Purpose of review: To review the recent literature supporting the idea that in some patients suspected of having a new ICU-acquired infection, antibiotics can be withheld until evidence to confirm diagnosis is obtained.
Recent findings: Recent publications demonstrate that in community-acquired pneumonia, severe sepsis presenting to the emergency room, and suspected ICU-acquired infection, the time to antibiotic therapy does not necessarily seem to be a key determinant of outcome.
Summary: In the ICU, patients without septic shock but suspected of having an ICU-acquired infection may be able to have antibiotics withheld until infection is confirmed using a combination of laboratory, radiologic, and microbiological data.