Sepsis therapeutic approaches

Staphylococcus aureus is responsible for a variety of skin infections which require therapeutic approaches different from those of streptococcal infections. Staphylococcal celluhtis is indistinguishable clinically from streptococcal cellulitis and responds to cloxacillin or flucloxacillin, but generally fails to respond to penicillin owing to penicillinase (/3-lactamase) production. Staphylococcus aureus is an important cause of superficial, localized skin sepsis which varies ftom small pustules to boils and occasionally to a more deeply invasive, suppurative skin abscess known as a carbuncle. Antibiotics are generally not indicated for these conditions. Pustules and boils settle with antiseptic soaps or creams and often discharge spontaneously, whereas carbuncles frequently require surgical drainage. Staphylococcus aureus may also cause... 

FIGURE 79-1. Therapeutic approach to sepsis. C S, culture and sensitivity. 

In a randomized controlled trial conducted by Nemoto et al, 98 patients were assigned to either conventional treatment or PMX B (Nemoto et al., 2001). The overall survival was significantly better in the treated group. When looking at subgroups, the authors concluded that this therapeutic approach was more likely to improve survival when applied earlier in sepsis. One criticism of this conclusion is that the subgroups contained a low number of patients to make a definitive statement in this regard. 

Interleukins produced by a variety of cells including T cells, monocytes and macrophages. Recombinant interleukin-2 (aldesleukin) is used to treat metastatic renal cell carcinoma and malignant melanoma. Interleukin-1 may play a part in conditions such as the sepsis syndrome and rheumatoid arthritis, and successful blockade of its receptor offers a therapeutic approach for these conditions. 

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