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Annu Rev Pathol. 2006;1:467-96.

Severe sepsis and septic shock: the role of gram-negative bacteremia.

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Departments of Internal Medicine and Microbiology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9113, USA.


Although Gram-negative bacteria have often been implicated in the pathogenesis of severe sepsis and septic shock, how they trigger these often lethal syndromes is uncertain. In particular, the role played by blood-borne bacteria is controversial. This review considers two alternatives. In the first, circulating Gram-negative bacteria induce toxic reactions directly within the vasculature; in the second, the major inflammatory stimulus occurs in local extravascular sites of infection and circulating bacteria contribute little to inducing toxic responses. Evidence for each alternative is found in the literature. Bacteremia and severe sepsis are not so closely linked that the most striking cases can be a model for the rest. Intravascular and extravascular triggers may warrant different approaches to prevention and therapy.

[Indexed for MEDLINE]

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