Our findings support the Surviving Sepsis Campaign’s recommendation of antibiotic administration within 1 hr of recognition of septic shock and suggest that the recommendations from the ED-SEPSIS Working Group that “administration of antibiotics within the time of ED care and as soon as possible once there is a reasonable suspicion of severe sepsis/septic shock will likely increase the chance of favour able outcome compared with later administration”are not rigorous enough given our current understanding of the role of appropriate antibiotics in the treatment of life-threatening severe sepsis.