Stewardship and Sepsis: Are They Compatible?
Main Article Content
Abstract
Sepsis is a leading cause of death and disability globally. Sepsis affects millions of individuals per year and carries high morbidity and mortality rates even if appropriate care is provided. In the United States, sepsis is considered the most common cause of inpatient death, affecting 1.7 million adults per year and contributing to 270 000 deaths. Globally, there were an estimated 49 million cases of sepsis in 2017. The annual economic burden from sepsis hospitalizations and post-acute care exceeds $60 billion. Despite advances in care, short-term mortality rates continue to exceed 15%.
Combining antimicrobial stewardship with diagnostic stewardship enhances sepsis management by improving recognition, treatment, and outcomes. Key factors include early detection of sepsis leading to optimal timing and initial choice of antimicrobials. Getting proper cultures and diagnostics improves de-escalation opportunities. Antimicrobial de-escalation reduces unnecessary broad-spectrum antimicrobials when the pathogen(s) and their susceptibilities are identified. Lastly, determining the optimal duration of antibiotic therapy based on diagnosis and clinical response. Over the past two decades, numerous randomized controlled trials (RCTs) have evaluated antibiotic durations for common clinical syndromes generally demonstrating that shorter courses are as effective as longer ones. Shorter treatment duration lowers risks of adverse drug reactions, multidrug resistance, and Clostridioides difficile infection. In conclusion, stewardship is not only compatible with sepsis care but also vital for better patient outcomes.
Keywords:
Sepsis, diagnostic stewardship, antimicrobial stewardship, rapid diagnostics, biomarkers, de-escalation
Article Details
How to Cite
SEPTIMUS, Edward J..
Stewardship and Sepsis: Are They Compatible?.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6746>. Date accessed: 07 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6746.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England). Jan 18 2020;395(10219):200-211. doi:10.1016/s0140-6736(19)32989-7
2. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. Feb 23 2016;315(8):801-10. doi:10.1001/jama.2016.0287
3. Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. Jama. Jul 2 2014;312(1):90-2. doi:10.1001/jama.2014.5804
4. Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. Jama. Oct 3 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836
5. Buchman TG, Simpson SQ, Sciarretta KL, et al. Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012-2018. Critical care medicine. Mar 2020;48(3):289-301. doi:10.1097/CCM.0000000000004226
6. Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. Oct 3 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836
7. Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. May 2010;38(5):1276-83. doi:10.1097/CCM.0b013e3181d8cc1d
8. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. Jama. Oct 27 2010;304(16):1787-94. doi:10.1001/jama.2010.1553
9. Evans L, Rhodes A, Alhazzani W, et al. Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Crit Care Med. Nov 1 2021;49(11):1974-1982. doi:10.1097/ccm.0000000000005357
10. Levy MM, Gesten FC, Phillips GS, et al. Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative. American journal of respiratory and critical care medicine. Dec 1 2018;198(11):1406-1412. doi:10.1164/rccm.201712-2545OC
11. Rhee C, Kadri SS, Dekker JP, et al. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use. JAMA Netw Open. Apr 1 2020;3(4):e202899. doi:10.1001/jamanetworkopen.2020.2899
12. Shappell CN, Klompas M, Ochoa A, Rhee C, Program CDCPE. Likelihood of Bacterial Infection in Patients Treated With Broad-Spectrum IV Antibiotics in the Emergency Department. Crit Care Med. Nov 1 2021;49(11):e1144-e1150. doi:10.1097/CCM.0000000000005090
13. Kariuki S. Global burden of antimicrobial resistance and forecasts to 2050. The Lancet. 2024;404(10459):1172-1173. doi:10.1016/S0140-6736(24)01885-3
14. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. Apr 2003;31(4):1250-6. doi:10.1097/01.Ccm.0000050454.01978.3b
15. Biebelberg B, Rhee C, Chen T, McKenna C, Klompas M. Heterogeneity of Sepsis Presentations and Mortality Rates. Annals of internal medicine. Jul 2024;177(7):985-987. doi:10.7326/m24-0400
16. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. Jul 2001;29(7):1303-10. doi:10.1097/00003246-200107000-00002
17. Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. Mar 2012;40(3):754-61. doi:10.1097/CCM.0b013e318232db65
18. Jolley RJ, Sawka KJ, Yergens DW, Quan H, Jetté N, Doig CJ. Validity of administrative data in recording sepsis: a systematic review. Critical care (London, England). Apr 6 2015;19(1):139. doi:10.1186/s13054-015-0847-3
19. Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care--reasons for caution. The New England journal of medicine. May 1 2014;370(18):1673-6. doi:10.1056/NEJMp1400276
20. Hueth KD, Prinzi AM, Timbrook TT. Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement. Antibiotics. 2022;11(2):250.
