{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:01:18Z","timestamp":1790456478037,"version":"4.1.0"},"reference-count":143,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high\u2010income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as \u226570% agreement across three iterative rounds using Likert scales (Rounds 1\u20132) and binary format (Round 3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus was achieved for 40 statements. Strong endorsement (82%\u201395%) was reached for structured hospital sepsis programs, NEWS\u20102 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6\u00a0h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first\u2010line vasopressor therapy. Experts also supported pharmacokinetic\u2010 and pharmacodynamic\u2010guided antibiotic dosing, prolonged infusion of time\u2010dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis\u20102, Sepsis\u20103, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high\u2010 and middle\u2010income healthcare systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joim.70145","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:34:58Z","timestamp":1786599298000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9929-3111","authenticated-orcid":false,"given":"M","family":"Borges\u2010Sa","sequence":"first","affiliation":[{"name":"Multidisciplinary Sepsis Unit ICU, Son Llatzer University Hospital  Palma de Mallorca Spain"},{"name":"School of Medicine, Balearic Islands University (UIB)  Palma de Mallorca Spain"},{"name":"Fundaci\u00f3n C\u00f3digo Sepsis  Valencia Spain"},{"name":"Sepsis Multidisciplinary Group Health Research Institute of the Balearic Islands (IdISBa)  Palma de Mallorca Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0533-4531","authenticated-orcid":false,"given":"A","family":"Giglio","sequence":"additional","affiliation":[{"name":"Multidisciplinary Sepsis Unit ICU, Son Llatzer University Hospital  Palma de Mallorca Spain"},{"name":"School of Medicine, Balearic Islands University (UIB)  Palma de Mallorca Spain"},{"name":"Sepsis Multidisciplinary Group Health Research Institute of the Balearic Islands (IdISBa)  Palma de Mallorca Spain"},{"name":"Finis Terrae University and Clinica Las Condes Hospital  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-4063","authenticated-orcid":false,"given":"I","family":"Martin\u2010Loeches","sequence":"additional","affiliation":[{"name":"Multidisciplinary Intensive Care, Department of Clinical Medicine, Trinity College, Wellcome Trust\u2010HRB Clinical Research Facility St James's University Hospital, Dublin  Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Nates","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Division of Anesthesiology Critical Care, and Pain Medicine The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JM","family":"Gonz\u00e1lez del Castillo","sequence":"additional","affiliation":[{"name":"Emergency Medicine Service Hospital Universitario San Carlos, Universidad Complutense  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y","family":"C\u00e1rdenas","sequence":"additional","affiliation":[{"name":"Department of Critical Care Fundaci\u00f3n Santa Fe de Bogot\u00e1  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0212-8414","authenticated-orcid":false,"given":"P","family":"Mergulhao","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine Department Hospital Lus\u00edadas Porto  Porto Portugal"},{"name":"Department of Medicine Faculty of Medicine University of Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"FJ","family":"Candel","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infectious Diseases IdISSC &amp; 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