{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:03:04Z","timestamp":1790697784679,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Antibiotic treatment duration in critically ill patients has undergone major reevaluation. Historically concerns for short therapy included a lower cure rate and emergence of resistance, whereas prolonged courses raised risks of microbiome disruption, superinfection, Clostridioides difficile colitis, and resistance. Defining optimal duration of therapy in sepsis and severe infections remains challenging due to heterogeneity in host immunity, pathogen virulence, infection site and source control.<\/jats:p>\n                  <jats:p>Mechanistic insights from microbiology and PK\/PD highlight how bacterial inoculum, biofilms, mutant selection windows and altered drug distribution in critical illness influence bacterial clearance and resistance selection. Experimental models and PK-optimized dosing strategies underscore the potential to shorten therapy by accelerating pathogen eradication.<\/jats:p>\n                  <jats:p>Across a range of serious infections, randomized trials consistently show that short course therapy (&amp;lt;7 days) is noninferior to longer courses, including bacteremia, intra-abdominal infections and ventilator-associated pneumonia. Biomarker guided strategies\u2014particularly procalcitonin-based algorithms\u2014might further individualize duration of therapy and safely reduce exposure. Uncertainty remains for S. aureus bacteremia, infections caused by non-fermenting Gram-negative bacilli, difficult to treat multidrug-resistant organisms, invasive candidiasis and immunocompromised patients.<\/jats:p>\n                  <jats:p>Robust evidence supports markedly reduced duration of therapy for uncomplicated bloodstream infections after effective source control, intra-abdominal infections and ventilator-associated pneumonia. Infections involving retained prosthetic material or devices often require prolonged therapy or long-term suppressive regimens.<\/jats:p>\n                  <jats:p>Future research must include adequately powered trials across diverse populations, and evaluate rapid diagnostics, host-response profiling, and individualized response-guided strategies. Optimizing antibiotic duration in critically ill patients ultimately requires integrating mechanistic understanding, individual clinical evolution, and stewardship principles to balance potential efficacy and potential harm.<\/jats:p>","DOI":"10.1093\/ajrccm\/aamag458","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:24:04Z","timestamp":1790594644000},"source":"Crossref","is-referenced-by-count":0,"title":["Duration of antibiotic therapy in sepsis and severe infections in critically ill patients"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6063-7383","authenticated-orcid":false,"given":"Jean-Fran\u00e7ois","family":"Timsit","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris-Cit\u00e9, INSERM, IAME, U1137, Team MOCLID , Paris,","place":["France"]},{"name":"APHP, Bichat Hospital, Medical and Infectious Diseases ICU , F75018, Paris,","place":["France"]},{"name":"OUTCOME REA Research Group , 93000 Drancy,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6218-435X","authenticated-orcid":false,"given":"Jason A","family":"Roberts","sequence":"additional","affiliation":[{"name":"The University of Queensland, UQ Centre for Clinical Research , Brisbane,","place":["Australia"]},{"name":"Herston Infectious Diseases Institute (HeIDI), Metro North Health , Brisbane,","place":["Australia"]},{"name":"Royal Brisbane and Women\u2019s Hospital Departments of Pharmacy and Intensive Care Medicine, , Brisbane,","place":["Australia"]},{"name":"Nimes University Hospital UR UM 103, University of Montpellier, Division of Anesthesia Critical Care and Emergency and Pain Medicine, , Nimes,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6413-3396","authenticated-orcid":false,"given":"Souha","family":"Kanj","sequence":"additional","affiliation":[{"name":"American University of Beirut, Faculty of Medicine , Lebanon, AUBMC,PO -Box 11-0236, Riad El Solh 1107 2020, Beirut,","place":["Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0145-9740","authenticated-orcid":false,"given":"Matteo","family":"Bassetti","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliera Metropolitana, San Martino Hospital Infectious Diseases Unit, , Genoa,","place":["Italy"]},{"name":"University of Genoa Department of Health Sciences, , Genoa,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1675-3173","authenticated-orcid":false,"given":"Rafael","family":"Canton","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ram\u00f3n y Cajal and Instituto Ram\u00f3n Cajal de Investigaci\u00f3n Sanitaria (IRYCIS) Servicio de Microbiologia. . Madrid.","place":["Spain"]},{"name":"CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III. Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-0164","authenticated-orcid":false,"given":"Paul","family":"Dark","sequence":"additional","affiliation":[{"name":"University of Manchester Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, ,","place":["UK"]},{"name":"Critical Care and Major Trauma Services, Northern Care Alliance NHS Foundation Trust , Greater Manchester,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1002-2989","authenticated-orcid":false,"given":"Robert","family":"Fowler","sequence":"additional","affiliation":[{"name":"University of Toronto Sunnybrook Health Sciences Centre, , Toronto,","place":["Canada"]},{"name":"University of Toronto Institute of Health Policy, Management and Evaluation, , Toronto,","place":["Canada"]},{"name":"ICES , Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8380-368X","authenticated-orcid":false,"given":"Angela","family":"Huttner","sequence":"additional","affiliation":[{"name":"Geneva University Hospitals and Faculty of Medicine Division of Infectious Diseases, , Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marin H","family":"Kollef","sequence":"additional","affiliation":[{"name":"WashU Medicine Division of Pulmonary & Critical Care Medicine, , St. Louis, MO,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott T","family":"Micek","sequence":"additional","affiliation":[{"name":"University of Health Sciences and Pharmacy in St. Louis Department of Pharmacy Practice, , St. Louis, MO,","place":["USA"]},{"name":"Center for Health Outcomes Research and Education, University of Health Sciences and Pharmacy in St. Louis , St. Louis, MO,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8155-2661","authenticated-orcid":false,"given":"Robert G","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Western Michigan University Homer Stryker MD School of Medicine Department of Surgery, , Kalamazoo, MI,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Thy","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Cit\u00e9, INSERM, IAME, U1137, Team MOCLID , Paris,","place":["France"]},{"name":"APHP, Bichat Hospital, Medical and Infectious Diseases ICU , F75018, Paris,","place":["France"]},{"name":"OUTCOME REA Research Group , 93000 Drancy,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3181-9791","authenticated-orcid":false,"given":"Dafna","family":"Yahav","sequence":"additional","affiliation":[{"name":"Tel Aviv University Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel; School of Medicine, Faculty of Medical and Health Sciences, , Tel Aviv,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8827-3764","authenticated-orcid":false,"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"University of Toronto Sunnybrook Health Sciences Centre, , Toronto,","place":["Canada"]},{"name":"University of Toronto Institute of Health Policy, Management and Evaluation, , Toronto,","place":["Canada"]},{"name":"ICES , Toronto,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,29]]},"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article-pdf\/doi\/10.1093\/ajrccm\/aamag458\/71465779\/aamag458.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article-pdf\/doi\/10.1093\/ajrccm\/aamag458\/71465779\/aamag458.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:16:51Z","timestamp":1790695011000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article\/doi\/10.1093\/ajrccm\/aamag458\/8845489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/ajrccm\/aamag458","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"article-number":"aamag458"}}