# French guidelines on sepsis: A pragmatic frame to manage septic patients

Marc Leone, Marwan Bouras, Antoine Bianchi, Elodie Macé, Jean Michel Constantin, Jacques Duranteau, Rémy Gauzit, Bertrand Guidet, Frédéric Pène, Djillali Annane, et al.

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Marc Leone, Marwan Bouras, Antoine Bianchi, Elodie Macé, Jean Michel Constantin, et al. French guidelines on sepsis: A pragmatic frame to manage septic patients. Anaesthesia Critical Care & Pain Medicine, 2025, 44 (6), pp.101643. 10.1016/j.accpm.2025.101643. inserm-05387119

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Submitted on 28 Nov 2025

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Technical note

French guidelines on sepsis: A pragmatic frame to manage septic patients

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Marc Leone<sup>a,*</sup>, Marwan Bouras<sup>b</sup>, Antoine Bianchi<sup>a</sup>, Elodie Macé<sup>a</sup>, Jean Michel Constantin<sup>c</sup>, Jacques Duranteau<sup>d</sup>, Rémy Gauzit<sup>e</sup>, Bertrand Guidet<sup>f,g</sup>, Frédéric Pène<sup>h</sup>, Djillali Annane<sup>i,j,k</sup>, Antoine Roquilly<sup>l,m</sup>

Sepsis is a major health issue representing the leading cause of admission to the intensive care unit (ICU) and carrying a high burden of mortality. In a retrospective cohort based on a French national hospitalisation database (2014–2018), 187,587 ICU stays were identified for septic shock, with a mortality rate at 90 days reaching 42% and a one-year readmission rate at 65% [1]. Of note, sepsis occurs in children and neonates in 40% of cases, and this high rate illustrates the need to include these groups of patients in all processes aiming at reducing the burden associated with sepsis [2].

To date, the management of sepsis is framed by international guidelines published by the experts of the Surviving Sepsis Campaign [3]. Ninety-three recommendations report how to manage patients with sepsis and septic shock in the emergency department and the ICU. However, the Surviving Sepsis Campaign is based on an international and global perspective and, by definition, does not consider national specificities or healthcare system characteristics. In addition, the recommendations have been mainly written by healthcare professionals working in emergency departments and ICUs. Thus, there is no mention of sepsis in the community, before hospital admission, and the rehabilitation of septic patients is not described.

A multiprofessional and multidisciplinary group that included French scientific societies and groups with an interest in sepsis was in charge of producing recommendations on sepsis from the community to after the hospital discharge. All types of patients were considered, from neonates to elderly patients. The group of experts followed the method prescribed by the Haute Autorité de Santé, which was the agency requesting these recommendations [4]. General practitioners, paediatricians, microbiologists, intensivists, emergency physicians, rehabilitation physicians, and infectious diseases physicians were involved in the process. Representatives from these organisations, the France Sepsis Association (a user association), the SEPSIS university hospital federation (FHU), and the PROMETHEUS university hospital institute (IHU) joined forces to analyse and synthesise data from scientific literature. Besides in-hospital management, these recommendations also aimed to provide guidance for the management of sepsis before admission to the hospital, emphasizing the role of general practitioners in early patient triage and coordination with pre-hospital services and emergency departments. In addition, preventive measures as vaccination and avoiding steroids in patients with suspected infections have been underlined, along with alternatives to hospitalisation in selected cases.

A group of anaesthesiologists/intensivists and infectious diseases physicians, due to their expertise in the management of acute life-threatening conditions and the organisation of critical

<footnote><sup>a</sup>Department of Anaesthesia and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France</footnote>

<footnote><sup>b</sup>Department of Anesthesiology and Critical Care Medicine, CHRU Brest, University of Bretagne Occidentale, Brest, France</footnote>

<footnote><sup>c</sup>Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France</footnote>

<footnote><sup>d</sup>Department of Anesthesiology and Intensive Care, Paris-Saclay University, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Équipe DYNAMIC, Inserm UMR_S999, LeKremlin-Bicêtre, France</footnote>

<footnote><sup>e</sup>Infectious Disease and Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France</footnote>

<footnote><sup>f</sup>Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, F-75012, Paris, France</footnote>

<footnote><sup>g</sup>Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, France</footnote>

<footnote><sup>h</sup>Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France</footnote>

