New developments in the treatment of gram-negative bacteremia.

Gram-negative bacteremia is an increasingly important nosocomial infectious problem. Endotoxin, endorphins, leukocyte agglutination and deficient opsonization all appear to be major factors in the pathogenesis of Gram-negative septic shock. Outcome has previously correlated best to underlying disease state. With appropriate double antibiotic therapy and hemodynamic support, however, mortality has decreased even for neutropenic patients. Corticosteroids, naloxone, granulocyte transfusions and immunotherapy are experimental adjunctive modes of therapy that offer hope for even better survival in the future.