Sepsis is often thought of as a condition that is diagnosed and managed in a hospital setting, but around 80% of cases begin outside of hospital, and Australia sees somewhere between 80,000 and 100,000 cases each year.¹

Sepsis is life-threatening organ dysfunction due to a dysregulated host response to an infection.² Common infections precipitating sepsis are respiratory, intra-abdominal and urinary.

However, sepsis can be particularly challenging to diagnose since early symptoms reflect the underlying infection and are often non-specific. It’s also made more complicated by the fact that there is no definitive diagnostic test, even in a hospital setting. Additionally, fever, fatigue, nausea, reduced appetite and malaise can be present in many infections that do not progress to sepsis.

Patients often attend with what appears to be a relatively mild infection, and GPs may be the first clinicians with the chance to recognise sepsis developing and intervene before it progresses to severe or critical illness. Here’s what to keep in mind.

Who is at increased risk?

Sepsis incidence has a bimodal distribution with peaks in the very young and the elderly.³ These extremes of age present particular challenges when it comes to recognising sepsis.

Infants may present with poor feeding, irritability, lethargy or reduced interaction with carers.

Older adults frequently present without classical signs of severe infection. Instead, the presenting complaint may be confusion, agitation, sleepiness, a fall, or a sudden decline in functional ability.⁴

Practice tip: Family members often provide the most important clue. Acute behavioural change should always prompt consideration of evolving sepsis.⁵

People with diabetes and kidney disease are also at increased risk. One-third of people hospitalised with sepsis have diabetes and one in six had have kidney disease, reinforcing the importance of maintaining a high index of suspicion in patients with chronic health conditions.^{1, 2}

Recognising the transition from infection to sepsis

Signs and symptoms that should cause concern include:

• Altered mental state or confusion
• Drowsiness
• Tachypnoea
• Breathlessness
• Tachycardia
• Hypotension
• Reduced urine output (dry nappies/diapers in babies and toddlers)
• Mottled or discoloured skin
• Persistent fever and rigors

Consider:

Is there evidence of deterioration?

Are there signs that an uncomplicated infection is transitioning to sepsis?

Is the infection behaving as expected or evolving into something more serious?

No single symptom makes the diagnosis. More commonly, it is the combination of infection, deterioration and evidence of physiological stress that should trigger concern.

The importance of safety-netting

Because many patients initially present before sepsis has declared itself, safety-netting is a key aspect of management. All patients diagnosed with a significant infection should be counselled about red flags to look out for.

Advise patients and families to seek urgent reassessment from a GP or emergency department if they experience increasing confusion, unusual drowsiness, worsening breathlessness, reduced urine output, inability to maintain oral intake, or rapid clinical decline.

Delay in diagnosis and treatment can be fatal; once sepsis is causing hypotension (septic shock), each hour of delay in providing appropriate antimicrobial treatment is associated with a 4-8% increase in risk of death.^{6, 7}

Sepsis does not end at hospital discharge

Historically, we have viewed sepsis as an acute illness from which patients either recover or die. Increasingly, we recognise that recovery is often incomplete. Around 40% to 50% of survivors experience ongoing physical, cognitive or psychological morbidity after sepsis that may persist for many years. This has been termed post-sepsis syndrome.⁸

Patients are also immunosuppressed after sepsis and around 25% of survivors will be readmitted to hospital within three months.⁹

Recognising post-sepsis syndrome

Survivors may present weeks or months after hospital discharge with symptoms that are difficult to categorise.

Common symptoms of post-sepsis syndrome include:

Physical symptoms

• Fatigue
• Reduced exercise tolerance
• Muscle weakness
• Chronic pain
• Sleep disturbance

Cognitive symptoms

• Poor concentration
• Memory difficulties
• Reduced executive function
• Brain fog

Psychological symptoms

• Anxiety
• Depression
• Post-traumatic stress symptoms
• Health-related fear and uncertainty

Many survivors report that they never quite returned to their previous baseline health.

These symptoms have become recognised following COVID19 (SARS-CoV-2 infection), severe forms of which are a particular type of viral sepsis. It is less well recognised that these sequelae can follow any infection that has resulted in sepsis.

Practice tip: When a patient presents with persistent fatigue, cognitive complaints, mood disturbance or unexplained functional decline, it is worth screening for recent sepsis and other severe infections.

The Australian Commission recommends screening for new physical, mental and cognitive deficits after sepsis and, where appropriate, consider referrals for:

• Physical support, such as physiotherapy or neurorehabilitation
• Emotional and psychological support (counselling, cognitive behavioural therapy or neuropsychiatric assessment)
• Allied health or medical specialist referral as appropriate

In a nutshell

Most sepsis starts in the community the early signs are frequently subtle, and the patients at greatest risk are often those in whom the diagnosis is hardest to make. Maintaining a high index of suspicion, paying attention to changes in cognition and behaviour, and providing effective safety-netting remain among the most powerful contributions general practitioners can make. Following sepsis, GPs have a crucial role in recognising post-sepsis syndrome and providing appropriate support and referral.

A practical resource for GPs

To support primary care clinicians, the Australian Commission on Safety and Quality in Health Care, in collaboration with Sepsis Australia, has developed the free online Sepsis in Primary Care learning module.¹⁰ This RACGP-accredited, case-based program is specifically designed for GPs and other primary healthcare professionals.

The module covers:

• Early recognition of sepsis in adults, children and maternity patients
• Risk factors for sepsis
• Screening tools and clinical pathways
• Escalation and referral decisions
• Safety-netting strategies
• Recognition and management of post-sepsis syndrome
• Communication and coordination of care across healthcare settings

The educational content focuses on practical, real-world scenarios that clinicians encounter in primary care and be accessed at https://learn.safetyandquality.gov.au/sepsis in primary care.

More information

Australian Commission on Safety and Quality in Health Care

Sepsis Australia

References

1. Australian Commission on Safety and Quality in Health Care. National Sepsis Program Extension Epidemiology Report. Sydney: ACSQHC; 2025.

2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. doi:10.1001/jama.2016.0287

3. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-11. doi:10.1016/S0140-6736(19)32989-7.

4. Putot A, Prendki V. New horizons in sepsis management in older patients. Age Ageing. 2023;52(2):afad016. doi:10.1093/ageing/afad016.

5. National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management (NG51). London: NICE; 2024.

6. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med. 2021;47(11):1181-1247.

7. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-96.

8. Prescott HC, Angus DC. Enhancing recovery from sepsis: a review. JAMA. 2018;319(1):62-75. doi:10.1001/jama.2017.17687.

9. Delano MJ, Ward PA. The immune system’s role in sepsis progression, resolution, and long-term outcome. Immunol Rev. 2016;274(1):330-53.

10. Australian Commission on Safety and Quality in Health Care. Online education – Sepsis in Primary Care [Internet]. Sydney: ACSQHC; 2025 May 14 [cited 2026 Oct 22].