<footnote><sup>i</sup>Department of Intensive Care, APHP University Versailles Saint Quentin, University Paris Saclay, Raymond Poincaré Hospital, Garches, France</footnote>

<footnote><sup>j</sup>SEPSIS Institute, Institut Hospitalo Universitaire IHU-3, Garches, France</footnote>

<footnote><sup>k</sup>Laboratory of Infection and Inflammation, U1173, School of Medicine, INSERM, University Versailles Saint Quentin, University Paris Saclay, Garches, France</footnote>

<footnote><sup>l</sup>Inserm, Institut de Recherche en Santé 2 Nantes Biotech, CHU Nantes, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France</footnote>

<footnote><sup>m</sup>CHU Nantes, Service d'Anesthesia Réanimation, Nantes Université, Nantes, France</footnote>

<footnote>* Corresponding author.
E-mail address: marc.leone@ap-hm.fr (M. Leone).</footnote>
<figure><img src="image_3.png" /><figcaption>**Fig. 1.** Box summarising the three steps of management of patients with sepsis from home to rehabilitation.</figcaption></figure>

care, actively contributed to the synthesis of scientific data and its translation into practical proposals. This group has been essential in adapting international standards, such as those of the Surviving Sepsis Campaign [3], to the French context, integrating both the imperatives of therapeutic efficacy (antibiotic therapy, fluid replacement strategy, use of vasopressors) and the organisational reality of critical care pathways.

During the hospital stay, the group in charge of recommendations proceeded to a translation of the Surviving Sepsis Campaign to the French health infrastructure [3]. Among 93 recommendations, nine were changed or rephrased to correspond to the national practice (Fig. 1). Briefly, the French adaptation of the Surviving Sepsis Campaign guidelines emphasised the need for individualisation, often based on a medical assessment of patients guided by monitoring. The French experts recommended the use of rapid diagnostic tests to reduce the time required to deliver an adequate treatment [5]. Early introduction of vasopressin, duration of antibiotic treatment not exceeding seven days in case of adequate source control, and use of high levels of positive expiratory pressure after excluding right cardiac dysfunction were recommended during the hospital stay. Specific recommendations were produced for the management of children and neonates, including, for instance, the use of immunoglobulins in refractory septic shock due to *Streptococcus*.

Early rehabilitation (within 48 h of ICU admission) was highlighted as a key component to improve functional outcomes and reduce complications, with structured programs extending beyond hospital discharge and tailored to frailty and socio-economic conditions. A standardised program in six steps is suggested, including one or two sessions daily, five days a week. Inclusion of healthcare professionals' experts in rehabilitation is recommended as soon as the patient is admitted to the ICU. The need for a multiprofessional approach to patients with sepsis is emphasised, including physiotherapists, psychologists, occupational therapists, speech therapists, social workers, and dieticians.

Sepsis is associated with a significant burden in survivors, and physical and cognitive disabilities impair their quality of life [6]. In the literature, experts suggested measures to prevent medical deterioration [7], which results in 16.4% of hospital readmission at one year [8]. After hospital discharge, the French experts suggest accompanying the patient in a rehabilitation center or at home. Good communication is required with general practitioners or advanced practice nurses. A written document with information on sepsis is transmitted to healthcare professionals managing the patients outside the hospital. The need to include family members in the process is underlined.

For the next years, the group of French experts needs to develop tools to diffuse these guidelines in the community and in the hospitals, both in healthcare and non-healthcare professionals, to public health authorities. After diffusion, studies to measure the implementation of these recommendations at each level will be required, as the compliance with guidelines was associated with patients' outcomes [9]. Future efforts should focus on the dissemination and implementation of these recommendations across the continuum of care and on assessing their impact on patient outcomes at the national level.

## Disclosures

ML served as speaker for Advanz Pharma, AOP Pharma, Edwards Life Sciences, Shionogi, Viatris, and Consultant for BioMerieux, Mindray, Previa; JD received personal fees for lectures from AOP Pharma, Octa Pharma, LFB, Edwards Life Science, and Viatris; FP received personal fees for consulting and lectures from GILEAD and MUNDIPHARMA. Other authors did report disclosures.

## Funding

This manuscript did not receive any specific funding.
## Acknowledgements

The authors are indebted to all participating societies and individuals involved in the development of the HAS recommendations on sepsis for their valuable contributions and support.

## References

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