Gram-Negative Septicemia

Abstract

During the 12-year and 2-month period ending March, 1967, 398 patients with Gram-negative sepsis were observed and studied at the University of Cincinnati Medical Center. The incidence was strikingly progressive and particularly rapid during the past 2 years. The causes of this increase were not clear, but seem to be related to the rapid extension of new and complex surgical procedures to elderly and other poor-risk patients whose resistance was diminished by extensive trauma, associated chronic diseases, and treatment with steroids, immunosuppressive agents and anticancer drugs. Of importance but as yet of undetermined incidence, have been a host of iatrogenic factors related to current surgical practice. Bacteria found most frequently were Escherichia coli, Aerobacter aeroegenes, Proteus and Pseudomonas aeruginosa. The sources of the infection leading to bacterial invasion of the blood stream included the urinary tract in over 1/2 the cases, the respiratory tract, alimentary tract, and the skin. Approximately three-fourths of the patients acquired septicemia in the hospital, and their prognosis was more grave. Prophylactic antibiotic therapy was ineffective in preventing Gram-negative septicemia, particularly in poor-risk patients. In addition antibiotic therapy, particularly with large and prolonged dosage, may have contributed to the development and increasing incidence of Gram-negative septicemia. The single most important factor leading to fatality was septic shock complicating septicemia. Reduction of the incidence of septic shock during the past 2 years by earlier recognition of Gram-negative septicemia was followed by a marked drop in mortality rate.