Fungi, which are the major causes of hospital infections. SDD was first reported by Stoutenbeek et al. in the Netherlands with effects on trauma patients [228]; thereafter, the effects of SDD together with its subtype, SOD, were reported in many RCTs and meta-analyses [229-232]. In a large-scale RCT performed in 5,939 ICU patients at 13 ICUs in the Netherlands in 2009, groups treated with SDD and SOD showed reduced mortality compared with the nonintervention group [233]. It is common to administer polymyxin plus aminoglycosides or a new quinolone against gram-negative bacteria, and in combination with amphotericin B against fungi; however, the appropriate drug types and dose for SDD are not established yet [234]. Also, the ineffectiveness of SDD against carriers of bacteria that that are resistant to SDD drugs (MRSA, vancomycin-resistant Enterococcus, extended-spectrum beta lactamase-producing gramnegative bacilli, etc.) and the fear about the emergence of new resistant bacteria by performing SDD have been pointed out as problems [229,231,235-237]. The use of SDD for patients with sepsis was about 3 in Japan (from the first investigation of the Sepsis Registry Committee). An RCT at a single center reported that the use of SDD caused a significant increase in the 1-(4-Bromo-2-pyridyl)piperazine detection rate of resistant gram-positive cocci in the Methyl 2-((4-nitro-1h-pyrazol-1-yl)methyl)benzoate intestine (17.0 vs. 80.7 , control vs. SDD) and also a significant increase in the detection rate of resistant coagulase-negative Staphylococcus (25 vs. 66.9 ) [235]. A multicenter cohort study also reported an increased rate of detection in the intestine for resistant gram-negative bacteria (7 vs. 15 ) [236]. Although the effectiveness of SDD and SOD is demonstrated in an RCT and meta-analysis, their effectiveness in carriers of resistant bacteria is uncertain. Consequently, it is weakly recommended not to performOda et al. Journal of Intensive Care 2014, 2:55 http://www.jintensivecare.com/content/2/1/Page 18 ofSDD and SOD, owing to the possibility of an increase in resistant bacteria.SteroidCQ1: What is the indication of steroid therapy in sepsis? A1: The use of steroids is aimed at early recovery from shock in adult PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/13485127 patients with septic shock who do not respond to initial fluid resuscitation and vasoactive drugs (2B). Adrenocorticotropic hormone (ACTH) testing is not required to determine the indication for steroid therapy (2B). Concerning the adverse effects of steroid therapy, it should be noted that the incidence of de novo sepsis and septic shock are significantly higher, other PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/13485127 than hypernatremia and hyperglycemia (2B). Comment: A multicenter RCT conducted in France, involving 300 adult patients with septic shock who did not respond to initial fluid resuscitation and vasoactive drugs [22], reported improved early recovery from shock and reduced 28-day mortality with steroid therapy in patients with relative adrenal insufficiency (defined as patients who had an increased cortisol level of ijms17122034 in Europe in 2008 [240] showed that the time to reversal of shock was significantly shorter but the 28-day mortality was not reduced in the group with steroid therapy. In both the French trial and the CORTICUS study, low-dose and long-term administration of hydrocortisone at 200 mg/day for 5? days was.