[S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025]

Sepsis is an acute, life-threatening multiple organ dysfunction triggered by an infection.

This guideline is an update of the S3 guideline "Sepsis-prevention, diagnosis, therapy, and follow-up care" (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft [AMWF] Registry No. 079-001) of the German Sepsis Society (DSG) dated 31 December 2018. The update of the "Surviving sepsis campaign (SSC): international guidelines for management of sepsis and septic shock 2021" dated 4 October 2021, was used as the reference guideline. The DSG Guideline Commission compared each recommendation on the underlying PICO questions of the DSG Guideline 2018 (literature search until December 2018) with those of the SSC Guideline 2021 (literature search until July 2019) and evaluated the newly available published data (literature search until December 2024) by means of systematic update searches and literature reviews in compliance with the rules of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and the AWMF.

A total of 88 PICO questions were addressed, including those related to the diagnosis and treatment of infection and organ failure. Of these, two were agreed upon as statements, 29 as expert consensus, and 57 as evidence-based recommendations (26 with a strong and 31 with a weak recommendation grade). Compared to the previous 2018 guideline, 43 recommendations were reviewed but retained, 16 recommendations were modified, and 29 recommendations were newly issued.

Given the lack of evidence for numerous measures for the inpatient care of patients with sepsis or septic shock, old and new knowledge gaps were revealed. Among the evidence-based recommendations, the underlying GRADE quality of evidence was high for only 5 recommendations, moderate for 18 recommendations, low for 17 recommendations, and very low for 16. These evidence gaps can only be closed through future multicenter, noncommercial clinical trials. The update to the S3 guideline on sepsis includes some updates to the recommendations of the previous guideline. These updates will need to be incorporated into some of the case- and facility-specific quality assurance indicators of quality assurance (QA) procedure 2025. Impairments in health-related quality of life for survivors must be given greater focus in outpatient care.