The potential influence of delayed antibiotic therapy was first evaluated in patients with CAP. In a series of 18,209 Medicare patients older than 65 years admitted because of CAP [25], the antibiotic regimen used saved lives when the first dose was administered before hour 4 after admission. Of note, fewer than 50% of patients received antibiotics during the first 4 hours in this study and as many as 17% received antimicrobial treatment after hour 6. Those patients in whom administration of antimicrobial agents was delayed were elderly people with an atypical CAP presentation, or they exhibited clinical features inconsistent with a diagnosis of sepsis, such as the absence of fever and altered mental status [26] (specifically, patients in whom the diagnosis of infection was not obvious). Such a lack of aggressive and early antimicrobial therapy has been identified in various settings in which patients were being treated for such conditions as meningitis, cancer, CAP, and nosocomial pneumonia [27] [28] [29] [30] [31] [32] [33] . A recent retrospective analysis quantified the impact of delayed antimicrobial treatment in patients with severe sepsis. Kumar and coworkers [34] demonstrated that every additional hour without antibiotics increased the risk for death in hypotensive septic patients by 7.6% during the first 6 hours. Early antibiotic therapy has been incorporated into the Surviving Sepsis Campaign recommendations [35] , and we expect compliance with this component of the guidelines to increase from its current low level [36] .