Abstract

This chapter is concerned with the diagnosis and immediate treatment of patients with septic shock. Most clinicians will have a mental image of this condition and would expect to have little difficulty in recognizing it from the end of the bed, but despite this there is no universally accepted definition. Indeed, when clinical investigators attempt to arrive at a consensus there are wide variations in terms. Thus, a necessary preface to this chapter is a brief discussion of the controversy surrounding the nomenclature of these syndromes.

Keywords

Hydrocortisone Pancreatitis Gentamicin Staphylococcus Cephalosporin 

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References

  1. 1.
    Vincent J-L. Sepsis and septic shock: update on definitions. In Reinhart K, Eyrich K, Sprung C (Eds). Sepsis. Current perspectives in pathophysiology and therapy. Berlin: Springer-Verlag, 1994:3.Google Scholar
  2. 2.
    Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644, 1992.PubMedCrossRefGoogle Scholar
  3. 3.
    Bone RC, Fisher CJ Jr, Clemmer TP, et al. Sepsis syndrome: a valid clinical entity. Crit Care Med 17:389, 1989.PubMedCrossRefGoogle Scholar
  4. 4.
    Bone RC. Definitions and therapy of sepsis. In Reinhart K, Eyrich K, Sprung C (Eds). Sepsis. Current perspectives in pathophysiology and therapy. Berlin: Springer-Verlag, 1994: 228.Google Scholar
  5. 5.
    Forgacs IC, Eykyn SJ, Bradley RD. Serious infection in the intensive therapy unit: a 15 year study of bacteremia. Quarterly J Med 60:773, 1986.Google Scholar
  6. 6.
    Rangel-Frausto M. The epidemiology of bacterial sepsis. Infect Dis Clinics N Am 13:299, 1999.CrossRefGoogle Scholar
  7. 7.
    Ispahani P, Pearson NJ, Greenwood D. An analysis of community and hospital-acquired bacteremia in a large teaching hospital in the United Kingdom. Quarterly J Med 63:427, 1987.Google Scholar
  8. 8.
    Brun BC, Doyon F, Carlet J, et al. Incidence, risk factors and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. J Am Med Assoc 274:968, 1995.CrossRefGoogle Scholar
  9. 9.
    Pittet D, Wenzl RP. Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 155:1177, 1995.PubMedCrossRefGoogle Scholar
  10. 10.
    Crowe M, Ispahani P, Humphreys H, et al. Bacteremia in the adult intensive care unit of a teaching hospital in Nottinhgam, UK, 1985–1996. Eur J Clin Microbiol Infect Dis 17:377, 1998.PubMedGoogle Scholar
  11. 11.
    Wolff M, Brun-Buisson C, Lode H, et al. The changing epidemiology of severe infections in the ICU. Clin Microbiol Infect 3 (Suppl 1):S36, 1997.CrossRefGoogle Scholar
  12. 12.
    Roberts FJ, Geere IW, Coldman A. A three-year study of positive blood cultures, with emphasis on prognosis. Rev Infect Dis 13:34, 1991.PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen J, Abraham E. Microbiologic findings and correlations with serum Tumor Necrosis Factor-α in patients with severe sepsis and septic shock. J Infect Dis 180:116, 1999.PubMedCrossRefGoogle Scholar
  14. 14.
    Abraham E, Glauser M-P, Butler T, et al. p55 Tumor Necrosis Factor Receptor Fusion Protein in the Treatment of Patients with Severe Sepsis and Septic Shock. A randomized controlled multicenter trial. J Am Med Assoc 277:1531, 1997.CrossRefGoogle Scholar
  15. 15.
    Hanberger H, Garcia RJ, Gobernado M, et al. Antibiotic susceptibility among aerobic Gram-negative bacilli in intensive care units in 5 European countries. J Am Med Assoc 281:67, 1999.CrossRefGoogle Scholar
  16. 16.
