Circulating endotoxin during initial antibiotic treatment of severe gram-negative bacteremic infections.
The impact of antibiotics on total endotoxemia and circulating tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8 in 18 patients with severe bacteremic sepsis or septic shock due to gram-negative species was investigated. Endotoxemia, TNF-alpha, IL-6, and IL-8 were assayed before (H0) and 1 h (H1) and 4 h (H4) after the first antibiotic infusion. Endotoxemia decreased from H0 (median, 0.4 EU/mL; interquartile interval, 0.09-1.23) to H1 (median, 0.19 EU/mL; interquartile interval, 0.07-0.75; P = .03) and remained stable between H1 and H4 (median, 0.12 EU/mL; interquartile interval, 0.09-0.30; P = .4). IL-6 levels fell between H0 and H4 (P = .01) and between H1 and H4 (P = .03). IL-8 was higher at H0 than at H1 (P = .04) and at H4 (P = .01). These results suggest that endotoxemia is not increased by antibiotherapy of severe gram-negative bacteremia.
Maury
E
E
Service de Réanimation Médicale, Unité INSERM U 444, Hôpital Saint-Antoine, Paris, France.
Barakett
V
V
Blanchard
H
H
Guitton
C
C
Fitting
C
C
Vassal
T
T
Chauvin
P
P
Guidet
B
B
Offenstadt
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha