Too much of a good thing is not necessarily better.

摘要

In a situation of emerging multi-drug resistance among important pathogens and a very high (too high?) use of very-broad-spectrum antibiotics in the intensive care units (ICUs) worldwied, the importance of antimicrobial stewardship is increasingly necessary and action is urgently needed (1). At the same time, sepsis is a continuous risk for patients in the ICUs and because delay to appropriate antimicrobial therapy in severe bacterial infections is related to mortality (2-4), it is recommended in guidelines to initiate antimicrobial therapy within 1 hr (5). The diagnosis of sepsis is hampered, however, by its nonspecific presentation because the systemic inflammatory response syndrome is common not only in severe infection, but also in various noninfec-tious conditions of inflammation. The clinician needs help to rational use of potent antimicrobial therapy if we should not give way to blind very broad-spectrum antibiotic exposure to everyone, which will be the way directly to untreatable infections resulting from multiresistant organisms (6).