Pathogenesis and therapy of shock due to infection: experimental and clinical studies

The problem of shock due to infection received only random interest by investigators prior to World War II. This is in contrast to the more intensive studies carried out on shock caused by hemorrhage, trauma and burns. Research on shock and infection should be expanded for at least two reasons. First, although the advances in surgical techniques and the availability of blood and blood substitutes have contributed to a better treatment of shock, simultaneously the factor of infection has been brought into sharper focus. Second, while the management of infections has been greatly benefited by the introduction of the sulfonamides and antibiotics, these drugs in turn have led to additional problems in this field. The widespread use of chemotherapeutic agents has resulted in the emergence of antibiotic-resistant strains of staphylococci, often complicating the treatment of patients with shock. In addition, antibiotic-susceptible invasive bacteria have frequently been eliminated from the tissues, leaving the less virulent and resistant species, such as the gram-negative coliform bacilli, to multiply and to cause serious disease. The increasing importance of sepsis due to these gram-negative organisms became apparent during World War II (1, 2, 3, 4, 5, 6, 7). This report is largely concerned with sepsis and shock due to gram-negative coliform bacteria.