Initial antimicrobial management of sepsis

Crit Care. 2021 Aug 26;25(1):307. doi: 10.1186/s13054-021-03736-w.


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.

Keywords: Antibiotic therapy; Antimicrobial therapy; Bacteremia; Biomarkers; Fungal infection; Intra-abdominal infection; Pharmacokinetics; Pneumonia; Sepsis.

Publication types

  • Review

MeSH terms

  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / therapeutic use*
  • Biomarkers / analysis
  • Biomarkers / blood
  • Humans
  • Sepsis / drug therapy*
  • Time Factors*
  • Time-to-Treatment / standards
  • Time-to-Treatment / statistics & numerical data


  • Anti-Infective Agents
  • Biomarkers