Sepsis primary prevention
|
Resident Survival Guide |
|
Sepsis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Sepsis primary prevention On the Web |
|
American Roentgen Ray Society Images of Sepsis primary prevention |
|
Risk calculators and risk factors for Sepsis primary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2] Jason Le, B.S.[3]
Sepsis primary prevention
Primary prevention of sepsis targets the upstream infections and modifiable host and environmental factors that lead to sepsis, before septic illness begins. It includes community and public-health prevention, healthcare-associated infection prevention, and optimization of host factors in populations at increased risk. Vaccination and healthcare-associated infection prevention bundles are the principal clinician-facing interventions.
Vaccination
Vaccination is a major community-level strategy for preventing infections that can progress to sepsis, including pneumococcal disease and influenza, with additional vaccines indicated for specific populations such as those at risk for meningococcal disease, Haemophilus influenzae type b, respiratory syncytial virus (RSV), and SARS-CoV-2 infection.[1][2]
Pneumococcal vaccination
Current adult pneumococcal vaccination strategies include PCV20 or PCV21 alone, or PCV15 followed by PPSV23; a single-dose pneumococcal conjugate vaccine (PCV20 or PCV21) is generally preferred over the two-dose PCV15→PPSV23 sequence when a single-dose option is available.[3][4][5]
The age-based threshold for routine adult pneumococcal conjugate vaccination was lowered from 65 to 50 years because invasive pneumococcal disease incidence begins to rise at age 50, with particularly early and substantial burden in Black adults.[3][5]
PCV21 targets a broader set of serotypes responsible for adult invasive pneumococcal disease than PCV20. Available surveillance estimates suggest coverage of approximately 82–84% of adult invasive pneumococcal disease serotypes with PCV21 versus approximately 50–58% with PCV20; regional serotype epidemiology, including serotype 4, may influence the relative value of the vaccines.[5][6]
Other vaccination priorities
- Influenza: Maintain annual influenza vaccination according to current age-, pregnancy-, and risk-based recommendations, particularly in adults with chronic medical conditions.[7]
- Asplenia or hyposplenia: Ensure pneumococcal vaccination together with meningococcal ACWY, meningococcal B, and Hib vaccination as indicated. For elective splenectomy, vaccination should be completed at least 2 weeks before surgery when feasible; after emergency splenectomy, vaccination should be administered at least 2 weeks after surgery when clinically appropriate.[8]
- Immunocompromised patients: Maintain indicated influenza, SARS-CoV-2, pneumococcal, and RSV vaccination and address modifiable host factors such as nutritional status and control of underlying immunocompromising disease.[7]
- Neonatal sepsis prevention: Maternal group B streptococcal vaccination remains an investigational strategy; no maternal GBS vaccine had reached phase 3 development in the cited review.[9]
Healthcare-associated infection prevention
Healthcare-associated infection prevention is a core primary-prevention strategy because device-, procedure-, and healthcare-associated infections can progress to hospital-onset sepsis.[10]
Central line-associated bloodstream infection
Core practices for prevention of central line-associated bloodstream infection (CLABSI) include:[11]
- Minimize unnecessary central venous catheter use and remove nonessential catheters promptly.
- Perform hand hygiene and use maximal sterile barrier precautions during insertion.
- Use alcoholic chlorhexidine skin antisepsis when not contraindicated.
- Use ultrasound guidance when appropriate.
- Prefer the subclavian site over jugular or femoral sites for ICU patients when clinically appropriate.
- Use chlorhexidine-impregnated dressings and daily chlorhexidine bathing of ICU patients older than 2 months when indicated.
- Maintain surveillance and audit adherence to prevention practices.
