Introduction

Sepsis and antimicrobial stewardship programmes coexist in tension, as they can appear to have apparently opposing messages around antimicrobial prescribing. In the era of increasing antimicrobial resistance (AMR), there is a need for greater alignment between sepsis and antimicrobial stewardship governance and management programmes. Antimicrobial therapy is an essential part of sepsis management with a focus on time-dependent recognition and resuscitation pathways.1 Sepsis is a clinical diagnosis, and delay to first-dose antimicrobial is associated with increasing mortality.1 To avoid potential unintended consequences from inappropriate antimicrobial prescribing, including increased AMR and healthcare-associated infections such as Clostridioides difficile infection, antimicrobial stewardship strategies including de-escalation protocols and stopping antimicrobials in non-infective cases should be a fundamental component of sepsis quality improvement initiatives.2 Perceived tensions remain, however, between managing sepsis and effective antimicrobial stewardship, and these perceptions are likely to be heightened by media reporting of the issues.3 The purpose of this viewpoint is to discuss these tensions, and suggest that a change in mindset is required with an integrated understanding of sepsis and AMR as two sides of the same coin.