Gram-negative sepsis and endotoxic shock (lecture).

Abstract

15 tables present data based on 233039 admissions during a 6-year period with 254 deaths from sepsis recorded. Gram-positive sepsis patients were 1740 who grew 1907 pathogens with 78 deaths and a mortality rate of 4.4%. Gram-negative sepsis patients numbered 1236 and grew 1346 pathogens which resulted in 205 deaths a mortality rate of 16.6%. 1/133 admissions developed gram-positive sepsis and 1/188 patients developed gram-negative sepsis; 1/80 patients developed bacteremia. The commonest pathogens in the 1740 gram-positive sepsis patients were (in descending order): 1) S. epidermidis (596) S. aureus (254) S. viridans (155) Pneumococcus (132) beta-streptococci (128) and diphtheroids (118). In the 78 deaths among gram-positive sepsis patients the commonest cause of death (in descending order) was S. aureus (19) S. epidermidis (18) enterococci (10) pneumococci (9) and S. viridans (8). E. coli was by far the commonest cause of gram-negative sepsis with K. pneumoniae Bacteroides Proteus and Pseudomonas among other common causative agents. Of the 205 deaths again the commonest cause was E. coli followed by P. aeruginosa K. preumoniae Proteus Enterobacter and Enterococci. Mortality in general from gram-negative sepsis is 16.6% whereas in gram-negative urological sepsis mortality is 15.3%. Mortality in gram-negative urological sepsis showed a steady decline during the past 2 decades from 56.25% in 1959-1964 to 16.6% in 1968-1973. The steady lowering of mortality in gram-negative sepsis is attributed to: 1) preventitive measures; 2) early diagnosis; 3) early restoration of fluid electrolyte equilibrium and correction of lactic acidosis anoxia and/or renal/pulmonary malfunction; 4) early administration of antibiotics; and 5) restoration or correction of microcirculation with massive/pharmacological doses of glucocorticoids use of beta-adrenergic isoproterenol and diuretics such as furosemide and mannitol.