Gram-Negative Sepsis (10)
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 an increase in the mortality rate of 7 percent to 47 percent. Comparative mortality rates from our prospective study are shown in Table 3. For patients with sepsis syndrome alone, the mortality rate was 13 percent. These rates rose to 28 percent and 43 percent, respectively, for patients who demonstrated shock at the time of study admission and those who developed shock later. These findings clearly underscore the need for aggressive therapeutic intervention at the onset of sepsis syndrome to maximize the possibility of preventing shock and thereby improving mortality and morbidity. Recent advances in the management of sepsis with other than antimicrobial agents are certain to have a favorable impact in this regard.
Advances in biotechnology during the last decade have led to a renewed interest in the use of therapeutic antisera for the treatment of sepsis syndrome.
Table 3 — Differences m Mortality Bate Depending on Presence or Absence of Shock at Study Admission
|Sepsis Syndrome Alone (%)||Shock Present at Study Admission(%)||Development of Shock After Study Admission <%)|
|Totalf||10/77 (13)||19/69 (28)||19/44 (43)|
|Nonbacteremic||8/50 (16)||7/34 (21)||9/20 (45)|
|Bacteremic||2/26 (8)||11/341(32)||10/24 (42)|
|Gram (—)||1/16 (6)||8/23 (35)||7/16 (43)|
|Gram (+)||1/10||3/11 (27)||3/8 (38)|