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Background

Sepsis, defined as a dysregulated host response to infection leading to acute organ dysfunction, affects millions of patients per year. It is associated with 850,000 visits to US emergency departments (EDs) annually 1 and one-third of US hospitalizations that end in death or discharge to hospice. 2 Guidelines on sepsis management have long emphasized that early recognition and treatment are key to lowering mortality. Many observational studies have attempted to quantify the association between

Discussion

Overall, the 2021 SSC and ACEP guidelines have made significant progress in building consensus recommendations for antimicrobial timing and breadth, balancing the importance of rapid treatment for potentially septic patients with bona fide infections against the potential harms associated with antibiotics for those who are not infected. By casting a more critical light upon the limitations of existing evidence, they also forecast several areas where higher quality evidence is needed. For

Summary

From 2016 to 2020, sepsis guidelines and regulatory mandates encouraged increasingly brief targets—as short as 1 h—for initiating broad-spectrum antimicrobials for patients with suspected sepsis or septic shock. This sparked considerable controversy due to weaknesses in the underlying evidence and concern that strict antibiotic deadlines cause inadvertent harm by perpetuating or accelerating overtreatment at the expense of diagnostic inquiry. A third or more of patients treated for sepsis and