Sepsis

Our center participated in a large, multicenter, double-blind trial of 486 patients with suspected Gram-negative sepsis in which E5 was compared with placebo. The results indicated that administration of E5 significantly reduced mortality from sepsis and produced significant resolution of multiorgan failure in patients with Gram-negative sepsis who were not yet in refractory shock. Results […]

In 1982, Ziegler et al reported the development of an antiserum prepared by immunizing donors with the J5 mutant of E coli. These investigators showed a significant reduction in mortality in bacteremic patients who received the serum compared with those who did not. The development of hybridoma technology has stimulated the preparation of monoclonal antibodies […]

A patient with sepsis syndrome that progresses to septic shock as he or she becomes hypotensive has an increasingly poorer prognosis. (If the hypotension does not respond to fluid replacement therapy, it is referred to as refractory septic shock.) In a large retrospective review by Kreger et al, the presence of shock was associated with […]

Treatment Considerations The cornerstone of the clinical management of sepsis remains appropriate antimicrobial therapy and, where possible, removal of the sources of infection, such as catheters or prostheses. Appropriate antibiotic therapy decreased the occurrence of shock and the mortality rate by approximately 50 percent. Supportive measures for sepsis syndrome depend on the clinical and metabolic […]

Endotoxin release is a common feature of all Gram-negative bacteria, with the lipid A structure preserved across various species and serotypes. This substance activates the complement cascade, producing a chain of effects that can ultimately lead to ARDS. It can also activate factor XII and initiate another progression of events resulting in DIC.

Serum iron levels may drop markedly shortly after the onset of sepsis, apparently as a result of an iron redistribution phenomenon that may have a protective aspect. The DIC syndrome, which is evident only in more serious infections, is observed more commonly in Gram-negative than in Gram-positive infections; thrombocytopenia alone is often an early marker […]

The peripheral vasodilation associated with the early hyperdynamic changes results in well-perfused, warm skin. Previously, this early stage was referred to as warm shock. As the patient deteriorated and became vasoconstricted, the condition was termed cold shock. However, these terms are outdated and should not be used. Only rarely is increased systemic vascular resistance seen […]

In that investigation, we defined bacteremia as the presence of a positive blood culture obtained within 48 hours of study entry, but we did not require the demonstration of bacteremia for designation of sepsis syndrome. Fever is the most commonly observed sign of sepsis. Pyrogenic activity is stimulated by at least three endogenous substances: interleukin […]

These include the following: increasing use of chemotherapy and radiotherapy; more widespread employment of corticosteroids and immunosuppressive agents in inflammatory diseases and organ transplantation; greater survival of predisposed patients (including the elderly), as well as those with cancer, diabetes, major organ failure, or granulocytopenia; and the increased use of invasive devices, such as surgical prostheses, […]

The distributions of Gram-negative isolates and associated mortality rates summarized by Young2 for 11 studies covering the period 1955 to 1986 are shown in Table 1. Our center was involved in a recent prospective study of the natural history of Gram-negative bacterial sepsis. This investigation was conducted during the period from early 1987 to mid-1988. […]