Experimental production of lethal Escherichia coli bacteremia of pelvic origin.

To reproduce the syndrome of overwhelming Escherichia coli bacteremia and shock after pelvic instrumentation, a model was developed by feeding E. coli via drinking water to coliform-free rabbits, injecting nitrogen mustard intravenously, and inserting a temperature probe into the rectum. The temperature probe was inserted to mimic pelvic instrumentation of patients and to detect fever. Rabbits fed invasive serotypes of E. coli all suffered overwhelming bacteremia with high fever and fatal vascular collapse secondary to invasion of pelvic veins as the granulocyte count approached zero. In the absence of granulocytopenia, the rectal temperature probe produced an intensive inflammation with numerous polymorphonuclears and bacteremia did not develop. In the absence of rectal probing, granulocytopenic rabbits developed high fever without bacteremia. This model resembles human bacteremic shock with respect to the endogenous source of the bacteria, the high frequency of bacteremia due to E. coli and other enteric bacilli, the importance of pelvic instrumentation, and the associated immune disturbances such as granulocytopenia.