21. Tamma PD, Miller MA, Cosgrove SE. Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice. JAMA. 2019;321(2):139-140. doi:10.1001/jama.2018.19509
22. Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. The New England journal of medicine. Jun 8 2017;376(23):2235-2244. doi:10.1056/NEJMoa1703058
23. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA internal medicine. Sep 1 2017;177(9):1308-1315. doi:10.1001/jamainternmed.2017.1938
24. Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Critical care. 2015;19:319. doi:10.1186/s13054-015-1035-1
25. Rhee C, Chen T, Kadri SS, et al. Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals. JAMA Netw Open. Jun 3 2024;7(6):e2418923. doi:10.1001/jamanetworkopen.2024.18923
26. Gohil SK, Septimus E, Kleinman K, et al. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial. JAMA. 2024;doi:10.1001/jama.2024.6259
27. Gohil SK, Septimus E, Kleinman K, et al. Stewardship Prompts to Improve Antibiotic Selection for Pneumonia: The INSPIRE Randomized Clinical Trial. JAMA. 2024;doi:10.1001/jama.2024.6248
28. Kashiouris MG, Zemore Z, Kimball Z, et al. Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis. Critical care medicine. Oct 2019;47(10):1388-1395. doi:10.1097/CCM.0000000000003921
29. Taylor SP, Anderson WE, Beam K, Taylor B, Ellerman J, Kowalkowski MA. The Association Between Antibiotic Delay Intervals and Hospital Mortality Among Patients Treated in the Emergency Department for Suspected Sepsis. Critical care medicine. May 1 2021;49(5):741-747. doi:10.1097/CCM.0000000000004863
30. Kondo Y, Klompas M, McKenna CS, et al. Association Between the Sequence of beta-lactam and Vancomycin Administration and Mortality in Patients with Suspected Sepsis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Dec 5 2024;doi:10.1093/cid/ciae599
31. Amoah J, Klein EY, Chiotos K, Cosgrove SE, Tamma PD. Administration of a beta-Lactam Prior to Vancomycin as the First Dose of Antibiotic Therapy Improves Survival in Patients With Bloodstream Infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Aug 24 2022;75(1):98-104. doi:10.1093/cid/ciab865
32. Fabre V, Klein E, Salinas AB, et al. A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study. Journal of clinical microbiology. Sep 22 2020;58(10)doi:10.1128/jcm.01053-20
33. Wolk DM, Parrott JS, Babady NE, et al. The American Society for Microbiology’s evidence-based laboratory medicine practice guidelines for the diagnosis of bloodstream infections using rapid tests: a systematic review and meta-analysis. Clinical Microbiology Reviews. 0(0):e00137-24. doi:doi:10.1128/cmr.00137-24
34. Ipe DS, Sundac L, Benjamin WH, Jr, Moore KH, Ulett GC. Asymptomatic bacteriuria: prevalence rates of causal microorganisms, etiology of infection in different patient populations, and recent advances in molecular detection. FEMS Microbiology Letters. 2013;346(1):1-10. doi:10.1111/1574-6968.12204
35. Spivak ES, Burk M, Zhang R, et al. Management of Bacteriuria in Veterans Affairs Hospitals. Clinical Infectious Diseases. 2017;65(6):910-917. doi:10.1093/cid/cix474
36. Petty LA, Vaughn VM, Flanders SA, et al. Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department. Open forum infectious diseases. 2020;7(12)doi:10.1093/ofid/ofaa537
37. Claeys KC, Trautner BW, Leekha S, et al. Optimal Urine Culture Diagnostic Stewardship Practice—Results from an Expert Modified-Delphi Procedure. Clinical Infectious Diseases. 2021;75(3):382-389. doi:10.1093/cid/ciab987
38. Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clinical Chemistry and Laboratory Medicine (CCLM). 2019;57(9):1308-1318. doi:doi:10.1515/cclm-2018-1181
39. Candel FJ, Salavert M, Cantón R, et al. The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document. Critical care (London, England). Dec 30 2024;28(1):440. doi:10.1186/s13054-024-05224-3
