Miguel Salavert

Background: Sepsis remains a major global health challenge. International guidelines exist, but their implementation is inconsistent, and supporting evidence largely comes from high‐income settings. The objective of this study was to generate international, multidisciplinary expert consensus on controversial aspects of sepsis management within the framework of sepsis code programs. Methods: A multinational modified Delphi study was conducted with 164 experts from 22 countries, 12 specialties, and 105 scientific societies. Seven domains were evaluated: early diagnosis, biomarkers, diagnostic microbiology, hemodynamic monitoring, source control, antimicrobial therapy, and hemodynamic management. Consensus was defined as ≥70% agreement across three iterative rounds using Likert scales (Rounds 1–2) and binary format (Round 3). Results: Consensus was achieved for 40 statements. Strong endorsement (82%–95%) was reached for structured hospital sepsis programs, NEWS‐2 as the preferred early recognition tool, biomarker use (notably procalcitonin) to complement clinical assessment, urgent source control within 6 h independent of hemodynamic status, rapid molecular diagnostics integrated with antimicrobial stewardship, and norepinephrine as first‐line vasopressor therapy. Experts also supported pharmacokinetic‐ and pharmacodynamic‐guided antibiotic dosing, prolonged infusion of time‐dependent agents, and dynamic rather than fixed fluid strategies. No consensus was reached on routine reliance on Sepsis‐2, Sepsis‐3, or qSOFA; high mean arterial pressure targets; or universal combination antimicrobial therapy. Conclusions: These results provide multidisciplinary guidance for sepsis management, with emphasis on rapid recognition, targeted antimicrobial therapy, timely source control, and hemodynamic management guided by patient physiology. The recommendations are applicable to high‐ and middle‐income healthcare systems.

At a time of great concern regarding trends in morbidity and mortality from infections, and mindful of the limitations of our current approaches to combating them, this document sets out a structured programme of proposals aimed at improving, in the short and medium term, the survival of the most at-risk patients with severe infections. These are complementary proposals which, on the one hand, reinforce already established initiatives and, on the other, introduce some novel aspects to the approach to this complex problem. They focus on accelerating, standardising, and refining the clinical diagnosis of severe infection and its microbiological diagnosis and, above all, on improving the effectiveness of antimicrobial treatment, based on its immediate initiation with the most effective treatment available, and with an improved capacity to integrate innovation into all stages and processes. This programme is designed to be implemented within the framework of the Antimicrobial Stewardship Programmes (ASPs) (hence the name ASP-COMPLEX), and requires appropriate dissemination and surveillance policies, alongside a collaborative environment among the multiple stakeholders involved in delivering innovation (experts, ASP teams, healthcare administration, academia, the pharmaceutical industry, etc.).

The management of febrile neutropenia (FN) in oncohematological patients is undergoing a paradigm shift driven by a deeper understanding of patients’ pathophysiological heterogeneity, the increasing speed and accuracy of microbiological diagnostics, the emergence of new antibiotics, and the incorporation of predictive artificial intelligence (AI) as a tool to support clinical decision-making. Our objective is to provide an updated and comprehensive overview of the factors influencing antibiotic treatment in FN. We propose that its management should be based on three essential pillars. First, accurate risk stratification for bacterial infection. Second, ensuring that patients receive appropriate empirical antibiotic therapy, tailoring the initial choice according to the results of surveillance cultures from oropharyngeal and/or fecal microbiota. Finally, prioritizing antibiotic choices that preserve intestinal microbiota eubiosis as much as possible. Reducing colonization and overgrowth of facultative aerobic/anaerobic flora (Enterobacteriaceae, non-fermenting Gram-negative bacilli, and Enterococcus spp.) while preserving strict anaerobic flora decreases the risk of bacterial translocation and complications such as graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) or loss of CAR-T functionality. This decision model, grounded in objective criteria, aims to balance the need for effective empirical coverage with responsible antibiotic use.

Suboptimal antimicrobial use is a global challenge driven by entrenched misconceptions and dogmas. This article aims to critically evaluate and debunk several widespread myths in infectious disease management that lead to overdiagnosis and overtreatment. Through a nonsystematic literature review, this manuscript examines key misconceptions across various aspects of antimicrobial therapy, including administration routes, drug mechanisms, treatment duration, and the interplay with infection source control. It also explores the influence of evolving concepts like long-acting antimicrobials and the human microbiome. We challenge the dogmas that intravenous antibiotics are superior to oral agents, that longer courses are always better, and that bactericidal drugs are more effective than bacteriostatic ones. The review highlights the paramount importance of source control and surgical intervention in treating severe infections and cautions against misinformation surrounding the human microbiome. The medical community must critically re-evaluate long-standing clinical practices to improve antibiotic stewardship. By debunking these myths, we can promote a more precise, safe, and effective approach to antimicrobial use, ultimately reducing unnecessary prescribing and combating antimicrobial resistance.

Pneumonia is the leading cause of death from infection in the developed world. In recent years, researchers and healthcare professionals have worked extensively to reduce this burden. Prevention is better than cure, and significant advances have been made in areas such as vaccination and the prevention of nosocomial pneumonia in intensive care units. Comprehensive surveillance programmes and new diagnostic methods have been developed to assess trends in this disease and to identify the infectious agents involved. Clinical presentation can be challenging in elderly patients or those with certain comorbidities, prompting new studies in these populations to address these issues. Correct and early management of severe community-acquired pneumonia represents a major opportunity to reduce its associated mortality. Although fungal pathogens are an uncommon cause of lung infection, they are associated with high morbidity and mortality, highlighting the need for new approaches. Finally, new drugs are available for the treatment of pneumonia, and a thorough understanding of them is key to ensuring their correct use, particularly to combat multi-resistance. To provide an update on these points, a multidisciplinary team of Spanish experts convened at the Sixth Annual Meeting of Pneumonia Day, under the scientific sponsorship of GEIPC-SEIMC. This paper reflects the information shared at this meeting, offering the latest insights on these topics and supporting a holistic approach to pneumonia management.