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Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings., Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the final consensus statements., Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include consensus on managing patients with sepsis outside a designated critical care area, triggers for escalating clinical management and criteria for safe transfer to another facility. The experts agreed on the following: in the absence of serum lactate, clinical parameters such as altered mental status, capillary refill time and urine output may be used to guide resuscitation; special considerations regarding the volume of fluid used for resuscitation, especially in tropical infections, including the use of simple tests to assess fluid responsiveness when facilities for advanced hemodynamic monitoring are limited; use of Ringer's lactate or Hartmann's solution as balanced salt solutions; epinephrine when norepinephrine or vasopressin are unavailable; and the administration of vasopressors via a peripheral vein if central venous access is unavailable or not feasible. Similarly, where facilities for investigation are unavailable, there was consensus for empirical antimicrobial administration without delay when sepsis was strongly suspected, as was the empirical use of antiparasitic agents in patients with suspicion of parasitic infections., Conclusion: Using a Delphi method, international experts reached consensus to generate expert clinical practice statements providing guidance to clinicians worldwide on the management of sepsis in resource-limited settings. These statements complement existing guidelines where evidence is lacking and add relevant aspects of sepsis management that are not addressed by current international guidelines. Future studies are needed to assess the effects of these practice statements and address remaining uncertainties., Competing Interests: Declarations. Conflicts of interest: Massimo Antonelli: Grants from GE and Fisher & Paykel; Lecture fees from Menarini, Shionogi, Fisher & Paykel, Dimar. Jan De Waele: Consulted for Biomerieux, Menarini, MSD, Pfizer, Roche Diagnostics, ThermoFisher and Viatris (fees and honoraria paid to institution). Supported by a Sr Clinical Research Grant from the Research Foundation Flanders (FWO, Ref.1881020N). Jigeeshu Divatia: Lecture fees from Edwards India paid to my institution. Simon Finfer: Supported by an NHMRC Investigator Fellowship (Leadership Level 3 App 2017580), has received consulting fees paid to his employer from RevImmune Inc. and owns options in Sepsis Scout. Naomi E Hammond: Supported by an NHMRC Investigator Fellowship (Emerging Leader Level 1 App 1196320), has received consulting fees paid to her employer from RevImmune Inc. Arthur Kwizera: Grants from the Wellcome Trust; NIHR; Fisher & Paykel Ltd; Gradian Health Systems; Vygon Ltd; Speaker support from the ESICM; Makerere University Research and Innovation Fund. Marlies Ostermann: Institution received research funding from Baxter and Biomerieux. Ethical approval and consent: The study protocol was registered on clinicaltrials.gov [NCT05909384]. Oxford Tropical Research Ethics Committee (OxTREC) confirmed that the study was exempt from ethics review in March 2023. Consent to participate and publish: All authors and collaborators consented to participate in and publish this study., (© 2024. The Author(s).)