Gram-negative bacteremic shock: pathophysiology, clinical features, and treatment

Life-threatening, gram-negative-rod bacteremia often complicates modern surgical procedures. The development of shock in association with gram-negative bacteremia represents a grave complication. The pathophysiology and clinical features of gram-negative bacteremic shock are reviewed, and contemporary forms of therapy are evaluated.

Reliability of a single urine culture in establishing diagnosis of asymptomatic bacteriuria in adult males

Fifty-nine asymptomatic men without catheters of ileal-loop bladders, who were attending a urology clinic and were incidentally discovered to have 100,000 or more Enterobacteriaceae per ml ("significant bacteriuria") in a clean voided urine sample, were prospectively evaluated. To identify these 59 patients, 5,876 urine samples, collected exclusively from men, had been subjected to quantitation and identification. A repeat urine culture performed on these patients invariably confirmed the results of the initial culture. The reproducibility of a single urine culture containing significant bacteriuria occurred independently of the tissue source of infection, as determined by the antibody-coated-bacteria immunofluorescence test. We conclude that a single urine culture obtained from a cooperative man can establish the diagnosis of asymptomatic bacteriuria.

Fever of unknown origin: a view from the community hospital

A prospective study was performed in a community hospital to determine the specific diseases responsible for "fever of unknown origin." Thirty-four adults with persistent unexplained fever were subjected to extensive diagnostic evaluations. Alcoholic hepatitis and recurrent pulmonary emboli were found to be frequent causes of "fever of unknown origin" in this patient population. Approximately a third of the patients had no disease identified which would have explained the persistent fever. This group of patients, for whom no diagnosis was established, shared an important characteristic: failure to lose more than two pounds/week during the hospitalization.

Fever of unknown origin: attempts to isolate L-forms and other aberrant bacterial forms

An investigation was conducted with 65 selected febrile patients, 33 of whom fulfilled in all respects the classic criteria of "fever of unknown origin." Clinical evaluation included extensive radiological and immunological testing. Multiple blood cultures were examined by conventional methods in control studies. In addition, venous blood was cultured in a variety of hyperosmolar media using the special techniques used to detect L-forms and other cell wall-defective bacterial forms. By the extensive methods used, no bacterial forms were isolated. The use of media containing osmotic stabilizers did not detect L-forms or other aberrant bacterial forms, nor did it contribute to the determination of the etiology of fever of unknown origin in these patients.