Septicaemia

Abstract

Septicaemia still presents a major diagnostic and therapeutic challenge to the clinician. Most cases are hospital-acquired and the reasons for their increasing prevalence are discussed, with reference to predisposing factors and opportunistic infections. The pathology and bacteriology of proven cases (positive blood cultures) in 1974 in a modern children's and maternity hospital complex are presented. Gram-positive and Gram-negative varieties are compared and the molecular biology and mechanisms of endo- and exotoxaemia described. Successful therapy demands correct choice of antibiotic and the development of shock requires skilled supportive measures. For the former a rational scheme is outlined and a plea is made for collection of data for this purpose. Polypharmacy is deprecated and either an aminoglycoside or a cephalosporin forms the mainstay of therapy. The emergence of Bacteroides sp. in cases of abdominal and puerperal sepsis necessitates addition of a lincomycin or metronidazole. Superinfection with systemic candidiasis requires 5-fluorocytosine.