High-risk suspected sepsis in adult — FFICM MCQ

Correct answer: B — Give broad-spectrum intravenous antibiotics within 1 hour

The correct answer is B, give broad-spectrum intravenous antibiotics within 1 hour. This woman has a probable urinary source (positive nitrites and leucocytes) with septic shock physiology: NEWS2 of 12, hypotension (systolic BP 86 mmHg), tachypnoea, fever and new hypoxia, placing her in the high risk category for severe illness or death from sepsis. NICE NG51 mandates that patients meeting high risk criteria receive IV broad-spectrum antibiotics within 1 hour of recognition, alongside blood cultures, lactate, fluids and senior review, because delay beyond this window is associated with increased mortality. Blood cultures have already been taken and IV access secured, so nothing should delay immediate empirical antimicrobial therapy. Why the other options are wrong: C. Wait for urine culture before antibiotics: culture results take 24 to 48 hours and withholding treatment in a hypotensive, hypoxic patient risks progression to irreversible septic shock and death. E. Give oral antibiotics and discharge with safety netting: oral bioavailability and absorption are unreliable in shock, and a NEWS2 of 12 with organ dysfunction mandates hospital admission and IV therapy, not discharge. D. Repeat observations in 6 hours before escalation: this patient already meets high risk sepsis criteria; observation alone breaches the 1 hour treatment target and allows ongoing tissue hypoperfusion. A. Start corticosteroids before antimicrobial therapy: steroids are reserved for septic shock unresponsive to fluids and vasopressors, never as a substitute for or given before source control and antibiotics. Key point: a high risk NEWS2 score with hypotension and hypoxia mandates broad-spectrum IV antibiotics within 1 hour per NICE NG51, without waiting for culture confirmation.

Reference: NICE guideline NG51, Sepsis: recognition, diagnosis and early management, high risk criteria mandate IV broad-spectrum antibiotics within 1 hour (updated 2024), https://www.nice.org.uk/guidance/ng51