Abstract
Seven hundred and thirteen cases of septicemia whose causative organisms were detected from peripheral blood at 48 pediatric institutions throughout Japan during 1980-4984 were analyzed with respect to their chemotherapeutic outcome relative to causative microorganisms.
Against Gram-positive cocci including S. pyogenes, S. agalactiae, S. viridans, S. pneumoniae, E. faecalis, penicillins (PCs) demonstrated excellent results, and cephalosporin antibiotics (CEPs) also showed good results except against E. faecalis.
Combinations of PCs and aminoglycosides (AGs) resulted in a significantly high fatality rate in streptococcal infections, and very significantly high fatality rate of 38.7% in infections due to S. aureus. Combinations of CEPs and AGs showed a little lower rate than the above combinations, but monotherapy gave the best result.
Infections due to S. epidermidis revealed better prognosis than those due to S. aureus.
We recommend that PC II (PCase resistant) and CEP I or II should be combined with fosfomycin (FOM), if necessary, for the treatment of staphylococcal septicemia.
For the treatment of septicemia due to H. influenzae, ampicillin (ABPC) is the best drug against sensitive strains and CEP IV or V may also be the drug of choice even against ABPC resistant strains.
Against septicemia due to E. coli, although its prognosis is not good in general, monotherapy gave the lowest mortality.
Among combined therapies,“CEPs+AGs” resulted in a significantly lower death rate of 13.3% than “PCs+AGs” which showed a death rate of 38.3%.
Pseudomonas septicemia is very difficult to treat with by a monotherapy using even PC IV, CEP V or AGs any of which is effective against P. aerugmosa.
However, even then, the combination of “β-lactam+AGs” gave higher mortality than monotherapies.
Enterobacter septicemia also results in a high mortality rate. The treatment of septicemia due to these causative agents needs further improvement using a combined therapy of antibiotics or other supplementary therapies.
In this paper, we reported current states of different treatment and outcomes in Japan of septicemia due to different causative agents including other agents than ones mentioned above like Gram-negative rods, Gram-positive rods, anaerobes and fungi.
Some consideration was given about high mortality rates among septicemia in children treated with orthodox combinations of “ABPC+gentamicin”.
