The Shock Syndrome Associated with Bacteremia Due to Gram-Negative Bacilli

Antibiotics have caused remarkable changes in the incidence and management of infectious diseases. Infections due to Gram-positive organisms, notably those caused by pneumococci and streptococci, have diminished in incidence and in severity. On the other hand, this decline has been paralleled by a decided increase both in the frequency and in the severity of disease caused by Gram-negative bacteria, including the coliform group.1-9 This changing pattern has been attributed to at least two factors. First, the Gram-positive bacteria are effectively suppressed by chemotherapeutic agents. Secondly, there has been the emergence of an increasingly larger proportion of Gram-negative micro-organisms that are highly resistant to the action of available antibiotics.1-4Studies in individual patients have shown that the relatively nonpathogenic strains of bacteria, such as Escherichia coli, Proteus vulgaris, Aerobacter aerogenes, or Pseudomonas aeruginosa, may actually invade and cause infection during the course of antibiotic treatment.5-9This paradox has