Gram-negative septicemia and shock.

Gram-negative septicemia is an old disease with dramatic changes in the arena of modern medicine. Whereas it was most often the domain of the infectious disease specialist and the abdominal surgeon 25 years ago, it is now managed in most medical practice specialties. It requires thorough understanding by all practitioners. Its physiology is increasingly well understood. The relationships between sepsis and host underlying diseases are important. Nonspecific therapies are important for early management of septicemia and impending shock, but specific application of immunotherapy in the form of antibody or vaccines, antibiotics selected for the most likely organism, and perhaps even pharmacotherapy directed at recognized intrinsic mediators of host responses to bacteremia, hold the greatest promise for a successful outcome.