Abstract

Receive: RSS Feeds, eTOCs, free email alerts (when new articles cite this article), more» Information about commercial reprint orders: http://cmr.asm.org/site/misc/reprints.xhtml To subscribe to to another ASM Journal go to: http://journals.asm.org/site/subscriptions/ 0893-8512/93/040443-02$02.00/0 CLINICAL MICROBIOLOGY REVIEWS, October 1993, p. 443 444 Vol. 6, No. 4 Letter to the Editor Bone reviewed the syndrome of gram-negative sepsis with an emphasis on aspects of its clinical management and the promise of antiendotoxin immunotherapy (3). He suggested that the triggering of mediators by bacterial endotoxin, which antimicrobial therapy fails to address, is the basis for the continuing high mortality and complications associated with this condition. The new terminology presented is an important step toward progress in this area, as it is based on the recognition that patient outcome in thissyndrome is more closely related to the degree of organ damage than to the documentation of infection (i.e., bacteremia) by the microbiology laboratory. For example, in the Veterans Administration systemic sepsis study, alterations in mental state were a powerful predictor of outcome (odds ratio for mortality, 2.36; P < 0.0001) whereas gram-negative bacteremia was not (odds ratio for mortality, 1.32; P was not significant [12]). As a consequence, recent efforts have focused on the