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Severe sepsis and septic shock are as common and lethal as other acute life-threatening conditions that emergency physicians routinely confront such as acute myocardial infarction, stroke, and trauma. Recent studies have led to a better understanding of the pathogenic mechanisms and the development of new or newly applied therapies. These therapies place early and aggressive management of severe sepsis and septic shock as integral to improving outcome. This independent review of the literature examines the recent pathogenic, diagnostic, and therapeutic advances in severe sepsis and septic shock for adults, with particular relevance to emergency practice. Recommendations are provided for therapies that have been shown to improve outcomes, including early goal-directed therapy, early and appropriate antimicrobials, source control, recombinant human activated protein C, corticosteroids, and low tidal volume mechanical ventilation.

[Ann Emerg Med. 2013;62:78-79.] In this issue, May et al 1 offer a review and call for action in a nascent yet important area of emergency medicine, antibiotic stewardship. The stewardship approach seeks to have clinicians more carefully weigh when and how to use antibiotics, targeting bacterial infection resolution while maintaining the utility of antibiotics. Many forces work against this noble cause, notably regulatory and performance measures designed to promote timely antibiotic administration. These measures may have pushed emergency physicians to administer antibiotics when not warranted— eg, if any possible pneumonia might be present even if bacterial pneumonia is unlikely—to avoid penalties or perceived poor care. Based on the input of many, this wellintended regulatory push with unintended consequences is now