[Sepsis: Update 2026]

Sepsis remains a leading cause of in-hospital mortality and represents a particular challenge in pulmonology, as the respiratory tract is involved in up to 50% of cases. In Germany, approximately 279,000 patients develop sepsis annually, with reported in-hospital mortality approaching 40%, depending on data source and case mix. Delayed diagnosis is associated with worse outcomes, underscoring the importance of structured early recognition, guideline-based therapy, and quality assurance measures.The current Sepsis-3 definition describes sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection, diagnosed by an increase of ≥2 points in the SOFA score. Septic shock is defined as persistent hypotension despite adequate fluid resuscitation, lactate levels >2 mmol/L, and the need for vasopressors to maintain a mean arterial pressure of ≥65 mmHg.Since the beginning of 2026, a nationwide quality assurance procedure has been in place, which covers screening rates, antibiotic administration, standardized treatment procedures, and training of medical staff. Its aim is to improve process quality and patient outcomes.The updated 2025 German sepsis guideline recommends the NEWS2 score as an alternative to qSOFA due to its simplicity and clinical practicality, both of which are accepted within the quality assurance procedure. Early lactate measurement is also advised when sepsis is suspected.Antimicrobial therapy should be preceded by the collection of at least two sets of blood cultures. In septic shock, antibiotics should be initiated within one hour; in sepsis without septic shock, within three hours. Initial hemodynamic stabilization includes administration of 30 ml/kg of balanced crystalloids within the first three hours. If hypotension persists, norepinephrine is the vasopressor of choice.The guideline further emphasizes structured post-sepsis care. Survivors should be informed early about potential long-term sequelae, including post-intensive care syndrome (PICS), and supported through coordinated discharge planning and follow-up.