Sepsis remains a major global health issue, with nearly 49 million cases and 11 million deaths annually. International guidelines emphasise routine screening and standardised treatment protocols for high-risk patients. The World Health Assembly’s 2017 Resolution 70.7 and the G7 Health Ministers’ 2022 statement have called for enhanced prevention, diagnosis, and management efforts. However, the readiness of hospital facilities to meet these goals remains uncertain.
The European Sepsis Care Survey (ESCS) assessed the state of sepsis care in hospitals, focusing on the implementation of sepsis recognition and management guidelines.
Designed as a cross-sectional questionnaire, the ESCS was developed by a multiprofessional steering committee and reviewed by European scientific societies. It included 94 questions covering emergency departments, inpatient wards, and ICUs. The survey examined adherence to the Surviving Sepsis Campaign guidelines, quality improvement initiatives (QIIs), and the availability of essential infrastructure such as medical emergency teams, imaging, microbiology labs, and surgical services. Hospitals were categorised by region, size, and type (university, general, or private).
Findings highlighted gaps in standardised sepsis screening and management, emphasising the need for enhanced hospital readiness.
The survey received responses from 1,294 hospitals; a final sample of 1,023 hospitals from 69 countries was analysed. Most hospitals were from Western Europe (32.7%), Eastern Europe (21.0%), Southern Europe (18.1%), and Northern Europe (9.8%), with a smaller representation from non-European regions.
Among the participating hospitals, 56.5% were general hospitals, 35.7% were university hospitals, and 7.8% were private hospitals. Responses regarding ward practices came mainly from medical and surgical wards, while ICU-related statements were primarily from interdisciplinary ICUs.
The Sepsis-3 definition was the most commonly used, reported by 45.4% of hospitals, with higher adoption in Northern (48.0%) and Southern Europe (53.5%) compared to Eastern (39.5%) and Western Europe (43.0%). Sepsis-1 was used in 24.5% of hospitals, particularly in Eastern Europe (37.7%). Additionally, 23.2% of hospitals applied both Sepsis-1 and Sepsis-3 criteria, while 6.9% used other definitions or had no set criteria. Sepsis-3 was more frequently adopted in university hospitals (51.0%) and in larger hospitals with over 750 beds.
Standardised sepsis screening was implemented in 54.2% of emergency departments (EDs), 47.9% of hospital wards, and 61.7% of ICUs, with significant regional differences. Screening was more common in EDs and wards in Northern Europe compared to other regions. However, no significant differences were observed based on hospital size or type.
Daily screening occurred in 51.0% of wards and 75.8% of ICUs, while the rest conducted screenings less frequently or on demand. Common screening criteria in EDs and wards included respiratory rate (89.8% in EDs, 85.0% in wards), blood pressure, temperature, heart rate, and mental status. Lactate measurement was used in 77.9% of EDs and 61.8% of wards. In ICUs, the most frequently used criteria were blood pressure (92.3%), temperature (91.9%), lactate (89.8%), respiratory rate (89.4%), and mental status (89.3%).
In hospitals using the Sepsis-1 definition, the full set of Systemic Inflammatory Response Syndrome (SIRS) criteria was applied in 56.3% of EDs and 63.1% of ICUs, though many used a reduced set. Hospitals following the Sepsis-3 definition were more likely to use the quick Sequential Organ Failure Assessment (qSOFA) and SOFA scores, especially in ICUs (82.5% vs. 51.4% in Sepsis-1 hospitals).
Early warning scores, such as the New Early Warning Score (NEWS) or Modified Early Warning Score (MEWS), were used in 31.1% of EDs, 38.2% of wards, and 19.6% of ICUs. Medical emergency teams (METs) were more common in Northern Europe (79.6%) but less available in other regions. Their presence varied by hospital size, from 43.3% in hospitals with 0–250 beds to 58.8% in those with over 1,000 beds. University hospitals (58.6%) had METs more often than general hospitals (47.5%).
