorNates, Joseph
dc.contributor.authorGonzález del Castillo, Josemaría
dc.contributor.authorCárdenas, Yenny
dc.contributor.authorMergulhao, P.
dc.contributor.authorCandel, F. J.
dc.contributor.authorZaragoza, R.
dc.contributor.authorLarrosa-Escartin, M. N.
dc.contributor.authorVidal-Cortés, P.
dc.contributor.authorMaseda, E.
dc.contributor.authorReina, R.
dc.contributor.authorPaiva, J. A.
dc.contributor.authordel Pozo, J. L.
dc.contributor.authorVillegas, M. V.
dc.contributor.authorSalavert, M.
dc.contributor.authorSoriano, C.
dc.contributor.authorHidalgo, J.
dc.contributor.authorMachuca, I.
dc.contributor.authorGonçalves-Pereira, J.
dc.contributor.authorManuel-Vázquez, A.
dc.contributor.authorLisboa, T.
dc.contributor.authorPichardo-Viñas, M.
dc.contributor.authorBarberán, J.
dc.contributor.authorEsparza, G.
dc.contributor.authorCastillo-Abrego, G.
dc.contributor.authorEstella, A.
dc.contributor.authorOrtega, K.
dc.contributor.authorMatos, A.
dc.contributor.authorRaimondi, N.
dc.contributor.authorFerrer, R.
dc.contributor.authorSanchez, J. R.
dc.contributor.authorHuelmo, I.
dc.contributor.authorGorordo-Delsol, L. A.
dc.contributor.authorCampozano, V.
dc.contributor.authorSoriano, A.
dc.contributor.authorPerez, J.
dc.contributor.authorRodriguez, A.
dc.coverage.spatialSuecia
dc.date.accessioned2026-08-18T15:44:11Z
dc.date.available2026-08-18T15:44:11Z
dc.date.issued0004-08-26
dc.descriptionConsenso iberoamericano del manejo de la sepsis.
dc.description.abstractBackground. Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high-income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs. Methods. A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1–2) and binary format (Round 3). Results. Consensus was achieved for 40 statements. Strong endorsement (82%–95%) was reached for structured hospital sepsis programs, NEWS-2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first-line vasopressor therapy. Experts also supported pharmacokinetic- and pharmacodynamic-guided antibiotic dosing, prolonged infusion of time-dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis-2, Sepsis-3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy. Conclusions. These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high- and middle-income healthcare systems.
dc.description.embargo04/08/2027
dc.identifier.citationJournal of Internal Medicine (2026) pp. 1–23
dc.identifier.doihttps://doi.org/10.1111/joim.70145
dc.identifier.issne1365-2796
dc.identifier.orcidhttps://orcid.org/0000-0002-0533-4531
dc.identifier.urihttps://hdl.handle.net/20.500.12254/7709
dc.language.isoen
dc.publisherJohn Wiley & Sons Ltd
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/
dc.subjectantimicrobial stewardship
dc.subjectDelphi consensus
dc.subjectearly recognition
dc.subjecthemodynamic management
dc.subjectinternational guidelines
dc.subjectmultidisciplinary care
dc.subjectsepsis code
dc.subjectsepsis
dc.subjectseptic shock
dc.titleInternational multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach
dc.typeArticle
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