Intensive Care Med (2019) 45:243–245 https://doi.org/10.1007/s00134-018-5272-z WHAT’S NEW IN INTENSIVE CARE Infectious diseases: the 10 common truths I never believed Jordi Rello 1,2* , Emine Alp 3 and Kalwaje Eshwara Vandana 4 © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM Te feld of infectious diseases has caught us with many surprises. Even in the time of modern medicine, evolu- tionary perspectives on disease biology and manage- ment have continued to challenge us from time to time (Fig. 1). Integration of knowledge from various felds of science has opened an exciting arena, rufing our beliefs learned in medical schools or during practice of clinical medicine. Ten selected topics that developed under the infuence of certain evolutionary factors in medicine are presented in Table 1. Most reports have consistently reported Streptococcus pneumoniae as the leading cause of community-acquired pneumonia. However, a recent study performing sen- sitive molecular assays has analyzed the prevalence of viruses as the cause of severe pneumonia requiring hos- pitalization and suggesting that rhinovirus is the most prevalent organism [1]. Current management should include the use of multiplex PCR for respiratory viruses in severe episodes, and antiviral therapy (Cidofovir) or enriched immunoglobulins may emerge as new therapies. For decades, identifcation and subsequent antimi- crobial susceptibility testing have consistently required at least 48–72 h to be informative. Subsequent to the introduction of matrix-assisted laser desorption ioni- zation-time of fight mass spectrometry (MALDI-TOF MS) for routine diagnostic microbiology, identifcation of bacteria from blood culture is possible as soon as 6 h with a major clinical outcome beneft [2]. Further studies should incorporate rapid diagnostic tests as point of care to identify resistant phenotypes at the bedside. It is highly suggested to avoid the use of antimicrobi- als that have tested resistant in vitro. However, for certain infections by carbapenem-resistant Klebsiella pneumo- niae for which alternative therapeutic options are not available or not proven successful, it is recommended to review the therapy based on minimum inhibitory con- centrations (MICs) of carbapenems. For isolates with MICs between 4 and 8 mcg/ml, or even up to 16 mcg/ ml, recent reports have suggested that high-dose and extended infusion of carbapenem is a good option when combined with a susceptible agent (such as tigecycline, colistin or fosfomycin) [3]. Recent reports also suggest that the double carbapenems, combining ertapenem- meropenem, could be efective for therapy of infections by carbapenemase-producing K. pneumoniae [4]. Traditionally, randomized controlled trials with adju- vant therapy to treat sepsis have not considered the need to personalize prescriptions. Some reports have recently demonstrated that the response to therapy would be very diferent in some subsets of patients. Fur- ther studies should incorporate the newer suggestions *Correspondence: jrello@crips.es 1 Vall d’Hebron Barcelona Campus Hospital, Ps Vall d’Hebron 119. AMI- 14a Planta, 08035 Barcelona, Spain Full author information is available at the end of the article