Shock Caused by Gram-negative Microorganisms

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Abstract
Between 1956 and 1960, 692 adult patients at the Los Angeles County Hospital had bacteremia caused by gram-negative enteric organisms. In 169 patients the clinical course was complicated by hypotension and manifestations of shock. Shock occurred most frequently in elderly patients with urinary tract infection who had urethral catheterization or other pelvic or perineal manipulation. Patients with diabetes mellitus or hepatobiliary disease had special predisposition to shock. Except for pregnant females shock was an unusual complication under 35 years of age. The most frequent organism isolated in patients with shock was Escherichia coli. Proteus was associated with the highest mortality. The most effective antibodies were chloramphenicol, streptomycin and tetracycline. When antibiotics were administered "correctly," on the basis of antibiotic sensitivity tests, survival was significantly improved. Mortality due to bacteremia alone was 20%, and that due to bacteremia with shock was 82%. Vasopressor agents seemingly improved the clinical state of patients, but no beneficial effect on mortality was demonstrated. Beneficial effects were observed, however, when pharmacological amounts of corticosteroids were used.