40. Eubank TA, Long SW, Perez KK. Role of Rapid Diagnostics in Diagnosis and Management of Patients With Sepsis. The Journal of infectious diseases. Jul 21 2020;222(Suppl 2):S103-s109. doi:10.1093/infdis/jiaa263
41. Reitz KM, Kennedy J, Li SR, et al. Association Between Time to Source Control in Sepsis and 90-Day Mortality. JAMA Surg. Sep 1 2022;157(9):817-826. doi:10.1001/jamasurg.2022.2761
42. Kam KQ, Chen T, Kadri SS, et al. Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Feb 5 2025;80(1):108-117. doi:10.1093/cid/ciae591
43. Spellberg B. The New Antibiotic Mantra—“Shorter Is Better”. JAMA internal medicine. 2016;176(9):1254-1255. doi:10.1001/jamainternmed.2016.3646
44. de Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. The Lancet Infectious diseases. Jul 2016;16(7):819-827. doi:10.1016/s1473-3099(16)00053-0
45. Dark P, Hossain A, McAuley DF, et al. Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. Jama. Feb 25 2025;333(8):682-693. doi:10.1001/jama.2024.26458
2. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. Feb 23 2016;315(8):801-10. doi:10.1001/jama.2016.0287
3. Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. Jama. Jul 2 2014;312(1):90-2. doi:10.1001/jama.2014.5804
4. Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. Jama. Oct 3 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836
5. Buchman TG, Simpson SQ, Sciarretta KL, et al. Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012-2018. Critical care medicine. Mar 2020;48(3):289-301. doi:10.1097/CCM.0000000000004226
6. Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. Oct 3 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836
7. Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. May 2010;38(5):1276-83. doi:10.1097/CCM.0b013e3181d8cc1d
8. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. Jama. Oct 27 2010;304(16):1787-94. doi:10.1001/jama.2010.1553
9. Evans L, Rhodes A, Alhazzani W, et al. Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Crit Care Med. Nov 1 2021;49(11):1974-1982. doi:10.1097/ccm.0000000000005357
10. Levy MM, Gesten FC, Phillips GS, et al. Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative. American journal of respiratory and critical care medicine. Dec 1 2018;198(11):1406-1412. doi:10.1164/rccm.201712-2545OC
11. Rhee C, Kadri SS, Dekker JP, et al. Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use. JAMA Netw Open. Apr 1 2020;3(4):e202899. doi:10.1001/jamanetworkopen.2020.2899
12. Shappell CN, Klompas M, Ochoa A, Rhee C, Program CDCPE. Likelihood of Bacterial Infection in Patients Treated With Broad-Spectrum IV Antibiotics in the Emergency Department. Crit Care Med. Nov 1 2021;49(11):e1144-e1150. doi:10.1097/CCM.0000000000005090
13. Kariuki S. Global burden of antimicrobial resistance and forecasts to 2050. The Lancet. 2024;404(10459):1172-1173. doi:10.1016/S0140-6736(24)01885-3
14. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. Apr 2003;31(4):1250-6. doi:10.1097/01.Ccm.0000050454.01978.3b
15. Biebelberg B, Rhee C, Chen T, McKenna C, Klompas M. Heterogeneity of Sepsis Presentations and Mortality Rates. Annals of internal medicine. Jul 2024;177(7):985-987. doi:10.7326/m24-0400
16. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. Jul 2001;29(7):1303-10. doi:10.1097/00003246-200107000-00002
17. Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. Mar 2012;40(3):754-61. doi:10.1097/CCM.0b013e318232db65
18. Jolley RJ, Sawka KJ, Yergens DW, Quan H, Jetté N, Doig CJ. Validity of administrative data in recording sepsis: a systematic review. Critical care (London, England). Apr 6 2015;19(1):139. doi:10.1186/s13054-015-0847-3
19. Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care--reasons for caution. The New England journal of medicine. May 1 2014;370(18):1673-6. doi:10.1056/NEJMp1400276
20. Hueth KD, Prinzi AM, Timbrook TT. Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement. Antibiotics. 2022;11(2):250.
