Urosepsis.

Many years ago Osler suggested that "it is of use from time to time to take stock, so to speak, of our knowledge of a particular disease to see where we stand in regard to it, to inquire to what conclusions these accumulated facts seem to point, and to ascertain in what direction we may look for fruitful investigations in the future." With regard to gram-negative bacteremia, there is extant a notable and striking increase in both the incidence of these infections and the involvement of organisms that previously caused disease only uncommonly. Factors related to this escalation include an increase in the number of elderly and debilitated hospitalized patients, the large number of individuals with malignant disease who are immunosuppressed by their disease and the drugs used to treat them, the ubiquity of various types of respirators, drainage tubes, and catheters that may be colonized by gram-negative bacteria, and the progressively increasing resistance of these organisms to a growing number of antimicrobial agents. The emergence of resistance is at least partly due to the inappropriate use of antibiotics, often in combination, for prophylaxis or empiric therapy. It is unfortunate that even the necessary use of antibiotics will increase the frequency of disease caused by these gram-negative organisms. The inescapable conclusion is that gram-negative infections and bacteremia will only increase in prevalence in the future. Investigation of the pathophysiology of shock due to gram-negative sepsis has revealed that most of the physiologic alterations are mediated by products of the host's own immune system.(ABSTRACT TRUNCATED AT 250 WORDS)