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Suspected sepsis from urinary tract infection — MSRA MCQ

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Hardall topics relevant for this examSuspected sepsis from urinary tract infectionMSRA

A 73-year-old man is assessed during a home visit for 2 days of dysuria, rigors and increasing lethargy. He has type 2 diabetes and polymyalgia rheumatica treated with prednisolone 10 mg daily. His daughter reports that he is newly confused and has been unable to get out of bed this morning. He is flushed and drowsy but rousable. Temperature is 38.7°C, respiratory rate 25 breaths/minute, pulse 116 beats/minute, blood pressure 86/54 mmHg and oxygen saturation 95% on air. There is suprapubic tenderness without flank pain. The nearest emergency department is usually 35 minutes away by ambulance. He has no documented advance care plan or treatment-escalation limitation. What is the most appropriate immediate management in primary care?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Call 999 for immediate transfer, pre-alert the receiving acute service, and provide supportive care while awaiting the ambulance

Explanation lettering: D = shown as B · B = shown as C · C = shown as D

This man has suspected urinary infection with high-risk features for severe illness or death from sepsis in the community: profound hypotension (systolic blood pressure 86 mmHg) and new altered mental state, alongside tachypnoea and tachycardia. NICE advises immediate emergency referral, usually by 999 ambulance, and pre-alerting secondary care when any high-risk criterion is present. Transfer should not be delayed for primary-care investigations, a trial of oral treatment, or observation after parenteral antibiotics. A is inappropriate because cultures and oral treatment delay resuscitation-capable emergency care. B may appear attractive because early antimicrobial treatment matters, but a period of community observation is unsafe in a hypotensive, confused patient. C would be suitable only where a definitive diagnosis is reached and the condition can safely be managed outside hospital; this patient cannot. E provides a potentially appropriate destination in some local systems, but non-emergency transport and delayed escalation are unsuitable for high-risk suspected sepsis. Pre-hospital antibiotics by GPs are specifically relevant where transfer time to the emergency department is routinely more than 1 hour. Here, usual transfer time is 35 minutes, so the priority is immediate ambulance transfer and pre-alerting rather than delaying conveyance to administer treatment in the home.

Reference: NICE: Suspected sepsis in people aged 16 or over — Managing suspected sepsis (2025) — https://www.nice.org.uk/guidance/ng253/chapter/Managing-suspected-sepsis NICE: Suspected sepsis in people aged 16 or over — Managing suspected sepsis (2025) — https://www.nice.org.uk/guidance/ng253/chapter/Managing-suspected-sepsis