New criteria for selecting the proper antimicrobial chemotherapy for severe sepsis and septic shock

The mortality rate resulting from severe bacterial sepsis, particularly tha t associated with shock, still approaches 50% in spite of appropriate antim icrobial therapy and optimum supportive care. Bacterial endotoxins that are part of the cell wall are one of the cofactors in the pathogenesis of seps is and septic shock and are often induced by antimicrobial chemotherapy eve n if it is administered rationally. Not all antimicrobial agents are equall y capable of inducing septic shock; this is dependant on their mechanism of action rather than on the causative pathogen species. The quantity of endo toxin released depends on the drug dose and whether filaments or spheroplas t formation predominates. Some antibiotics such as carbapenems, ceftriaxone , cefepime, glycopeptides, aminoglycosides and quinolones do not have the p ropensity to provoke septic shock because their rapid bactericidal activity induces mainly spheroplast or fragile spheroplast-like bacterial forms. (C ) 1999 Published by Elsevier Science B.V. and International Society of Chem otherapy. All rights reserved.