[New sepsis guidelines: Surviving Sepsis Campaign 2026 and German Sepsis Society 2025 -Competing or complementary?].
Die Anaesthesiologie · 2026-11-02 · Guideline / consensus
Abstract
BACKGROUND: Sepsis is one of the leading causes of death in intensive care units worldwide. In German-speaking countries, patient management is primarily guided by two sets of guidelines: the international Surviving Sepsis Campaign (SSC) guidelines and the S3 guidelines of the German Sepsis Society (DSG). While the DSG guidelines were published in 2025 as an evidence-based adaptation of the SSC 2021 guidelines, the SSC has since released an updated international version in 2026. OBJECTIVE: To provide a structured analysis of the key content areas, similarities and differences between the two guidelines, with a particular focus on the timing of treatment initiation, anti-infective treatment and hemodynamic management. RESULTS: Both guidelines reflect not so much a fundamental shift in strategy but more a consolidation of evidence and a refinement of concepts. Three overarching themes can be identified: a broadened perspective encompassing the entire continuum of care, from the prehospital setting to post-sepsis follow-up, the increasing integration of antibiotic stewardship principles and in SSC 2026, the introduction of a graded sepsis terminology (definite/probable/possible/unlikely). Areas of agreement include the importance of early anti-infective treatment, the preferential use of balanced crystalloids, norepinephrine as the first-line vasopressor, the inclusion of capillary refill time as a perfusion parameter and a strong recommendation for prolonged or continuous beta-lactam infusion. Differences are evident in the specificity of antimicrobial recommendations, the definition of risk factors warranting empirical antifungal treatment and several new recommendations introduced in SSC 2026, such as a lower mean arterial pressure (MAP) target of 60-65 mm Hg for patients aged ≥ 65 years, initiation of treatment in the prehospital setting and source control within 6 h. CONCLUSION: The DSG 2025 and SSC 2026 guidelines should be regarded as complementary rather than competing frameworks. The DSG 2025 remains the practical, high-resolution handbook for care in the Central European context, while the SSC 2026 outlines the international direction: away from a purely acute care set of rules towards an individualized, continuum-based model of care.
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Tags
Antibiotics · Cardiovascular drugs · Crystalloids · Fluids & blood · Other drugs · Vasopressors
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