Fig. 1.

The need for immediate broad-spectrum empiric antimicrobial therapy for selected patients with severe sepsis may be life-saving, but may also put pressure to overuse antibiotics and drive antibiotic resistance. Thus, this approach comes with the obligation to try to control resistance by de-escalating therapy once serial clinical, microbiologic and laboratory data become available. De-escalation can be in the form of shorter duration of therapy, less broad-spectrum agents, fewer drugs, or a combination of these interventions