Gram-negative sepsis in the intensive care unit: avoiding therapeutic failure

Purpose of review The purpose of this review is to examine some of the latest concepts in the management of sepsis and septic shock in the Intensive Care environment, with a focus on Gram-negative infections. Recent findings Recent developments in adjunctive therapies for sepsis and septic shock are discussed including protocol-driven therapies, the importance of timely appropriate antimicrobials and the growing threat and implications of rising Gram-negative antimicrobial resistance. Summary The balance between the most effective and the most responsible prescribing is difficult to strike, but recognition of the impact of antibiotic failure makes it even more important to consider how we husband the microflora of the ICU. New therapeutic options are somewhat limited but goal-directed protocol-driven approaches linked with sound knowledge of the microflora and our impact upon it as an ecosystem is essential.