Catheter-associated urinary tract infection
Prevent catheter-associated urinary tract infection by avoiding unnecessary urinary catheterization, using aseptic insertion technique, maintaining a closed drainage system with the drainage bag below bladder level, and removing catheters promptly when no longer indicated.[10]
Ventilator-associated and hospital-acquired pneumonia
Prevention of ventilator-associated and hospital-acquired pneumonia includes semirecumbent positioning, appropriate antiseptic oral care, standardized daily tooth brushing, minimization of unnecessary sedation, and early mobilization when clinically feasible.[10][12]
Surgical-site infection and other healthcare-associated infections
Surgical-site infection prevention includes appropriate perioperative antimicrobial prophylaxis, clipper rather than razor hair removal when hair removal is necessary, and perioperative glucose control.[10]
Antimicrobial stewardship and hand hygiene reduce transmission of antimicrobial-resistant organisms and Clostridioides difficile. Targeted surveillance and decolonization strategies may reduce selected healthcare-associated infections such as MRSA infection.[10][12]
Host-risk optimization
Chronic medical conditions are associated with increased future sepsis risk, with risk increasing as the number of comorbid conditions increases. Reported associations include chronic lung disease, peripheral artery disease, chronic kidney disease, myocardial infarction, diabetes, and stroke.[13][14]
Primary prevention in these populations includes maintaining vaccination, mobility and nutritional status; reducing frailty; optimizing chronic disease management; and ensuring timely attention to local wound and other infections.[15]
Public-health and system measures
Access to clean water, sanitation, and hygiene (WASH), together with clean childbirth and surgical practices and hand hygiene, are fundamental public-health measures for reducing infections that can progress to sepsis, particularly in settings with a high infectious disease burden.[1][9]
At the clinical-system level, vaccination programs, infection-prevention bundles, antimicrobial stewardship, and surveillance should be implemented as ongoing quality-improvement measures rather than relying solely on individual clinician behavior.[12]
Clinically actionable recommendations
- Verify and complete age- and risk-based pneumococcal vaccination at relevant encounters, particularly in adults aged ≥50 years and in adults aged 19–49 years with qualifying risk conditions.[3]
- Maintain annual influenza vaccination and other indicated vaccines in older adults and patients with chronic or immunocompromising conditions.[7]
- For patients with asplenia or hyposplenia, ensure indicated pneumococcal, meningococcal ACWY, meningococcal B, and Hib vaccination and appropriately time vaccination around splenectomy.[8]
- Implement and audit CLABSI, CAUTI, and pneumonia-prevention bundles, with prompt removal of invasive devices when they are no longer needed.[11][10]
- Embed antimicrobial stewardship and hand-hygiene programs to reduce antimicrobial-resistant and C. difficile infections.[10][12]
Common pitfalls
- Conflating primary prevention with screening or early recognition of established infection. Warning signs and symptom-based recognition belong in Sepsis history and symptoms and Sepsis screening rather than this microchapter.
- Missing vaccination opportunities in adults aged 19–49 years with risk conditions, who remain substantially under-vaccinated.
- Leaving nonessential central venous or urinary catheters in place.
- Treating vaccination as a one-time intervention rather than reassessing age-, risk-, pregnancy-, and immunocompromise-based indications as recommendations evolve.
Vaccination coverage in eligible at-risk adults remains suboptimal: only about 23% of adults aged 19–64 years with a risk condition had ever received a pneumococcal vaccine (2018 NHIS), and risk-eligible adults aged 19–64 years had roughly 33% coverage as of 2023, well below coverage in adults ≥65 years.[16][17]
Areas of uncertainty
No licensed vaccine directly prevents sepsis; vaccination reduces sepsis risk indirectly by preventing infections that can progress to sepsis.[1][9]
The current preference for higher-valent PCVs incorporates serotype coverage and immunogenicity data rather than definitive head-to-head sepsis-prevention outcomes.[5]
The real-world effectiveness of PCV20 and PCV21 against pneumococcal disease is not yet established; current serotype-coverage estimates are based on vaccine-induced antibody responses rather than demonstrated disease reduction. PCV21-unique serotypes also show lower antibiotic susceptibility than PCV20-unique serotypes.[5][6]
The maternal GBS vaccine remains investigational, and selective digestive decontamination in mechanically ventilated patients remains a setting-dependent intervention rather than universal standard practice.[9][18]
References
- ↑ 1.0 1.1 1.2 Reinhart K, Daniels R, Kissoon N; et al. (2017). "Recognizing Sepsis as a Global Health Priority — A WHO Resolution". New England Journal of Medicine. 377 (5): 414–417. doi:10.1056/NEJMp1707170.
- ↑ Abels W, Reinhart K, Neugebauer E; et al. (2023). "Improving prevention and early detection of sepsis among patient groups at risk: Introducing a model for a multimodal information campaign—The SepWiss study protocol". PLOS ONE: e0305107. doi:10.1371/journal.pone.0305107.
- ↑ 3.0 3.1 3.2 Kobayashi M, Leidner AJ, Gierke R; et al. (2025). "Expanded Recommendations for Use of Pneumococcal Conjugate Vaccines Among Adults Aged ≥50 Years: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024". MMWR Morbidity and Mortality Weekly Report. 74 (1): 1–8. doi:10.15585/mmwr.mm7401a1.