    Opal SM, Cohen J. Are there fundamental differences of clincal relevance between Gram positive and Gram negative bacterial sepsis? Crit Care Med 27:1608, 1999.PubMedCrossRefGoogle Scholar
  17. 17.
    Kreger BE, Craven DE, McCabe WR. Gram-negative bacteremia IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344, 1980.PubMedCrossRefGoogle Scholar
  18. 18.
    Circiumaru B, Baidock G, Cohen J. A prospective study of fever in the intensive care unit. Intensive Care Med 25:668, 1999.PubMedCrossRefGoogle Scholar
  19. 19.
    O’Grady NP, Barie PS, Bartlett JG. et al. Practice guidelines for evaluating new fever in critically ill adult patients. Critical Care Med 26:1041, 1998.Google Scholar
  20. 20.
    Llewelyn M, Cohen J. Diagnosis of infection in sepsis. Intensive Care Med 27 (suppl 1): S10, 2001.PubMedCrossRefGoogle Scholar
  21. 21.
    Carlet J. Rapid diagnostic methods in the detection of sepsis. Infect Dis Clinics N Am 13:483, 1999.CrossRefGoogle Scholar
  22. 22.
    Povoa P, Almeida E, Moreira P, et al. C-reactive protein as an indicator of sepsis. Intensive Care Med 24:1052, 1998.PubMedCrossRefGoogle Scholar
  23. 23.
    de Werra I, Jaccard C, Corradin SB, et al. Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Critical Care Med 25:607, 1997.CrossRefGoogle Scholar
  24. 24.
    Oberhoffer M, Karzai W, Meier-Hellmann A, et al. Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-α and interleulin-6 in patients with sepsis. Critical Care Med 27:1814, 1999.CrossRefGoogle Scholar
  25. 25.
    Ugarte H, Silva E, Mercan D, et al. Procalcitonin used as a marker of infection in the intensive care unit. Critical Care Med 27:498, 1999.CrossRefGoogle Scholar
  26. 26.
    Danner RL, Elin RJ, Hosseini JM, et al. Endo-toxemia in human septic shock. Chest 99:169, 1991.PubMedCrossRefGoogle Scholar
  27. 27.
    Guidet B, Barakett V, Vassal T, et al. Endotoxemia and bacteremia in patients with sepsis syndrome in the intensive care unit. Chest 106:1194, 1994.PubMedCrossRefGoogle Scholar
  28. 28.
    Bates DW, Parsonnet J, Ketchum PA, et al. Limulus Amebocyte Lysate assay for detection of endotoxin in patients with sepsis syndrome. Clin Infect Dis 27:582, 1998.PubMedCrossRefGoogle Scholar
  29. 29.
    Casey LC, Balk RA, Bone RC. Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 119:771, 1993.PubMedCrossRefGoogle Scholar
  30. 30.
    Fink PC, Grunert JH. Endotoxemia in intensive care patients: a longitudinal study with the limulus amebocyte lysate test. Klinische Wochenschrift 62:986, 1984.PubMedCrossRefGoogle Scholar
  31. 31.
    Cohen J. The detection and interpretation of endotoxemia. Intensive Care Med 26 (suppl 1):S51,2000.PubMedCrossRefGoogle Scholar
  32. 32.
    Hurley JC. Reappraisal with meta-analysis of bacteremia, endotoxemia, and mortality in Gram-negative sepsis. J Clin Microbiol 33:1278, 1995.PubMedGoogle Scholar
  33. 33.
    Brandtzaeg P, Kerrulf P, Gaustad P, et al. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis 159:195, 1989.PubMedCrossRefGoogle Scholar
  34. 34.
    Edwards JD. Management of septic shock. Br Med J 306:1661, 1993.CrossRefGoogle Scholar
  35. 35.
    Dellinger RP. Current therapy for sepsis. Infect Dis Clinics N Am 13:495, 1999.CrossRefGoogle Scholar
  36. 36.
    Wheeler AP, Bernard GR. Treating patients with severe sepsis. New Engl J Med 340:207, 1999.PubMedCrossRefGoogle Scholar
  37. 37.
    Byl B, Clevenbergh P, Jacobs F, et al. Impact of infectious disaeases specialists and microbiologic data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 29:60, 1999.PubMedCrossRefGoogle Scholar
