[The evolution of antimicrobial therapy for sepsis]

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host immune response to infection, representing a critical global public health challenge, its high incidence and mortality rates continue to pose severe challenges in critical care medicine. Antibacterial agents are the cornerstone of sepsis management, yet its strategies are not static. Over the past decades, the philosophy of antimicrobial stewardship in sepsis has undergone profound evolution, driven by a deeper understanding of its pathophysiology, the escalating global crisis of antimicrobial resistance, and the continuous accumulation of evidence-based medical data. This article aims to systematically review the evolving landscape of anti-infective therapy for sepsis, focusing on key aspects such as epidemiology and pathogen resistance, timing of antibiotic initiation, empirical selection, dosing and administration methods, de-escalation and short-course strategies, as well as emerging sepsis sub-phenotypes and artificial intelligence-assisted decision-making. This article seeks to summarize past experiences, clarify misconceptions, and outline a future path toward transformation based on precision medicine.