Factors contributing to delayed initiation of appropriate antimicrobial treatment in patients with streptococcal bacteremia

In their insightful commentary, Dequidt et al. [1] raise important questions regarding the impact of appropriate antimicrobial treatment on the survival of patients with streptococcal bacteremia.[2] Dequidt et al. [1] are correct that the cited article[3] showed a numerical, but not statistically significant, impact of appropriate antimicrobial treatment on mortality among patients with streptococcal bacteremia.The positive impact of appropriate antimicrobial treatment on survival was shown in a meta-analysis on invasive pneumococcal disease, where inappropriate empiric therapy was associated with increased mortality (P 0.002; 95% CI 1.27-3.00).[4] This metaanalysis demonstrated that while appropriate antimicrobial treatment is an important predictor of ----