Abstract
Background: Sepsis remains a major cause of deterioration, intensive care admission, prolonged hospitalization, and death in Canadian acute-care hospitals. Recognition can be delayed because early manifestations are nonspecific and may overlap with the patient's admitting illness.
Objective: To provide a Canada-oriented review of early recognition and management of sepsis in hospitalized adults, emphasizing the 2026 British Columbia adult sepsis guidance, current Canadian health-system considerations, and the 2026 Surviving Sepsis Campaign (SSC).
Methods: Narrative review of contemporary sepsis guidance and major supporting trials, with priority given to Canadian provincial resources, the Canadian Critical Care Society (CCCS), the Canadian Institute for Health Information (CIHI), and the 2026 SSC.
Results: Canada does not currently have one contemporary pan-Canadian adult sepsis clinical practice guideline. In practice, international evidence is implemented through provincial and institutional pathways. The 2026 BC guideline, applicable to adults across acute-care settings, uses modified SIRS criteria plus clinical risk factors for screening, recommends lactate measurement within 3 hours, antibiotics within 1 hour for shock or probable/definite sepsis, and within 3 hours for possible sepsis without shock when concern persists. Balanced crystalloids, early norepinephrine, dynamic assessment of fluid responsiveness, timely source control, and daily antimicrobial reassessment are central principles. Canadian implementation must also account for local antibiograms, rural and remote transfer pathways, critical-care capacity, and stewardship infrastructure.
Conclusion: Canadian sepsis care is best approached as a locally implemented, evidence-based pathway rather than a single national protocol. Early recognition, timely antimicrobials when indicated, individualized resuscitation, rapid source control, and multidisciplinary reassessment remain the core of care.
Access this Research Article
Full-text reading and high-resolution galley PDF downloads for this peer-reviewed paper are restricted to subscribed readers and participating institutions.
Subscribe to IJCPM
Get 1-year unlimited access to all closed-access research articles, clinical reports, and downloadable PDF galleys.
Subscriber Log In
Already have an active subscription or institutional credentials? Log in to read this article immediately.
Ethics & Declarations
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. All authors read and approved the final manuscript.
Ethics Approval and Consent to Participate
Not applicable. This study did not involve human participants, animal experimentation, or confidential patient clinical data.
Consent for Publication
Not applicable, or informed consent for publication was obtained from all individual participants where relevant.
Competing Interests
The authors declare that they have no competing financial or non-financial interests.
Funding
The authors declare that no funds, grants, or other financial support were received during the preparation of this manuscript.
Data Availability Statement
Data sharing is not applicable to this article as no new datasets were generated or analyzed during the current study.
References
-
1.
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287.
-
2.
Canadian Institute for Health Information. In-Hospital Sepsis. Updated September 2026. Accessed September 2026.
-
3.
Canadian Critical Care Society. Guidelines. Canadian Critical Care Society. Accessed September 2026.
-
4.
Health Quality BC. BC Initial Adult Sepsis Recognition & Management Guidelines. Last revised July 2026.
-
5.
Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026;54(4):725-812. doi:10.1097/CCM.0000000000007075.
-
6.
Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022;386(26):2459-2470. doi:10.1056/NEJMoa2202707.
-
7.
National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023;388(6):499-510. doi:10.1056/NEJMoa2212663.
-
8.
Venkatesh B, Finfer S, Cohen J, et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. N Engl J Med. 2018;378(9):797-808. doi:10.1056/NEJMoa1705835.
-
9.
Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. N Engl J Med. 2018;378(9):809-818. doi:10.1056/NEJMoa1705716.
-
10.
Vanini D, Reid S, Pero E, Rappaport S, Groth CM. Impact of pharmacist involvement on hospital sepsis response teams. Am J Health Syst Pharm. 2026. Online ahead of print. doi:10.1093/ajhp/zxag195.
-
11.
Health Quality BC. Sepsis: provincial resources and quality-improvement impact. Accessed September 2026.
Rights and Permissions
This article is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
This license allows users to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material for any purpose, even commercially), provided appropriate credit is given to the original author(s) and source, a link to the Creative Commons license is provided, and any changes made are indicated.
The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in a credit line to the material.
© 2026 Judy Zimmerman et al. International Journal of Clinical Pharmacy and Medicine.