Standardised sepsis management protocols were available in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. There were significant regional differences in protocol implementation in EDs, but no notable variations based on hospital size.
Only 31.4% of respondents reported having programmes to improve sepsis care, and hospital-wide QIIs were present in just 9.8% of hospitals, with significant regional differences. Hospitals with QIIs had better implementation of sepsis screening, standardised management, antibiotic stewardship, and antimicrobial guidelines.
Only 4.6% of hospitals allocated additional funding for sepsis programmes. ICU staff were more frequently involved in these initiatives than ED or ward staff. Sepsis prevalence and mortality were tracked in 54.3% and 45.0% of hospitals, respectively. Compliance with sepsis bundles was measured in 18.1% of hospitals, time to antibiotic therapy in 21.1%, sepsis severity in 25.0%, and blood culture ordering in 47.5%.
Nearly 90% of hospitals had 24/7 access to imaging (CT/MRI) for infection source identification, with availability higher in larger hospitals. However, microbiological diagnostic services were time-limited in 89.6% of hospitals, with only 10.4% offering around-the-clock services for blood culture incubation, pathogen identification, and result communication.
Surgical source control was available at all times in 87% of hospitals, with the highest availability in Western Europe (95.5%) and the lowest in Asia, Central/South America, and Africa (71.1%). Smaller hospitals (0–250 beds) had lower availability (79.9%) than larger hospitals. Interventional source control (e.g., radiology-guided procedures) was available 24/7 in 31.7% of hospitals, while 5.3% lacked source control services entirely, requiring patient transfers.
In ICU management of sepsis, balanced crystalloids were more commonly used than saline (89.0% vs. 39.7%). Albumin was used by 40.8%, while gelatin, hydroxyethyl starch, and dextran were less common. Norepinephrine (93.1%) was the primary first-line vasoactive agent. The most common parameters for fluid resuscitation included blood pressure, heart rate, and urine output (92.5% and 92.2%), with lactate clearance used by 79.3%. Point-of-care lactate testing was widely available in EDs and ICUs (83% and 91.5%).
Regarding antimicrobial treatment, 74% of hospitals followed standard guidelines, with higher adherence in Northern and Western Europe (92.8% and 89.2%). Antibiotic stewardship teams were common in Western (80.4%) and Northern Europe (77.4%). In wards, clinical teams typically treated sepsis, with 24.5% of hospitals involving infectious disease specialists. Procalcitonin was frequently used in ICUs (72.7%) and less often in wards (52.7%) to guide antiinfective management.
The survey revealed significant gaps in sepsis care. In European hospitals, despite the long-standing recommendation for sepsis screening, only 62% of ICUs, 54% of EDs, and 48% of wards implemented sepsis screening, with many not screening daily or only doing so on demand. Hospitals with QIIs had better results, with sepsis screening rates over 70%, but only 31.4% of hospitals had QIIs, and just 9.8% had regular QIIs across the entire hospital. The study highlighted that 74% of U.S. hospitals had standardised sepsis protocols, in contrast to the low uptake in Europe.
The survey also pointed to the lack of consistent sepsis programmes and financial support for such initiatives, with only 4.6% of hospitals investing in sepsis programmes. This contrasts sharply with U.S. hospitals, where 55% had executive sponsors for sepsis programmes.
Regarding infrastructure, 90% of hospitals had limited access to 24-hour microbiological diagnostic services, and small hospitals often lacked round-the-clock imaging or surgical services for timely source control. Delays in identifying pathogens and providing source control can worsen patient outcomes.
Overall, the findings suggest a need for greater implementation of sepsis screening tools, adherence to treatment protocols based on international guidelines, and improved infrastructure for diagnostics and source control. These improvements are crucial to meet global health recommendations and reduce sepsis-related mortality.
Source: American Journal of Respiratory and Critical Care Medicine
Image Credit: iStock
References:
Scheer CS et al. (2025) Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey. American Journal of Respiratory and Critical Care Medicine.
