INTRODUCTION

Sepsis is a leading cause of mortality in ICUs in India using high resources. Despite the major advancements in critical care, case-fatality rates remain high because of delayed recognition, usage of empiric broad-spectrum antibiotics, and a high burden of multiple drug-resistant organisms (MDROs) 1, 4. The cost of antimicrobial resistance (AMR) in Indian ICUs is substantial due to longer hospital stays, expensive last resort drugs, organ support, and excess mortality, imposing a heavy financial and societal toll 4. Diagnostic uncertainty amplifies the problem when clinicians can’t rapidly distinguish bacterial causes from fungal causes of sepsis or sepsis from sterile inflammation and this leads to their default to “cover all causative agents”, accelerating AMR and adverse events. Indian experience highlights how diagnostic errors cascade into wrong antimicrobial choices and worse outcomes, strengthening the case for diagnostic stewardship as the front-end of antimicrobial stewardship (AMS) 5.