**4. Conclusions**

For patients with sepsis, we opt to an optimal doses of empiric broad spectrum intravenous therapy with one or more antimicrobials be administered, in a prompt fashion (eg, within one hour) of clinical presentation. For patients with septic shock with likely gram negative sepsis we suggest combination therapy (at least two) from different classes given with the intent of covering a known or suspected pathogen with more than one antibiotic. It is the only guarantor for sufficient activity to cover a broad range of gram negative and positive organisms and, if suspected, against fungi and viruses. Agent selection depends upon patient's history, co morbidities, immune defects, clinical context, suspected site of infection, presence of invasive devices, and local prevalence and resistance patterns.

The advent of new technologies (multiplex-PCR) with the ability to type and characterize microorganisms without the need for conventional culture techniques may negate the requirement for highly specialized microbiology staff and facilities. These methods could eventually contribute significantly to improved management of patients with sepsis and septic shock as well as antibiotic stewardship programs.
