Initial antimicrobial management of sepsis

Michael S. Niederman, Rebecca M. Baron, Lila Bouadma, Thierry Calandra, Nick Daneman, Jan DeWaele, Marin H. Kollef, Jeffrey Lipman, Girish B. Nair

Research output: Contribution to journalReview articlepeer-review

63 Scopus citations


Sepsis is a common consequence of infection, associated with a mortality rate > 25%. Although community-acquired sepsis is more common, hospital-acquired infection is more lethal. The most common site of infection is the lung, followed by abdominal infection, catheter-associated blood steam infection and urinary tract infection. Gram-negative sepsis is more common than gram-positive infection, but sepsis can also be due to fungal and viral pathogens. To reduce mortality, it is necessary to give immediate, empiric, broad-spectrum therapy to those with severe sepsis and/or shock, but this approach can drive antimicrobial overuse and resistance and should be accompanied by a commitment to de-escalation and antimicrobial stewardship. Biomarkers such a procalcitonin can provide decision support for antibiotic use, and may identify patients with a low likelihood of infection, and in some settings, can guide duration of antibiotic therapy. Sepsis can involve drug-resistant pathogens, and this often necessitates consideration of newer antimicrobial agents.

Original languageEnglish
Article number307
JournalCritical Care
Issue number1
StatePublished - Dec 2021


  • Antibiotic therapy
  • Antimicrobial therapy
  • Bacteremia
  • Biomarkers
  • Fungal infection
  • Intra-abdominal infection
  • Pharmacokinetics
  • Pneumonia
  • Sepsis


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