(3) Treatment. Give 5000 units of tetanus immune globulin (human)
intramuscularly. Give tetanus antitoxin, 100,000 units intravenously after testing for
horse serum sensitivity if tetanus immune globulin is not available. Put the patient on
bed rest and avoid exciting him. Take steps to maintain the airway. Administer
penicillin-G or tetracycline as directed. Clean the wound thoroughly of dead tissue and
foreign matter. If necessary, feed the patient by gastric tube. Insert a Foley catheter if
urinary retention occurs.
Gram-negative organisms may be identified by using the Gram stain procedure.
Examined under the microscope, these organisms retain the pink or red counterstain,
safranin. Four species of bacteria most frequently cause gram-negative infections:
Escherichia coli, Enterobacter, Klebsiella pneumoniae aeruginosa, and Proteus. Gram-
negative bacteria invade the bodies of individuals not in the best of health. Persons in
good health are not usually bothered by gram-negative infections.
a. Infection Development. Gram-negative infections develop in various parts
of the body and have a variety of causes.
(1) On the skin, these infections are a form of leukemia and must be treated
with chemotherapeutic agents.
(2) In the respiratory tract, these infections develop from aspiration,
tracheostomy, and mechanical ventilation.
(3) In the vascular system, gram-negative infections develop from
intravenous catheters, intracardiac pacemakers, venous cutdowns, pressure-monitoring
devices, total parenteral nutrition, and surgical procedures.
(4) In the gastrointestinal tract, infections develop from obstruction,
perforation, abscesses, and diverticuli.
(5) In the genitourinary tract, infections come from indwelling catheters, and
(6) In the reproductive system, gram-negative infections develop from
abortion, and postpartum (after child-birth) period.
b. Signs/Symptoms. During the early stage, the skin is warm and dry. The
patient may experience a shaking chill, and his temperature may rise rapidly. The
patient's personality may change; his behavior may not be appropriate. Low blood
pressure may be indicated by cool, clammy skin, tachycardia/tachypnea, proceeding to
peripheral cyanosis, oliguria, and death as a result of vascular collapse.