Correct sepsis classification–A must for antimicrobial stewardship: A longitudinal observational study

Table 1 Three-step model used for sepsis classification

Step	Description
Step 1: Evidence of dysregulated host response	Assessed using the National Early Warning Score-2 ≥ 6
Step 2: Risk factors for infection	Evaluated based on the presence of risk factors such as chronic illnesses, malnutrition, unhygienic living conditions, immunosuppressive states, age, trauma, structural diseases, recent surgery, travel history, animal bites, and previous hospitalizations
Step 3: Evidence of infection	Determined through:
3 (A) Clinical evidence	Syndromic diagnosis including pyelonephritis, infective endocarditis, intra-abdominal infections, skin and soft tissue infections, meningitis, cerebrospinal fluid shunt infections, catheter-related infections, osteomyelitis, abscesses, and pneumonia
3 (B) Supportive/suggestive evidence	Imaging (X-ray, ultrasonography, computed tomography, magnetic resonance imaging, positron emission tomography) and biomarkers (blood, urine, other fluids)
3 (C) Confirmatory evidence	Direct visualization, endoscopic evidence, microscopy and culture growth, PCR/gene detection, and immunological methods
Interpretation	Sepsis categories/classification
(1) Step-1 = negative; (2) Step-1 = positive with step-2 and 3 = negative	Asepsis
Step-1, 2 and 3 (A) = positive	Possible sepsis
Step-1, 2 and 3 (B) = positive	Probable sepsis
Step-1, 2 and 3 (C) = positive	Confirmed sepsis