21. Tamma PD, Miller MA, Cosgrove SE. Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice. JAMA. 2019;321(2):139-140. doi:10.1001/jama.2018.19509
22. Seymour CW, Gesten F, Prescott HC, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. The New England journal of medicine. Jun 8 2017;376(23):2235-2244. doi:10.1056/NEJMoa1703058
23. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA internal medicine. Sep 1 2017;177(9):1308-1315. doi:10.1001/jamainternmed.2017.1938
24. Klein Klouwenberg PM, Cremer OL, van Vught LA, et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Critical care. 2015;19:319. doi:10.1186/s13054-015-1035-1
25. Rhee C, Chen T, Kadri SS, et al. Trends in Empiric Broad-Spectrum Antibiotic Use for Suspected Community-Onset Sepsis in US Hospitals. JAMA Netw Open. Jun 3 2024;7(6):e2418923. doi:10.1001/jamanetworkopen.2024.18923
26. Gohil SK, Septimus E, Kleinman K, et al. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial. JAMA. 2024;doi:10.1001/jama.2024.6259
27. Gohil SK, Septimus E, Kleinman K, et al. Stewardship Prompts to Improve Antibiotic Selection for Pneumonia: The INSPIRE Randomized Clinical Trial. JAMA. 2024;doi:10.1001/jama.2024.6248
28. Kashiouris MG, Zemore Z, Kimball Z, et al. Supply Chain Delays in Antimicrobial Administration After the Initial Clinician Order and Mortality in Patients With Sepsis. Critical care medicine. Oct 2019;47(10):1388-1395. doi:10.1097/CCM.0000000000003921
29. Taylor SP, Anderson WE, Beam K, Taylor B, Ellerman J, Kowalkowski MA. The Association Between Antibiotic Delay Intervals and Hospital Mortality Among Patients Treated in the Emergency Department for Suspected Sepsis. Critical care medicine. May 1 2021;49(5):741-747. doi:10.1097/CCM.0000000000004863
30. Kondo Y, Klompas M, McKenna CS, et al. Association Between the Sequence of beta-lactam and Vancomycin Administration and Mortality in Patients with Suspected Sepsis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Dec 5 2024;doi:10.1093/cid/ciae599
31. Amoah J, Klein EY, Chiotos K, Cosgrove SE, Tamma PD. Administration of a beta-Lactam Prior to Vancomycin as the First Dose of Antibiotic Therapy Improves Survival in Patients With Bloodstream Infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Aug 24 2022;75(1):98-104. doi:10.1093/cid/ciab865
32. Fabre V, Klein E, Salinas AB, et al. A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study. Journal of clinical microbiology. Sep 22 2020;58(10)doi:10.1128/jcm.01053-20
33. Wolk DM, Parrott JS, Babady NE, et al. The American Society for Microbiology’s evidence-based laboratory medicine practice guidelines for the diagnosis of bloodstream infections using rapid tests: a systematic review and meta-analysis. Clinical Microbiology Reviews. 0(0):e00137-24. doi:doi:10.1128/cmr.00137-24
34. Ipe DS, Sundac L, Benjamin WH, Jr, Moore KH, Ulett GC. Asymptomatic bacteriuria: prevalence rates of causal microorganisms, etiology of infection in different patient populations, and recent advances in molecular detection. FEMS Microbiology Letters. 2013;346(1):1-10. doi:10.1111/1574-6968.12204
35. Spivak ES, Burk M, Zhang R, et al. Management of Bacteriuria in Veterans Affairs Hospitals. Clinical Infectious Diseases. 2017;65(6):910-917. doi:10.1093/cid/cix474
36. Petty LA, Vaughn VM, Flanders SA, et al. Assessment of Testing and Treatment of Asymptomatic Bacteriuria Initiated in the Emergency Department. Open forum infectious diseases. 2020;7(12)doi:10.1093/ofid/ofaa537
37. Claeys KC, Trautner BW, Leekha S, et al. Optimal Urine Culture Diagnostic Stewardship Practice—Results from an Expert Modified-Delphi Procedure. Clinical Infectious Diseases. 2021;75(3):382-389. doi:10.1093/cid/ciab987
38. Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clinical Chemistry and Laboratory Medicine (CCLM). 2019;57(9):1308-1318. doi:doi:10.1515/cclm-2018-1181
39. Candel FJ, Salavert M, Cantón R, et al. The role of rapid multiplex molecular syndromic panels in the clinical management of infections in critically ill patients: an experts-opinion document. Critical care (London, England). Dec 30 2024;28(1):440. doi:10.1186/s13054-024-05224-3
40. Eubank TA, Long SW, Perez KK. Role of Rapid Diagnostics in Diagnosis and Management of Patients With Sepsis. The Journal of infectious diseases. Jul 21 2020;222(Suppl 2):S103-s109. doi:10.1093/infdis/jiaa263
41. Reitz KM, Kennedy J, Li SR, et al. Association Between Time to Source Control in Sepsis and 90-Day Mortality. JAMA Surg. Sep 1 2022;157(9):817-826. doi:10.1001/jamasurg.2022.2761
42. Kam KQ, Chen T, Kadri SS, et al. Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Feb 5 2025;80(1):108-117. doi:10.1093/cid/ciae591
43. Spellberg B. The New Antibiotic Mantra—“Shorter Is Better”. JAMA internal medicine. 2016;176(9):1254-1255. doi:10.1001/jamainternmed.2016.3646
44. de Jong E, van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. The Lancet Infectious diseases. Jul 2016;16(7):819-827. doi:10.1016/s1473-3099(16)00053-0
45. Dark P, Hossain A, McAuley DF, et al. Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. Jama. Feb 25 2025;333(8):682-693. doi:10.1001/jama.2024.26458