  38. 38.
    Bochud P-Y, Glauser M-P, Calandra T. Antibiotics in sepsis Intensive Care Med 27 (suppl 1):S33, 2001.CrossRefGoogle Scholar
  39. 39.
    Dofferhoff AS, Potthoff H, Bom VJ, et al. The release of endotoxin, TNF and IL-6 during the antibiotic treatment of experimental Gram-negative sepsis. J Endotoxin Res 2:37, 1995.Google Scholar
  40. 40.
    Jackson JJ, Kropp H. ß-lactam antibiotic-induced release of free endotoxin: in vitro comparison of penicillin-binding protein (PBP) 2-specific imipenem and PBP 3-specifk ceftazidime. J Infect Dis 165:1033, 1992.PubMedCrossRefGoogle Scholar
  41. 41.
    Prins JM, van Deventer SJ, Kuijper EJ, et al. Clinical relevance of antibiotic-induced endotoxin release. Antimicrob Agents Chemo 38: 1211, 1994.CrossRefGoogle Scholar
  42. 42.
    Lehner PJ, Davies KA, Walport MJ, et al. Meningococcal septicaemia in a C6-deficient patient and effects of plasma transfusion on lipopolysaccharide release. Lancet 340:1379, 1992.PubMedCrossRefGoogle Scholar
  43. 43.
    Prins JM, van Agtmael M, Kuijper EJ, et al. Antibiotic-induced endotoxin release in patients with Gram-negative urosepsis: a double-blind study comparing imipenem and ceftazidime. J Infect Dis 172:886, 1995.PubMedCrossRefGoogle Scholar
  44. 44.
    Maury E, Barakett V, Blanchard H, et al. Circulating endotoxin during initial antibiotic treatment of severe Gram-negative bacteremic infections. J Infect Dis 178:270, 1998.PubMedCrossRefGoogle Scholar
  45. 45.
    Levi M, ten Cate H. Disseminated intravascular coagulation. New Engl J Med 341:586, 1999.PubMedCrossRefGoogle Scholar
  46. 46.
    Eisele B, Lamy M, Thijs LG, et al. Antithrombin III in patients with severe sepsis. A randomized, placebo-controlled, double-blind multicenter trial plus a meta-analysis on all randomized, placebo-controlled, double-blind trials with antithrombin III in severe sepsis. Intensive Care Med 24:663, 1998.PubMedCrossRefGoogle Scholar
  47. 47.
    Roback MG, Stack AM, Thompson C, et al. Activated protein C concentrate for the treatment of meningococcal endotoxin shock in rabbits. Shock 9:138, 1998.PubMedCrossRefGoogle Scholar
  48. 48.
    Bernard GR, Vincent JL, Laterre G-F, et al. Efficacy safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699, 2001.PubMedCrossRefGoogle Scholar
  49. 49.
    Hinshaw LB, Peduzzi P, Young E, et al. Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. New Engl J Med 317:659, 1987.CrossRefGoogle Scholar
  50. 50.
    Bone RC, Fisher CJ Jr, Clemmer TP, et al. A controlled clinical trial of high-dose methylpred-nisolone in the treatment of severe sepsis and septic shock. New Engl J Med 317:653, 1987.PubMedCrossRefGoogle Scholar
  51. 51.
    Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 23:1430, 1995.PubMedCrossRefGoogle Scholar
  52. 52.
    Bollaert P-E, Charpentier C, Levy B, et al. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 26:645, 1998.PubMedCrossRefGoogle Scholar
  53. 53.
    Annane D. Effects of the combination of hydrocortisone and fludrocortisone on mortality in septic shock. Crit Care Med 26:A46, 2001.Google Scholar
  54. 54.
    Cohen J. Adjunctive therapy in sepsis: a critical analysis of the clinical trial programme. Brit Med Bull 55:212, 1999.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Jonathan Cohen

There are no affiliations available

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