Mechanism-oriented therapy for multiple systems organ failure

Damage caused by systemic sepsis is only in part caused by the viable microbe and therefore treatable by antibiotics. Most damage is produced by host defenses. The rationale for anti-inflammatory therapy in severely septic patients is based on these concepts. A variety of anti-inflammatory agents are being studied that might help "tide the patient through" the initial phases of the septic event until antimicrobial therapy has had a chance to work. Antibiotics certainly help minimize the suppurative complications of bacteremia/septicemia. The initial approach to the septic patient should be rapid but thorough, permitting data to be gathered that will permit decisions ultimately to be made as to whether or not sepsis was actually present and what appropriate therapeutic agents are best for longer term treatment. The septic patient will continue to provide a challenge to the clinician. The better one understands the mechanisms involved in the pathophysiology of the development of severe sepsis, septic shock, and the syndrome of MSOF, the better will become the clinical management of such patients. Also, development of additional such insights will certainly permit important new therapeutic modalities to evolve.