Le C, et al. - The frequency and cause of inadequate initial antibiotic therapy with vancomycin and piperacillin-tazobactam were determined in patients with severe sepsis and septic shock in the Emergency Department (ED). Researchers also characterized its impact on patient outcomes, and identified patients who would benefit from an alternative initial empiric regimen. For approximately 24% of patients with either severe sepsis or septic shock, vancomycin and piperacillin-tazobactam proved an inappropriate antibiotic combination in the ED. An alternative regimen could be beneficial for patients with known chronic obstructive pulmonary disease, residence at a skilled nursing facility, a history concerning for Clostridium difficile, and immunosuppression.