- ↑ Kobayashi M, Leidner AJ, Gierke R; et al. (2024). "Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024". MMWR Morbidity and Mortality Weekly Report. 73 (36): 793–798. doi:10.15585/mmwr.mm7336a3.
- ↑ 5.0 5.1 5.2 5.3 5.4 Olarte L, Musher DM, Rodriguez-Barradas MC. (2025). "Higher-Valent Pneumococcal Conjugate Vaccines—Perspective for 2026". JAMA Internal Medicine. 185 (12): 1493–1494. doi:10.1001/jamainternmed.2025.5436.
- ↑ 6.0 6.1 Bensaci MF, Bauer KA, Klinker K; et al. (2025). "Post-Pandemic Trends in Streptococcus Pneumoniae Serotype Epidemiology and Antibiotic Susceptibility in Adults With Invasive and Non-Invasive Pneumococcal Disease in the USA (2022-2023)". The Journal of Antimicrobial Chemotherapy. doi:10.1093/jac/dkaf414. PMID 41263169 Check
|pmid=value (help). - ↑ 7.0 7.1 7.2 Deinhardt-Emmer S, Chousterman BG, Schefold JC; et al. (2025). "Sepsis in Patients Who Are Immunocompromised: Diagnostic Challenges and Future Therapies". The Lancet Respiratory Medicine. 13 (7): 623–637. doi:10.1016/S2213-2600(25)00124-9. PMID 40409328 Check
|pmid=value (help). - ↑ 8.0 8.1 Lenti MV, Luu S, Carsetti R; et al. (2022). "Asplenia and spleen hypofunction". Nature Reviews Disease Primers. 8 (1): 71. doi:10.1038/s41572-022-00399-x.
- ↑ 9.0 9.1 9.2 9.3 "Combating sepsis: bottlenecks to breakthroughs". The Lancet Regional Health – Western Pacific. 38: 100923. 2023. doi:10.1016/j.lanwpc.2023.100923.
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 Hsu V. (2014). "Prevention of Health Care-Associated Infections". American Family Physician. 90 (6): 377–382. PMID 25251230.
- ↑ 11.0 11.1 Buetti N, Marschall J, Drees M; et al. (2022). "Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute-Care Hospitals: 2022 Update". Infection Control and Hospital Epidemiology. 43 (5): 553–569. doi:10.1017/ice.2022.87.
- ↑ 12.0 12.1 12.2 12.3 Rhee C, Masur H, Klompas M; et al. (2026). "IDSA/ACEP/ASM/PIDS/SCCM/SHEA/SHM/SIDP Multisociety Position Paper: Hospital Strategies to Improve Sepsis Outcomes". Clinical Infectious Diseases. doi:10.1093/cid/ciag438. PMID 42640090 Check
|pmid=value (help). - ↑ Wang HE, Shapiro NI, Griffin R; et al. (2012). "Chronic Medical Conditions and Risk of Sepsis". PLOS ONE. 7 (10): e48307. doi:10.1371/journal.pone.0048307. PMID 23118977.
- ↑ Qin C, Lin S, Pang L; et al. (2026). "Risk Factors for Sepsis: A Systematic Review and Meta-Analysis". Frontiers in Public Health. 14: 1790141. doi:10.3389/fpubh.2026.1790141. PMID 42433399 Check
|pmid=value (help). - ↑ Hotchkiss RS, Moldawer LL, Opal SM; et al. (2016). "Sepsis and septic shock". Nature Reviews Disease Primers. 2: 16045. doi:10.1038/nrdp.2016.45.
- ↑ Kobayashi M, Pilishvili T, Farrar JL; et al. (2023). "Pneumococcal Vaccine for Adults Aged ≥19 Years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023". MMWR Recommendations and Reports. 72 (3): 1–39. doi:10.15585/mmwr.rr7203a1.
- ↑ Ramachandran V, Tangney S, Gedlinske A; et al. (2025). "Pneumococcal Vaccination Knowledge, Attitudes, and Practices Among Surveyed U.S. Adults Aged 19-64 years at Increased Risk for Pneumococcal Disease". Vaccine. PMID 40957308 Check
|pmid=value (help). - ↑ Rahmel T, Siegler BH, Weigand MA; et al. (2026). "The evolution of sepsis care: from protocol-driven management to personalized intensive care". Infection. doi:10.1007/s15010-026-02852-5.